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Encoding and decoding of pain expressions: a judgement study
Abstract
The communication of pain requires a sufferer to encode and transmit the experience and an observer to decode and interpret it. Rosenthal's (1982) model of communication was applied to an analysis of the role of facial expression in the transmission of pain information. Videotapes of patients with shoulder pain undergoing a series of movements of the shoulder were shown to a group of 5 judges. Observers and patients provided ratings of the patients' pain on the same verbal descriptor scales. Analyses addressed relationships among patients' pain reports, observers' judgements of patients' pain and measures of patients' facial expressions based on the Facial Action Coding System. The results indicated that although observers can make coarse distinctions among patients' pain states, they (1) are not especially sensitive, and (2) are likely to systematically downgrade the intensity of patients' suffering. Moreover, observers appear to make insufficient use of information that is available in patients' facial expression. Implications of the findings for pain patients and for training of health-care workers are discussed as are directions for future research.
... Prkachin [97] 1994 Other observers 5 NRS/Likert .37 −0.76 0.94 ...
... 0.12 −0.05 0.43 Overestimation Melotti [145] 2009 Nurses 17 NRS/Likert .11 0.34 −0.56 0.79 Overestimation Milne [146] Ovayolu [149] 2015 Caregivers 220 NRS/Likert .08 0.10 −0.11 0.26 Overestimation Perreault [150] 2005 Other healthcare 78 NRS/Likert −.28* 0.12 −0.51 −0.06 Underestimation Perreault [95] 2006 Other healthcare 9 NRS/Likert −.26 0.35 −0.96 0.43 Underestimation Prkachin [97] 1994 Other observers 5 NRS/Likert −.39 0.49 −1.36 0.58 Underestimation Pronina [151] Shugarman [156] 2010 Nurses 94 VAS −.29** 0.11 −0.51 −0.06 Underestimation Silveria [106] 2010 Caregivers 142 VAS .20* 0.08 0.03 0.37 Overestimation Sjöström [109] 1997 Other healthcare 60 Other −1.07*** 0.16 −1.37 −0.76 Underestimation Sloman [157] 2005 Nurses 95 Faces −.23* 0.10 −0.43 −0.03 Underestimation Sneeuw [110] 1997 Caregivers 103 Faces .11 ...
... Powers [96] USA/Canada Mostly male Children Acute Surgery or procedure Inpatient Prkachin [97] USA/Canada Mostly female Acute Prkachin [98] USA/Canada Acute USA/Canada Mostly male Acute Laboratory Redinbaugh [99] USA/Canada Mostly female Adults (18+) Mostly female Chronic Cancer Inpatient Mostly female Chronic Inpatient Rhondali [101] USA/Canada Mostly female Adults (18+) Mostly female Chronic Cancer Inpatient Ruben [7] USA/Canada Mostly male Mostly female Acute Lab-based procedure Laboratory Ruben [102] USA/Canada Mostly female Adults (18+) Mostly female Acute Lab-based procedure Laboratory Salmon [103] Europe Mostly male Adults (18+) Mostly female Acute Surgery or procedure Inpatient Schneider [104] USA/Canada Children Mostly female Acute Surgery or procedure Outpatient USA/Canada Children Acute Surgery or procedure Outpatient Shega [105] USA/Canada Mostly female Older adults only (65+) ...
Background
Acute and chronic pain affects millions of adults yet it is often inadequately assessed and treated.
Purpose
The purpose of the present meta-analysis was to examine the overall level of pain assessment accuracy among caregivers and providers and identify patient, observer, and assessment level factors that moderate pain assessment accuracy.
Methods
A systematic literature search was conducted in PubMed and PsycINFO to identify studies addressing providers’ pain assessment accuracy, or studies that compared patients’ self-report of pain with observers’ (healthcare providers, caregivers, and strangers) assessment of pain. We present two separate meta-analyses examining the overall effect of under-/overestimation of pain and correlational pain assessment accuracy.
Results
Seventy-six articles meeting inclusion criteria yielded 94 independent effect sizes for the correlational accuracy meta-analysis. Ninety articles yielded 103 independent effect sizes for the paired comparison meta-analysis. The correlational pain assessment meta-analysis showed that in general, observers were significantly better than chance when assessing pain; however, the paired comparison meta-analysis showed that observers significantly underestimated patients’ pain. Patient’s age and gender, pain type, and provider type moderated these effects.
Conclusions
Results suggest that certain healthcare providers and caregivers need training to more accurately assess patient pain and that there are particular groups of patients who may be at a greater risk for having their pain inaccurately assessed.
... Prkachin et al. compared pain assessment by three methods, including: self-reporting, observer judgment, and FACS-coded facial actions among patients with shoulder injuries [46]. The results suggested that when the pain is severe, all three ratings are highly correlated. ...
... In contrast, when the pain is submaximal, observer judgment is not correlated with the other two methods. Prkachin et al. showed that observers tend to underestimate pain and the greater amount of clinical experience with patients increases this underestimation [46,47]. This underestimation is important when critical decisions need to be made about the patients. ...
... For pain videos, we computed the average intensity of AU6 and AU10 across all the frames of the video and chose the five videos that had the highest average intensity across all their frames. We chose AU6 and AU10 because they are important in expressing pain [46]. Since AU10 is important in expressing disgust, we computed the average intensity of AU10 across all the frames of each disgust source video and chose the five videos that had highest average intensity across all their frames. ...
In this paper, we introduce a novel application of social robotics in healthcare: high fidelity, facially expressive, robotic patient simulators (RPSs), and explore their usage within a clinical experimental context. Current commercially-available RPSs, the most commonly used humanoid robots worldwide, are substantially limited in their usability and fidelity due to the fact that they lack one of the most important clinical interaction and diagnostic tools: an expressive face. Using autonomous facial synthesis techniques, we synthesized pain both on a humanoid robot and comparable virtual avatar. We conducted an experiment with 51 clinicians and 51 laypersons (n = 102), to explore differences in pain perception across the two groups, and also to explore the effects of embodiment (robot or avatar) on pain perception. Our results suggest that clinicians have lower overall accuracy in detecting synthesized pain in comparison to lay participants. We also found that all participants are overall less accurate detecting pain from a humanoid robot in comparison to a comparable virtual avatar, lending support to other recent findings in the HRI community. This research ultimately reveals new insights into the use of RPSs as a training tool for calibrating clinicians' pain detection skills.
... Accurate estimation of others' pain from nonverbal cues is an essential aspect of interpersonal communication 45 . It forms part of the foundation for empathy 57 and caregiving 15 . ...
... As pain expressions are communicative behaviors, observers' interpretations of those expressions are a crucial aspect of pain communication 45 . Those interpretations are affected not only by the characteristics of pain expressions, but by observers' knowledge and biases about pain, and the characteristics of pain sufferers 13,18,26 . ...
Caregiving and other interpersonal interactions often require accurate perception of others’ pain from nonverbal cues, but perceivers may be subject to systematic biases based on gender, race, and other contextual factors. Such biases could contribute to systematic under-recognition and under-treatment of pain. In two experiments, we studied the impact of perceived patient sex on lay perceivers’ pain estimates and treatment recommendations. In Experiment 1 (N = 50), perceivers viewed facial video clips of female and male patients in chronic shoulder pain and estimated patients’ pain intensity. Multi-level linear modeling revealed that perceivers under-estimated female patients’ pain compared with male patients, after controlling for patients’ self-reported pain and pain facial expressiveness. Experiment 2 (N = 200) replicated these findings, and additionally found that 1) perceivers’ pain-related gender stereotypes, specifically beliefs about typical women's vs. men's willingness to express pain, predicted pain estimation biases; and 2) perceivers judged female patients as relatively more likely to benefit from psychotherapy, whereas male patients were judged to benefit more from pain medicine. In both experiments, the gender bias effect size was on average 2.45 points on a 0-100 pain scale. Gender biases in pain estimation may be an obstacle to effective pain care, and experimental approaches to characterizing biases, such as the one we tested here, could inform the development of interventions to reduce such biases.
Perspective
This study identifies a bias towards underestimation of pain in female patients, which is related to gender stereotypes. The findings suggest caregivers’ or even clinicians’ pain stereotypes are a potential target for intervention.
... In this field, most studies have focused on the communication skills of health professionals and have recommended a set of good practices based on listening to the patient, empathy and taking into account nonverbal behaviors (see Barreau & Tastet, 2007;Ranjan, Kumari, & Chakrawarty, 2015). For example, nonverbal pain signals such as facial expressions (e.g., Prkachin, Currie, & Craig, 1983;Prkachin, Berzins, & Mercer, 1994) are important indicators of patient suffering and must be taken into account during medical treatment (Prkachin et al., 1994). Other studies have also investigated the relationship between brain activity and pain sensations (see Garcia-Larrea & Peyron, 2013 for a review). ...
