Children with chronic pain are vulnerable to adverse outcomes, such as impaired quality of life and poor functioning. Recent risk and resilience models for adult chronic pain have aimed to conceptualize the complexity of pain, which may prove useful for pediatric populations. The purpose of this study was to examine the unique predictive value of prominent pain-related risk factors, investigate optimism’s role as a resilience factor, and explore protective mechanisms through which optimism exerts its benefits. Participants included 58 8-17 year-old children and adolescents with chronic pain. Pain intensity remained the best predictor of disability, but pain-related fear and optimism were unique predictors of well-being. Optimism contributed to adaptation by reducing pain-related fear and catastrophizing. Findings suggest that the predictive value of related risk factors is inconsistent across functioning outcomes, and optimism is an applicable resilience factor in pediatric pain through its minimization of pain-related risk factors.