... In this field, most studies have focused on the communication skills of health professionals and have recommended a set of good practices based on listening to the patient, empathy and taking into account nonverbal behaviors (see Barreau & Tastet, 2007;Ranjan, Kumari, & Chakrawarty, 2015). For example, nonverbal pain signals such as facial expressions (e.g., Prkachin, Currie, & Craig, 1983;Prkachin, Berzins, & Mercer, 1994) are important indicators of patient suffering and must be taken into account during medical treatment (Prkachin et al., 1994). Other studies have also investigated the relationship between brain activity and pain sensations (see Garcia-Larrea & Peyron, 2013 for a review). ...
Introduction. – The aim of this study was to clarify students’ knowledge and emotional feelings about
words used in the announcement of cancer diagnoses.
Method. – A total of 465 students registered in a higher education institution rated familiarity, valence
and arousal, and responded to questions about the definition and the contextual use of 20 cancer-related
target words.
Results. – The words were estimated as being unfamiliar and negative, and were poorly defined by the
majority of students. Many of these indicators varied according to whether the students reported having
a relative diagnosed with cancer, and to their level of vocabulary.
Discussion. – This study provides explanatory leads that should help to shed light on the nature of the
difficulties students have in understanding medical messages.
... Prkachin first reported the consistency of facial pain expressions for different pain modalities [237] and then together with Solomon developed a pain metric called Prkachin and Solomon Pain Intensity (PSPI) scale based on FACS in [238]. Although there is a debate about the correlation between self-reported pain and facial pain expression [122], many works found significant relationship between these two [58,115,174,236,239]. Another of the most widely used scales are the Visual Analogue Scale (VAS) [94]. ...
... These result to a non-linearly wrapped facial emotion levels (due to the presence of pain) in a high dimensional space [270]. A vast body of literature was produced in the recent years to automatically measure pain levels from facial color RGB images or videos [58,115,174,236,239]. ...
Automatic multimodal emotion recognition is a fundamental subject of interest in affective computing. Its main applications are in human-computer interaction. The systems developed for the foregoing purpose consider combinations of different modalities, based on vocal and visual cues. This thesis takes the foregoing modalities into account, in order to develop an automatic multimodal emotion recognition system. More specifically, it takes advantage of the information extracted from speech and face signals. From speech signals, Mel-frequency cepstral coefficients, filter-bank energies and prosodic features are extracted. Moreover, two different strategies are considered for analyzing the facial data. First, facial landmarks’ geometric relations, i.e. distances and angles, are computed. Second, we summarize each emotional video into a reduced set of key-frames. Then they are taught to visually discriminate between the emotions. In order to do so, a convolutional neural network is applied to the key-frames summarizing the videos. Afterward, the output confidence values of all the classifiers from both of the modalities are used to define a new feature space. Lastly, the latter values are learned for the final emotion label prediction, in a late fusion. The experiments are conducted on the SAVEE, Polish, Serbian, eNTERFACE’05 and RML datasets. The results show significant performance improvements by the proposed system in comparison to the existing alternatives, defining the current state-of-the-art on all the datasets. Additionally, we provide a review of emotional body gesture recognition systems proposed in the literature. The aim of the foregoing part is to help figure out possible future research directions for enhancing the performance of the proposed system. More clearly, we imply that incorporating data representing gestures, which constitute another major component of the visual modality, can result in a more efficient framework.
... Facial expressions have long been used to recognise and quantify pain in human patients who are unable to verbalise, such as neonates or patients with verbal or cognitive impairments (Boerner et al., 2013;Prkachin et al., 1994;Prkachin and Solomon, 2008;Schiavenato et al., 2008). Facial expressions have also been demonstrated to encode both the sensory and affective components of pain in humans (Kunz et al., 2012). ...
... The use of facial expressions to assess pain has become frequent in human medicine and research (Boerner et al., 2013;Prkachin et al., 1994;Prkachin and Solomon, 2008;Schiavenato et al., 2008). The Facial Action Coding System (FACS) was originally developed by Ekman and Friesen (1978) to measure changes of the face or groups of muscles, known as "action units" (AUs), to an emotional stimulus. ...
Effective management of pain is critical to the improvement of animal welfare. For this to happen, pain must be recognised and assessed in a variety of contexts. Pain is a complex phenomenon, making reliable, valid, and feasible measurement challenging. The use of facial expressions as a technique to assess pain in non-verbal human patients has been widely utilised for many years. More recently this technique has been developed for use in a number of non-human species: rodents, rabbits, ferrets, cats, sheep, pigs and horses. Facial expression scoring has been demonstrated to provide an effective means of identifying animal pain and in assessing its severity, overcoming some of the limitations of other measures for pain assessment in animals. However, there remain limitations and challenges to the use of facial expression as a welfare assessment tool which must be investigated. This paper reviews current facial expression pain scales (“Grimace Scales"), discussing the general conceptual and methodological issues faced when assessing pain, and highlighting the advantages of using facial expression scales over other pain assessment methods. We provide guidance on how facial expression scales should be developed so as to be valid and reliable, but we also provide guidance on how they should be used in clinical practice.
... The underlying neurologic condition and associated functional limitations may confuse the presentation of pain [52,53] Observers are likely to underestimate patients' suffering [54,55] Challenges in pain management Individuals with ID are at risk of developing drug-related side effects due to immature nervous systems, functional impairments, and the concurrent use of multiple medications [25] ...
This review is made up of two parts; the first part discussing intellectual disability (ID) in general, while the second part covers the pain associated with intellectual disability and the challenges and practical tips for the management of pain associated with (ID). Intellectual disability is characterized by deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. ID is a disorder with no definite cause but has multiple risk factors, including genetic, medical, and acquired. Vulnerable populations such as individuals with intellectual disability may experience more pain than the general population due to additional comorbidities and secondary conditions, or at least the same frequency of pain as in the general population. Pain in patients with ID remains largely unrecognized and untreated due to barriers to verbal and non-verbal communication. It is important to identify patients at risk to promptly prevent or minimize those risk factors. As pain is multifactorial, thus, a multimodal approach using both pharmacotherapy and non-pharmacological management is often the most beneficial. Parents and caregivers should be oriented to this disorder, given adequate training and education, and be actively involved with the treatment program. Significant work to create new pain assessment tools to improve pain practices for individuals with ID has taken place, including neuroimaging and electrophysiological studies. Recent advances in technology-based interventions such as virtual reality and artificial intelligence are rapidly growing to help give patients with ID promising results to develop pain coping skills with effective reduction of pain and anxiety. Therefore, this narrative review highlights the different aspects regarding the current status of the pain associated with intellectual disability, with more emphasis on the recent pieces of evidence for the assessment and management of pain among populations with intellectual disability.
... (1) The Facial Action Coding System (FACS) [27]: The FACS provides a list of muscular facial action units (AUs), based on specific facial muscle movements that may occur separately or in combination (as groups). FACS was found time and again to be a highly reliable scale for neurotypical adults by Craig and associates [28][29][30][31], as well as by other researchers [32]. FACS has been used in adults with dementia [33,34], and in individuals with mild to moderate levels of IDD undergoing seasonal influenza injections [11]. ...
Pain assessment poses a challenge in several groups of clients, yet specific barriers arise when it comes to pain assessment of individuals with intellectual and developmental disabilities (IDD), due mostly to communication challenges preventing valid and reliable self-reports. Despite increased interest in pain assessment of those diagnosed with IDD within recent years, little is known about pain behavior in this group. The present article overviews the current state of pain diagnosis for individuals with IDD, focusing on existing pain assessment scales. In addition, it suggests technological developments offering new ways to diagnose existence of pain in this population, such as a Smartphone App for caregivers based on unique acoustic characteristics of pain-related vocal responses, or the use of smart wearable shirts that enable continuous surveillance of vital physiological signs. Such novel technological solutions may improve diagnosis of pain in the IDD population, as well as in other individuals with complex communication needs, to provide better pain treatment and enhance overall quality of life.
... M. Prkachin & Mercer, 1989) and correlated with the subjective intensity of pain (K. M. Prkachin et al., 1994). With the exception of eye closure, each action, when present, was rated on a scale ranging from 1 (trace of action) to 5 (action at maximum intensity). ...
Despite growing evidence that psychopathy entails reduced emotional processing, the relationship between psychopathic traits and third-person pain perception is poorly understood. This study directly examined perception of others' pain in a sample of male and female students (N = 105) who completed the Self-Report Psychopathy scale (SRP-III) and the Toronto Empathy Questionnaire (TEQ). Participants watched a video of 60 one-second clips of other people experiencing pain. Following each clip, participants rated the perceived level of pain intensity and pain unpleasantness. Psychopathic traits were unrelated to response bias, suggesting that individuals high in psychopathic traits were no more or less likely to impute pain to others. However, higher levels of psychopathic traits, particularly callous affect and antisocial behavior, were associated with a decreased ability to discriminate others' pain. Sensitivity and response bias were unrelated to TEQ scores. These findings provide novel insights into the influence of psychopathic traits on emotional processing.
... Specifically: pain has a stable, unique, and universal facial expression (e.g. Craig, 1986Craig, , 1992Prkachin, 1992), which is expressed as early as infancy (Izard, 1994;Izard et al., 1983), and can be used by naïve observers to accurately rate both whether people are in pain (e.g., Akintola et al., 2017;Ekman, 1997;Langford et al., 2010;Littlewort et al., 2009) and how much pain they are experiencing (Labus et al., 2003;Prkachin et al., 1994). Like fear, pain expressions toward an object should be taken as a signal of avoidance: the item that caused one person pain is likely to be dangerous (painful) to others (see Craig, 2009 for overview of the social communication model of pain). ...
Here we investigated infants' developing ability to use emotional expressions as signals that guide their learning about objects. To do so, we presented 16- to 21-month-old infants (N = 99) with actors who conveyed anger, fear, or pain, and tested infants' generalization of others' emotional expressions (Study 1) and infants' exploration of objects (Study 2). Our findings suggest that infants attend to the information conveyed by emotional expressions: When two expressions provide different information (e.g., one conveys threat, and the other does not), infants treated those emotions differently, even if they were both negative. Specifically, infants were more likely to generalize negative emotional expressions that conveyed threat compared to nonthreatening negative emotions (Study 1) and were more likely avoid interacting with potentially threatening items compared to items that were merely evaluated negatively (Study 2). But, when two emotional expressions provided the same information (e.g., that an item was threatening) infants responded similarly to those two emotions (Study 1). These findings are in line with evolutionary theories, which posit that emotions are critical information signals that can be used to learn about the world. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Going down with the specifics, as previously mentioned, it appears in the individual condition that the frontal activation pattern for the face prevails, and prevails over the hand stimuli, thus suggesting the face has a strong widespread effect. Face it is a highly relevant stimulus, from early in life, people display a keen sensitivity to the occurrence of pain in others [64], and develop a highly refined ability to evaluate pain intensity from facial displays [65]. This ability usually develops in a one-to-one relation-ship between the newborn and the mother, which is a situation closer to the individual condition of face here depicted. ...
This research explored how the manipulation of interoceptive attentiveness (IA)
can influence the frontal (dorsolateral prefrontal cortex (DLPFC) and
somatosensory cortices) activity associated with the emotional regulation and
sensory response of observing pain in others. 20 individuals were asked to
observe face versus hand, painful/non-painful stimuli in an individual versus
social condition while brain hemodynamic response (oxygenated (O2Hb) and
deoxygenated hemoglobin (HHb) components) was measured via functional
Near-Infrared Spectroscopy (fNIRS). Images represented either a single person
(individual condition) or two persons in social interaction (social condition)
both for the pain and body part set of stimuli. The participants were split into
experimental (EXP) and control (CNT) groups, with the EXP explicitly required to
concentrate on its interoceptive correlates while observing the stimuli.
Quantitative statistical analyses were applied to both oxy- and deoxy-Hb data.
Firstly, significantly higher brain responsiveness was detected for pain in
comparison to no-pain stimuli in the individual condition. Secondly, a left/right
hemispheric lateralization was found for the individual and social condition,
respectively, in both groups. Besides, both groups showed higher DLPFC activation
for face stimuli presented in the individual condition compared to hand stimuli
in the social condition. However, face stimuli activation prevailed for the EXP
group, suggesting the IA phenomenon has certain features, namely it manifests
itself in the individual condition and for pain stimuli. We can conclude that IA
promoted the recruitment of internal adaptive regulatory strategies by engaging
both DLPFC and somatosensory regions towards emotionally relevant stimuli.
... Depending on facial and behavioral expressions might be the most accurate way of assessing pain in children as such expressions are usually consistent and occur in all people. [23][24][25] However, these expressions might be masked by a pre-existing condition affecting the cognitive abilities of the children which might be attributable to a disorder affecting the central nervous system, the child's environment and culture, and the way of treatment and response that he is used to with his caregiver. 26 It should also be noted that children with behavioral and developmental disabilities might present with events causing traumas, facial changes, and bizarre behavior as moaning which may be mistakenly included in the assessment of pain making it difficult to diagnose the signs of an existing condition. ...
Pain assessment and management have shown great advances in recent decades regarding the treatment protocols and the various assessment approaches that have been developed and validated to specific for pediatric patients. In this literature review, we aim to shed more light on the assessment of pain in pediatric patients and the challenges that healthcare workers might face during the process in primary healthcare centers. In neonates, the crying, require O2 to reach a saturations more than 95%, increasing vitals, expressionless, and sleepless score shows the greatest advantage over other scores (COMFORT and distress for mechanically ventilated neonates), while in infants the face, leg, activity, cancelability, and cry scale shows promising results. In older children, self-reporting by the visual analogue scale should be standardized whenever possible or facial, and behavioral assessment should be used. Assessment of pain in patients with cognitive and intellectual disabilities might be challenging, and therefore, it should be interpreted carefully not to be misdiagnosed, in addition to trying to obtain relevant information from a well-trained accompanying caregiver. Further investigations are needed, however, to standardize these scores and to spread awareness among clinicians and caregivers about the importance of appropriate pain assessment.
... But people use ''management techniques'' to control and sometimes override the operation of the universal facial affect program under some social settings. Prkachin included the social stimuli in Rothenthal's model and proposed a general model of a pain episode [9], which is composed of three stages: Experience, Encoding and Decoding. This model outlined the variability of the relationship between the intensity and quality of pain, and one's expression of pain. ...
Recent technological advances in robotic sensing and actuation methods have prompted development of a range of new medical training simulators with multiple feedback modalities. Learning to interpret facial expressions of a patient during medical examinations or procedures has been one of the key focus areas in medical training. This article reviews facial expression rendering systems in medical training simulators that have been reported to date. Facial expression rendering approaches in other domains are also summarized to incorporate the knowledge from those works into developing systems for medical training simulators. Classifications and comparisons of medical training simulators with facial expression rendering are presented, and important design features, merits and limitations are outlined. Medical educators, students and developers are identified as the three key stakeholders involved with these systems and their considerations and needs are presented. Physical-virtual (hybrid) approaches provide multimodal feedback, present accurate facial expression rendering, and can simulate patients of different age, gender and ethnicity group; makes it more versatile than virtual and physical systems. The overall findings of this review and proposed future directions are beneficial to researchers interested in initiating or developing such facial expression rendering systems in medical training simulators.
... Facial expressions of pain are largely comprised of four movements: brow lowering, orbit tightening (narrowing of the eye apertures and raising of the cheeks), levator tightening (raising of the upper lip and/or nose wrinkling), and eye closure (Prkachin, 1992). These actions have been found to vary in intensity, positively correlating with the subjective experience of pain (Prkachin, Berzins & Mercer, 1994;Prkachin & Mercer, 1989;Prkachin & Solomon, 2008). All video recordings have been scored for brow lowering, orbit tightening, and levator tightening using an intensity scale ranging from 1 (a trace of the action) to 5 (the action occurs at maximum intensity). ...
Pain has been identified as the most common reason for seeking medical care in emergency departments and yet has been found to be left widely undertreated. The pervasiveness of these visits, combined with the undertreatment of pain, can have detrimental consequences for patients and providers. As such, there is a pressing need to identify factors associated with effective pain treatment. A factor consistently found to motivate helping behaviour is personal distress; however, the intricacies of this relationship remain unclear. Specifically, willingness to help patients in pain has been linked to both high and low levels of personal distress. This dissertation aimed to clarify the nature of this relationship and to explore the potential moderating influence of both individual (i.e., third-person pain perception, emotion regulation, and psychopathic traits) and situational (i.e., cost of helping) factors. Two studies were conducted in which undergraduate students and medical students completed a prosocial task where they were asked to indicate how much time they wished to spend helping patients in pain. Overall, personal distress did not emerge as a significant predictor of helping behaviour, and this relationship was not moderated by the personal cost of helping (i.e., type of remuneration). Support was found, however, for the moderating role of individual traits. Specifically, Studies 1 and 2 identified three distinct emotional processing profiles: Sensitive Responders, Indifferent Responders, and Insensitive Responders. Moreover, these profiles were found to be differently related to prosocial behaviour. Overall, findings suggest that individual differences in emotional processing may moderate the relationship between empathy and prosocial behaviour, potentially contributing to disparities in the treatment of pain. Additionally, these findings highlight the importance of considering these traits simultaneously, as opposed to examining these variables in isolation.
... Observers, including parents, are likely to systematically underestimate patients' suffering. 10,50 Interestingly, underestimation bias was more pronounced in more experienced caregivers than in inexperienced ones. 39 Underestimation of pain is especially problematic when self-report is not available or reliable. ...
Introduction: Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language,
behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional
abilities and quality of life.
Objectives: This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD.
Methods: This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring
issues as well as the best available evidence and practice.
Results: The past decade of pain research has involved the development of standardized assessment tools appropriate for
individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There
is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and
highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment
approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by
biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to
adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to
compromised ability to self-report.
Conclusion: Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD
continue to emerge, and there are ongoing international collaborations.
... However, there are no objective assessment measures for pain, meaning that people must rely on language or non-verbal pain behaviours to communicate their suffering to others. These non-verbal pain behaviours such as facial expressions or guarding are often involuntary and there is evidence to suggest that they are inaccurately decoded by others (Prkachin, Berzins, & Mercer, 1994). Consequently, there is a necessary reliance on verbal reporting of pain, which can be problematic due to difficulty in pain description (Munday, Kneebone, & Newton-John, 2019). ...
Objectives
As there is no objective test for pain, sufferers rely on language to communicate their pain experience. Pain description frequently takes the form of metaphor; however, there has been limited research in this area. This study thus sought to extend previous findings on metaphor use in specific pain subgroups to a larger, heterogeneous chronic pain sample, utilizing a systematic method of metaphor analysis.
Design
Conceptual metaphor theory was utilized to explore the metaphors used by those with chronic pain via qualitative methodology.
Methods
An anonymous online survey was conducted which asked for the descriptions and metaphors people use to describe their pain. Systematic metaphor analysis was used to classify and analyse the metaphors used into specific metaphor source domains.
Results
Participants who reported chronic pain completed the survey (N = 247, age 19–78, M = 43.69). Seven overarching metaphor source domains were found. These were coded as Causes of Physical Damage , Common Pain Experiences , Electricity , Insects , Rigidity , Bodily Misperception , and Death and Mortality .
Conclusions
Participants utilized a wide variety of metaphors to describe their pain. The most common descriptions couched chronic pain in terms of physical damage. A better understanding of pain metaphors may have implications for improved health care communication and provide targets for clinical interventions.
... Aronfreed (1968) suggests that humans may be more likely to help others when the level of need or the potential benefit is greater. Evidence shows that humans are likely to underestimate the intensity of pain felt by others (Prkachin, Berzins, & Mercer, 1994). Our findings suggest that the opposite impact of empathy on pain judgment may counteract this underestimation. ...
Over the last two decades, research has devoted increasing attention to the examination of empathy. Yet research examining empathic accuracy, defined as how well we judge the emotional intensity felt by another, has grown more modestly. This asymmetry may be due to the complexity of paradigms used to study empathic accuracy, as well as to the fact that the stimuli used so far are dependent upon linguistic and cultural factors. To circumvent these issues, here we present a novel paradigm that examines the ability to assess empathic accuracy in a simple and implicit manner by using stimuli that are not dependent on language and culture. To this end, we devised two sets of stimuli: (1) a painful scenario set consisting of empathy-evoking still images; and (2) a facial expression set comprising morphed intensities of emotional facial expressions. Together, these sets can be used to study the effect of the empathic experience on an individual's ability to make accurate judgments of others' emotional facial intensity, a sub-process of empathic accuracy. We contend that adopting these sets may facilitate the replicability of findings across countries and populations, which in turn will increase the number of investigations of empathic accuracy.
... Facial expression is the most salient form of pain behaviour (Craig, Prkachin, & Grunau, 2011;Williams, 2002) and communicates information about the sensory and affective components of the multidimensional experience that is pain (Kunz, Lautenbacher, LeBlanc, & Rainville, 2012;Prkachin & Craig, 1995). Evidence suggests that a core expression of pain is characterized by four facial muscle movements, including brow-lowering, orbit-tightening, levator-contraction and to a lesser extent eye closure (Prkachin, 1992;Prkachin, Berzins, & Mercer, 1994;Prkachin & Solomon, 2008). Note that there is debate whether the facial expression of pain contains unitary properties with a single prototype (Prkachin & Solomon, 2008), or as many as four prototypes (Kunz & Lautenbacher, 2014). ...
Background
This article presents the results of a parallel‐group, non‐randomized, controlled study that evaluated the feasibility of an online training program for improving observer detection of facial pain expression.
Method
Fifty‐four undergraduate students attended two laboratory sessions interspersed by an intervention period where they were assigned to complete the Index of Facial Pain Expression (IFPE) ‐ an online training environment designed to teach observers to code facial muscle movements associated with pain ‐ or a no contact control. Participants completed questionnaires during the first session and watched parallel versions of the Sensitivity To Expression of Pain (STEP) test during laboratory sessions. STEP tests contained excerpts of facial expressions taken from patients with shoulder pain. Reliability of coding following the IFPE was measured. Signal detection methods were applied to pain ratings to the STEP tests to calculate measures of sensitivity and response bias to facial pain expression.
Results
Participants took 3.5‐hours to complete the IFPE. Training resulted in reliable coding of facial muscle movements associated with pain and improvements in sensitivity (from .75 to .87 in experimental relative to .75 to .80 in control), but not response bias, to facial expressions of clinical pain. Training was influenced by observer traits, including empathy, emotional intelligence (EI), and prior experience with individuals who experience chronic pain.
Conclusions
The IFPE represents a brief measurement system for facial pain expression with research applicability and potential clinical utility. The IFPE could help clinicians be more sensitive to expressions of clinical pain.
Significance
The index of facial pain expression (IFPE) is an online training program that can improve an observer's ability to reliably detect expressions of clinical pain after as few as 3.5‐hours of training.
This article is protected by copyright. All rights reserved.
... [23][24][25] Thus, it has been suggested that objective and comprehensive criteria, such as the Facial Action Coding System (FACS), should be considered among these tools to improve their reliability. 22,[26][27][28] FACS is an anatomical catalog of facial expressions that annotates each individual facial action unit (AU) with a unique numerical label and specific description. 29 Pain-related AUs include eyelid tightening (AU7) and lips parting (AU25). ...
Objectives: Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis.
Study design: A 2-week observational study. Setting: An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia.
Participants: Subjects were 10 residents (age range: 63.1-84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker.
Measurements: ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors.
Results: A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters' agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85-0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κ w =0.72 (95% CI: 0.58-0.86) at rest and κ w =0.69 (95% CI: 0.50-0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; p0.0012) and following mobilization (mean: 2.5 vs 1.7; p0.0001) compared to no pain and rest, respectively.
Conclusions: ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia.
... Although the indicator-based scales are easy to use in practice, the evaluation requires professional caregivers with plenty of training, and manual pain assessment is time-consuming and laboring for long-term continuous pain monitoring, as the caregiver has to assess infants' pain at short intervals. Moreover, such measures are easily disrupted by the observer's bias, and various influence factors such as clinical experience, underestimation of pain [16], background, and culture [17,18]. With the rapid development of machine learning and artificial intelligence, an automatic infant pain assessment system is desired for objective and accurate pain assessment. ...
Infants’ early exposure to painful procedures can have negative short and long-term effects on cognitive, neurological, and brain development. However, infants cannot express their subjective pain experience, as they do not communicate in any language. Facial expression is the most specific pain indicator, which has been effectively employed for automatic pain recognition. In this paper, dynamic pain facial expression representation and fusion scheme for automatic pain assessment in infants is proposed by combining temporal appearance facial features and temporal geometric facial features. We investigate the effects of various factors that influence pain reactivity in infants, such as individual variables of gestational age, gender, and race. Different automatic infant pain assessment models are constructed, depending on influence factors as well as facial profile view, which affect the model ability of pain recognition. It can be concluded that the profile-based infant pain assessment is feasible, as its performance is almost as good as that of the whole face. Moreover, gestational age is the most influencing factor for pain assessment, and it is necessary to construct specific models depending on it. This is mainly because of a lack of behavioral communication ability in infants with low gestational age, due to limited neurological development. To our best knowledge, this is the first study investigating infants’ pain recognition, highlighting profile facial views and various individual variables.
... [7] This includes cases where pain is evaluated by facial expressions. [8] This may be because the association between self-reported pain intensity and pain behavior in chronic pain is weak. [3] Although there is little research on the influence of pain underestimation on health outcomes in chronic pain, patients may also exaggerate pain-related behaviors to convince others that they are actually suffering from pain, according to the operant conditioning theory of chronic pain. ...
Although facial pain expressions are considered to be the most visible pain behaviors, it is known that the association between pain intensity and facial pain expression is weak for chronic pain. The authors hypothesized that the facial pain expressiveness was altered in chronic pain and investigated it with a mental rotation task using various facial expression, which seems to be associated with actual facial movements. As a task stimulus, 4 types of facial expression stimuli consisted of upper (tightening of eye and furrowed brows) and lower (raising upper lip) pain-specific facial expressions, and upper (eyeball deviation) and lower (tongue protrusion) facial movements not using facial muscles were used. Participants were asked to judge whether a stimulus presented at various rotation angles was left- or right-sided. The authors tested 40 patients with complex regional pain syndrome (CRPS) (12 women, age range 21–60) and 35 healthy controls (15 women, age range 26–64). In an analysis of reaction time (RT) using a linear mixed model, patients were slower to react to all types of stimuli (P = .001) and a significant interaction between group (patient or control) and type of facial expression was observed (P = .01). In the post hoc analysis only patients showed longer RTs to raising upper lip than other types of facial expressions. This reflects a deficit in mental rotation tasks especially for lower facial region pain expressions in CRPS, which may be related to the psychosocial aspects of pain. However, comprehensive intra- and interpersonal influences should be further investigated.
... Aronfreed (1968) suggests that humans may be more likely to help others when the level of need or the potential benefit is greater. Evidence shows that humans are likely to underestimate the intensity of pain felt by others (Prkachin, Berzins, & Mercer, 1994). Our findings suggest that the opposite impact of empathy on pain judgment may counteract this underestimation. ...
Empathy represents a fundamental ability that allows for the creation and cultivation of social bonds. As part of the empathic process, individuals use their own emotional state to interpret the content and intensity of other people’s emotions. Therefore, the current study was designed to test two hypotheses: (1) empathy for the pain of another will result in biased emotional intensity judgment; and (2) changing one’s emotion via emotion regulation will modulate these biased judgments. To test these hypotheses, in experiment one we used a modified version of a well-known task that triggers an empathic reaction We found that empathy resulted in biased emotional intensity judgment. To the best of our knowledge, this is the first demonstration of a bias in the recognition of emotional facial expressions as a function of empathy for pain. In experiment two, we replicated these findings in an independent sample, and further found that this biased emotional intensity judgment can be moderated via reappraisal. Taken together, our findings suggest that the novel task used here can be employed to further explore the relation between emotion regulation and empathy.
... 1) The Facial Action Coding System (FACS; (Ekman & Friesen, 1978)): The FACS is a list of facial actions (action units -AUs) based on movements of specific muscles or groups of muscles in the face. FACS was repeatedly found to be highly reliable for adults without IDD by Craig and associates (Craig & Grunau, 1988;Craig, Hyde, & Patrick, 1991;Craig, 1992;Craig, Korol, & Pillai, 2002), as well as by other researchers (LeResche & Dworkin, 1984;Prkachin, Berzins, & Mercer, 1994). This scale has been used with adults with cognitive impairment (IDD) due to dementia (Hadjistavropoulos, Craig, & Martin, 1997;Hurley, Volier, & Harnahan, 1992). ...
Children with intellectual and developmental disability (IDD) are prone to suffer more pain compared to their peers without disability. Nevertheless, the difficulty in assessing pain in this population has resulted in under-diagnosis and under-treatment. Despite a growth in pain evaluation for this population in the last couple of years; there is a need for professional intervention in this area with the intent to improve quality of care across their life span. The present article discuss the need for pain evaluation for children with IDD, describes the barriers in pain evaluation in this group of clients, and suggests some considerations in pain management for children with IDD. The authors would like to stress that since existing evidence suggests that up to 67-83% of children with IDD are in pain most of the time, we need to be thinking and addressing the topic of pain in this population 75% of the time we spend with those children. Moreover, the problem needs to be addressed with urgency, as musculoskeletal acute pain has the tendency to cause alterations within the central nervous system, turning the acute experience into a chronic condition.
... The ability of caregivers to evaluate accurately their patients' pain is crucial to proper management. Unfortunately, multiple studies have shown that healthcare professionals tend to underestimate patients' pain (Prkachin, Solomon, & Ross, 2007) compared with the evaluations of control participants without medical training (Cheng et al., 2007;Decety, Yang, & Cheng, 2010) and to the patients' own evaluations (Coran, Koropeckyj-Cox, & Arnold, 2013;Efficace et al., 2014;Kappesser, Williams, & Prkachin, 2006;Prkachin, Berzins, & Mercer, 1994;Puntillo, Neighbor, O'Neil, & Nixon, 2003). While the cause of this pain underestimation remains unclear, this phenomenon has been found to increase with caregiver's experience (Choini ere, Melzack, & Girard, 1990;Gleichgerrcht & Decety, 2014;Perry & Heidrich, 1982;Solomon, 2001) and has been shown to be related to changes in the neural response to vicarious pain (Cheng et al., 2007;Decety et al., 2010). ...
Aims:
To determine if there are brain activity differences between pediatric intensive care nurses and allied health professionals during pain intensity rating tasks and test whether these differences are related to the population observed (infant or adult) and professional experience.
Background:
The underestimation of patients' pain by healthcare professionals has generally been associated with patterns of change in neural response to vicarious pain, notably reduced activation in regions associated with affective sharing and increased activation in regions associated with regulation, compared with controls. Pediatric nurses, however, have recently been found to provide higher estimates of infants' pain in comparison to allied health controls, suggesting that changes in neural response of this population might be different than other health professionals.
Design:
Cross-sectional study METHODS: Functional MRI data were acquired from September 2014-June 2015 and used to compare changes in brain activity in 27 female pediatric care nurses and 24 allied health professionals while rating the pain of infants and adults in a series of video clips.
Results:
Pediatric nurses rated infant and adult pain higher than allied health professionals, but the two groups' neural response only differed during observation of infant pain; pediatric nurses mainly showed significantly less activation in the medial prefrontal cortex (linked to cognitive empathy) and in the left anterior insula and inferior frontal cortex (linked to affective sharing).
Conclusions:
Patterns of neural activity to vicarious pain may vary across healthcare professions and patient populations and the amount of professional experience might explain part of these differences. This article is protected by copyright. All rights reserved.
... The task of assessing the pain level from facial image or video is rather challenging. A substantial body of literature has been produced in the recent years to address the challenges [3,10,30,48,50]. A glimpse of the reason why pain level detection is difficult can be found in Figure 1 [14]. ...
Automatic pain detection is a long expected solution to a prevalent medical problem of pain management. This is more relevant when the subject of pain is young children or patients with limited ability to communicate about their pain experience. Computer vision-based analysis of facial pain expression provides a way of efficient pain detection. When deep machine learning methods came into the scene, automatic pain detection exhibited even better performance. In this paper, we figured out three important factors to exploit in automatic pain detection: spatial information available regarding to pain in each of the facial video frames, temporal axis information regarding to pain expression pattern in a subject video sequence, and variation of face resolution. We employed a combination of convolutional neural network and recurrent neural network to setup a deep hybrid pain detection framework that is able to exploit both spatial and temporal pain information from facial video. In order to analyze the effect of different facial resolutions, we introduce a super-resolution algorithm to generate facial video frames with different resolution setups. We investigated the performance on the publicly available UNBC-McMaster Shoulder Pain database. As a contribution, the paper provides novel and important information regarding to the performance of a hybrid deep learning framework for pain detection in facial images of different resolution.
... The FACS is a list of facial actions (of action units -AUs) based on movements of specific muscles or groups of muscles in the face. FACS was repeatedly found to be highly reliable by Craig and associates (49,50), as well as by other researchers (51). The FACS was found suitable for detecting pain behaviors in individuals with mild to moderate levels of IDD undergoing influenza injection (52), yet was found unsuitable for individuals diagnosed with severe-profound level of IDD (53). . ...
Children with intellectual and developmental disability (IDD) are prone to suffer more pain compared to their peers without disability. Nevertheless, the difficulty in assessing pain in this population has resulted in under-diagnosis and under-treatment. Despite a growth in pain evaluation for this population in the last couple of years; there is a need for professional intervention in this area with the intent to improve quality of care across their life span. The present article discuss the need for pain evaluation for children with IDD, describes the barriers in pain evaluation in this group of clients, and suggests some considerations in pain management for children with IDD. The authors would like to emphasis that since existing evidence suggests that up to 67-83% of children with IDD are in pain most of the time, we need to be thinking and addressing the topic of pain in this population 75% of the time we spend with those children. Moreover, the problem needs to be addressed with urgency, as musculoskeletal acute pain has the tendency to cause alterations within the central nervous system, turning the acute experience into a chronic condition.
... While pain communication is ubiquitous, studies suggest that observers regularly underestimate the intensity of the pain experience observed in others (Prkachin et al. 1994(Prkachin et al. , 2007Kappesser et al. 2006) and that this underestimation is higher in healthcare providers (Solomon 2001). Numerous factors can influence the perception of pain in others, (Coll et al. 2011;Hadjistavropoulos et al. 2011), but repeated exposure to others in pain has been suggested to play a role in pain underestimation in clinical settings (Prkachin et al. 2007;Prkachin and Rocha 2010). ...
Repeated exposure to others in pain has been shown to bias vicarious pain perception, but the neural correlates of this effect are currently not known. The current study therefore aimed at measuring electrocortical responses to facial expressions of pain following exposure to expressions of pain. To this end, a between-subject design was adopted. Participants in the Exposure group were exposed to facial expressions of intense pain, while the participants in the Control group were exposed to neutral expressions before performing the same pain detection task. As in previous studies, participants in the Exposure group showed a significantly more conservative bias when judging facial expressions pain, meaning that they were less inclined to judge moderate pain expressions as painful compared to participants in the Control group. Event-related potential analyses in response to pain or neutral expressions indicated that this effect was related to a relative decrease in the central late positive potential responses to pain expressions. Furthermore, while the early N170 response was not influenced by repeated exposure to pain expressions, the P100 component showed an adaptation effect in the Control group only. These results suggest that repeated exposure to vicarious pain do not influence early event-related potential responses to pain expressions but decreases the late central positive potential. These results are discussed in terms of changes in the perceived saliency of pain expressions following repeated exposure.
... In one study, naïve judges watched videotapes of patients with shoulder pain undergoing a painful series of shoulder movements (Prkachin et al. 1994). Although judges could make coarse distinctions among patients' pain states, they were not sensitive to precisely how much pain the patients were experiencing. ...
Accurate pain assessment is a joint function of both the judge perceiving correct (valid) cues of pain and targets displaying valid indicators of pain. The present research examined whether the judgeability of pain expressions could be altered by manipulating the nonverbal supportiveness of a videotaped physician who guided targets through an experimentally induced pain experience in the laboratory. Ten-s video clips of these targets during their pain experience were viewed by 95 naïve judges who assessed each target’s pain on an 11-point numeric rating scale. In addition, the video clips were rated by independent coders on 9-point scales (focused, calm, tense, distressed, composed, fidgety, determined, bored, and nervous). Judges’ pain assessment accuracy was calculated by correlating their inferred pain rating for each target with targets’ self-reported pain. Pain targets assigned to interact with the nonverbally supportive physician displayed more valid impressions of their pain and judges had higher pain assessment accuracy when viewing these targets compared to targets assigned to interact with the nonverbally unsupportive physician. Interventions for caregivers and healthcare providers that emphasize the importance of nonverbal behavior when interacting with pain sufferers are discussed.
... 83 Although facial expression is an indicator of the intensity of others' pain, 48 health care providers tend to underestimate pain intensity in patients. 34,64,66 Thus, in observers with medical expertise, the allocation of attentional resources to facial pain expressions might be modulated by top-down control. This control might be similar to the control that suppresses activation in the anterior cingulate cortex, anterior insula, and periaqueductal gray matter in physicians when witnessing a body part pricked by a needle, which is observed in control participants. ...
Pain facial expressions have important communicative values as they could indicate a potential dangerous situation. Thus, they should be detected rapidly. In this study, we investigated the cerebral network that could trigger this alarm signal in reaction to pain facial expressions. Nine epileptic patients with deep electrodes implanted after brain surgery were recorded when their attention were shifted away (implicit condition) or focused (explicit condition) to the emotional aspect of faces presented for 400 ms. Event-related potentials (ERP) of neutral faces were compared with ERP of pain faces, in the 800 ms after stimuli onset, in regions constituting the pain matrix, i.e. the cortical network responding to nociceptive stimuli. In the implicit condition, responses within the anterior insula had higher amplitudes for pain than for neutral faces, starting at ∼160 ms after stimuli onset, while such differences were not found neither in the sensory (posterior) insula nor in frontal high-order areas (BA 47). ERP of the anterior insula did not differ in amplitude or latency in the explicit condition. This result is in line with the role of anterior insula as interface between sensory processing and subjective feelings and shows its preponderant role in the implicit recognition of pain faces.
... Second, we cannot exclude that caregivers under assessed the pain of procedures they performed. Several studies have shown that caregivers under assess pain (Mä ntyselkä et al., 2001;Prkachin et al., 1994;Puntillo et al., 2003). Another important point to consider is the fact that the DAN pain scale assesses behavioral responses to a nociceptive procedure but that we do not know if the reduction of pain scores is associated with a reduction of long-term neurodevelopmental adverse effects. ...
Objectives:
Gender has been suggested to play a critical role in how facial expressions of pain are perceived by others. With the present study we aim to further investigate how gender might impact the decoding of facial expressions of pain, (i) by varying both the gender of the observer as well as the gender of the expressor and (ii) by considering two different aspects of the decoding process, namely intensity decoding and pain recognition.
Methods:
In two online-studies, videos of facial expressions of pain as well as of anger and disgust displayed by male and female avatars were presented to male and female participants. In the first study, valence and arousal ratings were assessed (intensity decoding) and in the second study, participants provided intensity ratings for different affective states, that allowed for assessing intensity decoding as well as pain recognition.
Results:
The gender of the avatar significantly affected the intensity decoding of facial expressions of pain, with higher ratings (arousal, valence, pain intensity) for female compared to male avatars. In contrast, the gender of the observer had no significant impact on intensity decoding. With regard to pain recognition (differentiating pain from anger and disgust), neither the gender of the avatar, nor the gender of the observer had any affect.
Conclusions:
Only the gender of the expressor seems to have a substantial impact on the decoding of facial expressions of pain, whereas the gender of the observer seems of less relevance. Reasons for the tendency to see more pain in female faces might be due to psychosocial factors (e.g., gender stereotypes) and require further research.
Negli ultimi due decenni la valutazione dei sistemi scolastici ha visto un crescente interesse, anche
rispetto al concetto di inclusione scolastica, che risulta sottorappresentata.
Lo scopo del lavoro è fornire un quadro sulla valutazione dell'inclusione scolastica e sugli strumenti
per misurarne gli effetti e l'impatto a livello europeo, guardando a tutti gli attori coinvolti in questo
processo così complesso.
La ricerca sviluppata all’interno di un progetto di ricerca europeo, è stata condotta a partire dallo
strumento PICOS (Methley, Campbell, Chew-Graham, McNally e Cheraghi-Sohi, 2014), per strutturare
una revisione della letteratura e per identificarne i focus.
Otto articoli sono stati inclusi e analizzati narrativamente nella sintesi qualitativa. Gli studi sono stati
organizzati intorno a cinque categorie che hanno permesso di codificarli rispetto alle tematiche e
alle questioni ancora aperte.
La revisione evidenzia la necessità di stabilire criteri e indicatori di valutazione comuni per l’inclusione
scolastica, al fine di costruire una collaborazione efficace a tutti i livelli del sistema educativo
(politica, leadership e utenti finali).
Per
A growing body of evidence demonstrates that perceivers recognize painful expressions less readily on Black (compared to White) faces. However, it is unclear how rapidly this bias emerges and whether it occurs automatically or effortfully—for example, via the deliberate application of consciously-held racialized beliefs regarding pain tolerance. Across five experiments we examined the speed and spontaneity of racial bias in pain perception. First, we observed that racial bias in pain perception was still evident under minimal presentation conditions (as brief as 33 ms) and was most apparent for ambiguous (versus high intensity) pain expressions (Exp. 1A-B). Notably, these findings generalized across both Black and White perceivers. Next, we manipulated the amount of cognitive load participants were under while viewing and rating Black and White faces in varying degrees of pain (Exps. 2A-C). Here, we observed that perceivers had more stringent thresholds for seeing pain on Black (versus White) faces regardless of whether participants were under high (versus low) load. Bayesian analyses of these data suggested strong evidence for the null hypothesis that racial bias in pain perception is not moderated by cognitive load. Together, these data demonstrate that racial bias in pain perception occurs rapidly, automatically, and with minimal visual input.
Across six studies ( N = 904), we suggest a novel mechanism for race disparities in pain treatment: Perceiver deficits in discriminating real from fake pain for Black (relative to White) individuals. Across Studies 1–4, White participants (Studies 1–4) and Black participants (Study 2) were better at discerning authentic from inauthentic pain expressions for White targets than for Black targets. This effect emerged for both subtle (Studies 1 and 2) and intense (Studies 3 and 4) pain stimuli. Studies 5 and 6 examined consequences for medical care decisions by examining pain treatment recommendations by laypeople (Study 5) and pain authenticity judgments by medical providers (Study 6). This work advances theory in pain perception, emotion judgment, and intergroup relations. It also has practical significance for identifying unexplored mechanisms causing racial disparities in medical care.
Pain is a dynamic, complex and multidimensional experience. The identification of pain from brain activity as neural readout may effectively provide a neural code for pain, and further provide useful information for pain diagnosis and treatment. Advances in neuroimaging and large-scale electrophysiology have enabled us to examine neural activity with improved spatial and temporal resolution, providing opportunities to decode pain in humans and freely behaving animals. This topical review provides a systematical overview of state-of-the-art methods for decoding pain from brain signals, with special emphasis on electrophysiological and neuroimaging modalities. We show how pain decoding analyses can help pain diagnosis and discovery of neurobiomarkers for chronic pain. Finally, we discuss the challenges in the research field and point to several important future research directions.
IntroductionIntellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life.Objectives
This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD.Methods
This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring issues as well as the best available evidence and practice.ResultsThe past decade of pain research has involved the development of standardized assessment tools appropriate for individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to compromised ability to self-report.Conclusion
Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.
Introduction:. Facial expressions of pain serve an essential social function by communicating suffering and soliciting aid. Accurate visual perception of painful expressions is critical because the misperception of pain signals can have serious clinical and social consequences. Therefore, it is essential that researchers have access to high-quality, diverse databases of painful expressions to better understand accuracy and bias in pain perception.
Objectives:. This article describes the development of a large-scale face stimulus database focusing on expressions of pain.
Methods:. We collected and normed a database of images of models posing painful facial expressions. We also characterized these stimuli in terms of the presence of a series of pain-relevant facial action units. In addition to our primary database of posed expressions, we provide a separate database of computer-rendered expressions of pain that may be applied to any neutral face photograph.
Results:. The resulting database comprises 229 unique (and now publicly available) painful expressions. To the best of our knowledge, there are no existing databases of this size, quality, or diversity in terms of race, gender, and expression intensity. We provide evidence for the reliability of expressions and evaluations of pain within these stimuli, as well as a full characterization of this set along dimensions relevant to pain such as perceived status, strength, and dominance. Moreover, our second database complements the primary set in terms of experimental control and precision.
Conclusion:. These stimuli will facilitate reproducible research in both experimental and clinical domains into the mechanisms supporting accuracy and bias in pain perception and care.
Pain, assumed to be the fifth vital sign, is an important symptom that needs to be adequately assessed in heath care. The visual changes reflected on the face of a person in pain may be apparent for only a few seconds and occur instinctively. Tracking these changes is a difficult and time-consuming process in a clinical setting. This is why it is motivating researchers and experts from medical, psychology and computer fields to conduct inter-disciplinary research in capturing facial expressions. This chapter contains a comprehensive review of technologies in the study of facial expression along with its application in pain assessment. The facial expressions of pain in children's (0-2 years) and in non-communicative patients need to be recognized as they are of utmost importance for proper diagnosis. Well designed computerized methodologies would streamline the process of patient assessment, increasing its accessibility to physicians and improving quality of care.
16 The automatic detection of facial expressions of pain has been needed to ensure accurate 17 pain assessment of patients who are unable to self-report pain. To overcome the challenges 18 of automatic systems for determining pain levels based on facial expressions in clinical patient 19 monitoring, a surface electromyography method was tested for feasibility in healthy 20 volunteers. In the current study, two types of experimental gradually increasing pain stimuli 21 were induced in thirty-one healthy volunteers who attended the study. We used a surface 22 electromyography method to measure the activity of five facial muscles to detect facial 23 expressions during pain induction. Statistical tests were used to analyze the continuous 24 electromyography data, and a supervised machine learning was applied for pain intensity 25 2 prediction model. Muscle activation of corrugator supercilii was most strongly associated with 26 self-reported pain, and the levator labii superioris and orbicularis oculi showed a statistically 27 significant increase in muscle activation when the pain stimulus reached subjects' self-28 reported pain thresholds. The two strongest features associated with pain, the waveform 29 length of the corrugator supercilii and levator labii superioris, were selected for a prediction 30 model. The performance of the pain prediction model resulted in a c-index of 0.64. In the study 31 results, the most detectable difference in muscle activity during the pain experience was 32 connected to eyebrow lowering, nose wrinkling and upper lip raising. As the performance of 33 the prediction model remains modest, we suggest testing with a larger sample size to further 34 explore the variables that affect variation in expressiveness and subjective pain experience. 35
Pain, assumed to be the fifth vital sign, is an important symptom that needs to be adequately assessed in heath care. The visual changes reflected on the face of a person in pain may be apparent for only a few seconds and occur instinctively. Tracking these changes is a difficult and time-consuming process in a clinical setting. This is why it is motivating researchers and experts from medical, psychology and computer fields to conduct inter-disciplinary research in capturing facial expressions. This chapter contains a comprehensive review of technologies in the study of facial expression along with its application in pain assessment. The facial expressions of pain in children's (0-2 years) and in non-communicative patients need to be recognized as they are of utmost importance for proper diagnosis. Well designed computerized methodologies would streamline the process of patient assessment, increasing its accessibility to physicians and improving quality of care.
Introduction:
Infants can experience pain similar to adults, and improperly controlled pain stimuli could have a long-term adverse impact on their cognitive and neurological function development. The biggest challenge of achieving good infant pain control is obtaining objective pain assessment when direct communication is lacking. For years, computer scientists have developed many different facial expression-centred machine learning (ML) methods for automatic infant pain assessment. Many of these ML algorithms showed rather satisfactory performance and have demonstrated good potential to be further enhanced for implementation in real-world clinical settings. To date, there is no prior research that has systematically summarised and compared the performance of these ML algorithms. Our proposed meta-analysis will provide the first comprehensive evidence on this topic to guide further ML algorithm development and clinical implementation.
Methods and analysis:
We will search four major public electronic medical and computer science databases including Web of Science, PubMed, Embase and IEEE Xplore Digital Library from January 2008 to present. All the articles will be imported into the Covidence platform for study eligibility screening and inclusion. Study-level extracted data will be stored in the Systematic Review Data Repository online platform. The primary outcome will be the prediction accuracy of the ML model. The secondary outcomes will be model utility measures including generalisability, interpretability and computational efficiency. All extracted outcome data will be imported into RevMan V.5.2.1 software and R V3.3.2 for analysis. Risk of bias will be summarised using the latest Prediction Model Study Risk of Bias Assessment Tool.
Ethics and dissemination:
This systematic review and meta-analysis will only use study-level data from public databases, thus formal ethical approval is not required. The results will be disseminated in the form of an official publication in a peer-reviewed journal and/or presentation at relevant conferences.
Prospero registration number:
CRD42019118784.
Effective management of pain is critical to the improvement of animal welfare. For this to happen, pain must be recognised and assessed in a variety of contexts. Pain is a complex phenomenon, making reliable, valid, and feasible measurement challenging. The use of facial expressions as a technique to assess pain in non-verbal human patients has been widely utilised for many years. More recently this technique has been developed for use in a number of non-human species: rodents, rabbits, ferrets, cats, sheep, pigs and horses. Facial expression scoring has been demonstrated to provide an effective means of identifying animal pain and in assessing its severity, overcoming some of the limitations of other measures for pain assessment in animals. However, there remain limitations and challenges to the use of facial expression as a welfare assessment tool which must be investigated. This paper reviews current facial expression pain scales ("Grimace Scales"), discussing the general conceptual and methodological issues faced when assessing pain, and highlighting the advantages of using facial expression scales over other pain assessment methods. We provide guidance on how facial expression scales should be developed so as to be valid and reliable, but we also provide guidance on how they should be used in clinical practice.
Patients with neurocognitive impairments can provide particular challenges in regard to treatment of pain. Difficulties may arise in assessment of pain, communication, treatment, confirmation of effect of intervention, or in all phases. As a result, these patients are at risk for poor pain management, with extremes of under- or over-treatment of pain. Caregivers’ input and contextual clues can be of significant help, provided this information is appropriately interpreted. Validated clinical scales play a key role in this patient population.
Third-person pain refers to the components and processes engaged when an observer is confronted by another person in pain. The literature that has arisen around this topic has approached it from diverse perspectives, including behavioral theory, social perception, affective science, psychophysiology, social neuroscience, evolutionary psychology, and clinical theory. This chapter begins with a review of the behavioral stimuli to third-person pain and then proceeds to a review of major findings and concepts in the field, organized around a component framework. The components include central nervous responses, autonomic and somatomotor responses, implicit and effortful perceptual and emotional processes, and overt behavior. Core findings and concepts linked to these third-person pain components are reviewed, methodological issues are discussed and areas for future research identified. The vast bulk of literature addressing third-person pain has emphasized prosocial features of the phenomenon. That people do not always respond to others’ pain with empathy and helping is emphasized and areas for research into malignant third-person pain reactions are identified.
Within the clinical education community, there is a desire to improve learners’ pain observation skills. Virtual patients can be used as a training tool for this purpose. In this paper, we present a pioneering approach for synthesizing naturalistic pain on virtual patients. Using the UNBC-McMaster pain archive and a CLM-based face tracker, we performed naturalistic pain synthesis. We conducted an experiment to validate our synthesis approach and compared it to manual methods that use FACS-trained animators. Our results suggest that our approach was effective, and yielded higher pain labeling accuracies compared to manually animated painful faces. This research offers a new tool to both the virtual patient and clinical education communities.
Pain is a subjective and multidimensional phenomenon with a combination of sensory, emotional/affective and cognitive facets. This emotional component is precisely the communication link between the painter and the observer as to elicit and suggest feelings in the latter. Different techniques are developed by painters to deliver an appropriate emotion to the observer.
Little is known about the effect of structured interventions for pain assessment and management in LTC. Pain is challenging to measure in this setting because of its subjective and variable nature, the inability of many residents to articulate pain, and the need for repeat measures to assess changes and treatment response. The Minimum Data Set (MDS) 2.0 includes three pain items that have relatively good reliability and validity among cognitively intact patients, but not among those with cognitive impairments or trouble communicating. MDS 3.0, to be implemented in October 2010, includes a more extensive pain assessment interview using either self-report or observation. This article suggests some ways in which LTC settings can better identify, track, and manage pain.
Examined the impact of pain-relevant, biasing information on judgments of the pain expressed in facial displays. 15 male and 15 female Ss (mean age 19.5 yrs) judged the videotaped expressions of females experiencing low, medium, and high intensity electric shocks. Ss were informed either that the shocked females had been exposed to a hypersensitivity or analgesic treatment, or the Ss received no prior information. The shocked females also had been exposed previously to either a tolerant social modeling or a no influence control condition, so that the impact of a social influence strategy on nonverbal expressions of pain could be examined. Sensory decision theory analyses of Ss' ratings indicated that the hypersensitivity instruction led to reports of greater observed pain in the absence of an effect on the ability to discriminate pain displays. Exposure of the shocked females to the tolerant modeling influence strategy dampened the pain display, making discriminations among the differing severities of electric shock more difficult. Results indicate that providing judges with information extrinsic to another person's distress can alter the severity of pain attributed to the other person. The discriminability analyses supported the conclusion that modeling influences are fundamental determinants of a broad range of reactions to pain, including nonverbal behavior. (French abstract) (31 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined adult judgments of the sensory intensity and affective discomfort experienced by newborn infants subjected to heel lancing. Video-recordings of 72 infants' reactions were categorized as high or low in cry pitch and facial activity by 28 mothers and 17 fathers of other young children. Findings indicate that cry and facial activity were determinants of the ratings, but variability in facial activity was more important than variation in cry pitch. Mothers rated the Ss as experiencing the event as less intense on the sensory dimension than did fathers. Discrete facial actions, identified using the neonatal facial coding system developed by R. V. Grunau and K. D. Craig (1987) correlated with the adult ratings. (French abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We provided a microanalytic description of facial reactions to a series of painful and nonpainful electric shocks and examined the impact of these as discrete facial cues for observer judgments of acute pain. Thirty female volunteers were videotaped and reported their discomfort in response to electric shocks after earlier exposure to one of three social influence conditions: a tolerant model, an intolerant model, or neutral peer presence. We coded the videotapes for facial activity using the Facial Action Coding System (Ekman & Friesen, 1978b), and peer judges rated them for painful discomfort. Subjects exposed to a tolerant model reported no more discomfort than did subjects exposed to an intolerant model, despite receiving more intense levels of shock, but were judged by observers to be in more pain. Analyses of facial activity yielded consistent findings: Tolerant-model subjects, though reporting discomfort equivalent to that reported in other groups, displayed more pain-related facial activity (brow lowering, narrowing of the eye aperture from below, raising the upper lip, and blinking). There was a substantial direct relation between observer judgments of distress and discrete, pain-related facial actions (mean multiple R = .74 for the various shock levels rated). These data indicate that nonverbal expression yields information about the response to noxious stimulation that is non-redundant with self-report.
This book is an updated text. It has new material on coding and methodological issues for a variety of areas in nonverbal behavior: facial actions, vocal behavior, and body movement. Issues relevant to judgment studies, methodology, reliability, analyses, etc. have also been updated. The topics are broad and include specific information about methodology and coding strategies in education, psychotherapy, deception, nonverbal sensitivity, and marital and group behavior. There is also a chapter detailing specific information on the technical aspects of recording the voice and face, and specifically in relation to deception studies. This book provides an overview and hands on information concerning the many methods and techniques that are available to code or rate affective behavior and emotional expression in different modalities. This books hopes to help further refining research methods and coding strategies that permit comparison of results from various laboratories where research on nonverbal behavior is being conducted. This will advance research in the field and help to coordinate results so that a more comprehensive understanding of affect expression can be developed.
Twenty-nine subjects used quantified verbal descriptors of sensory intensity (i.e., weak, mild, intense) or unpleasantness (i.e., annoying, unpleasant, distressing) to assess the intensity or unplesantness of sensations evoked by painful electrical stimulation of the tooth pulp over a broad stimulus range, and by a natural thermal tooth pulp stimulus, cold spray applied to exposed dentin. In addition, subjects matched the intensity or unpleasantness of the sensations evoked by the natural stimulus to that of the electrical stimuli by both the Method of Limits and the Method of Constant Stimuli.Quantified verbal descriptor values of either the sensory intensity or unpleasantness of the electrical stimuli were linearly related to stimulus intensity on a log scale, indicating that the relationships can be described by power functions. The quantified verbal description of the natural thermal stimulus and the intensity of the electrical stimulus directly matched to the thermal stimulus determined the coordinates of the clinical stimulus data point. This point was close to the experimental stimulus power function, indicating that the verbal magnitude of the clinical stimulus is predicted by the verbal magnitude of the specific electrical stimulus intensity that was matched to the clinical stimulus. This consistency supports the validity of the use of quantified verbal descriptors for the assessment of both experimentally controlled noxious stimulation and uncontrolled clinical pain sensations. It also supports the validity of direct matches between clinical and experimental pain sensations and the unpleasantness of these sensations. This procedure provides a useful independent validational paradigm for clinical pain assessment.
The results of two experiments show that ratio scales of sensory and affective verbal pain descriptors are valid, reliable and objective. In the first experiment, 16 subjects rated 15 sensory and 15 affective verbal pain descriptors by numerical magnitude estimation and by cross-modality matching to handgrip force. Ratio scales of sensory and affective verbal pain descriptors computed for two separate groups were highly correlated between the groups (sensory, r = 0.97; affective, r = 0.98), as well as over session (r = 0.99, 0.98). Scales based on an individual's data correlated equally with either another set of scales from the same individual (r = 0.96, 0.98) or a mean scale from a similar group (r = 0.96, 0.89). Sensory and affective verbal descriptor scales from the first experiment correlated highly (r = 0.99, 0.99) with those from the second experiment in which 40 subjects rated verbal pain descriptors by cross-modality matching to time duration and to handgrip force. The ratio responses to the verbal descriptors in both experiments demonstrated specific functional relationships found for measurable psychophysical stimuli. This result supports the validity of cross-modality matched ratio scales of verbal stimuli. The reliability of these scales is shown by the high between-session, between-group and between-experiment correlations. The objectivity is shown by the similarity of within-subject and between-subject correlations for both group and individual descriptor scales.
The results of two experiments suggest that sensory and affective verbal descriptors provide a valid scaling method which discriminates between the sensory intensity and the affect, or unpleasantness, of electrocutaneous stimuli. Twenty-four subjects judged the sensory intensity and affect of noxious electrocutaneous stimuli by choosing verbal descriptors from randomized lists and by cross-modality matching to time duration and to handgrip force. The psychophysical functions for sensory intensity generated by the descriptor and the cross-modality functions for sensory intensity generated by the descriptor and the cross-modality methods are the same. Psychophysical functions for affect generated by thedescriptor and the cross-modality methods are different. However, only the descriptor method produces psychophysical functions for affect that are significantly different from all the sensory functions. This result suggest that only the descriptor method distinguishes between sensory intensity and affect. The discriminative power of the descriptor method is demonstrated further in an experiment in which 32 subjects rated either the sensory intensity or the affect of the electrocutaneous stimuli immediately before and after an i.v. administration of 5 mg diazepam. This common minor tranquilizer significantly lowered affective descriptor responses (P less than 0.005) without altering sensory descriptor and sensory and affective handgrip responses. These experiments indicate that sensory and affective verbal pain descriptors may be used as a valid and sensitive tool for the evaluation of pain and pain control methods.
The process of discriminating among genuine, suppressed, and faked expressions of pain was examined. Untrained judges estimated the severity of pain being experienced when viewing videotaped facial expressions of chronic pain patients undergoing a painful diagnostic test or dissimulating reactions. Verbal feedback as to whether pain was experienced also was provided, so as to be either consistent or inconsistent with the facial expression. Judges were able to distinguish genuine pain faces from baseline expressions but, relative to genuine pain faces, attributed more pain to faked faces and less pain to suppressed ones. Advance warning of deception did not improve discrimination but led to a more conservative or nonempathic judging style. Verbal feedback increased or decreased judgments, as appropriate, but facial information consistently was assigned greater weight. An augmenting model of the judgment process that attaches considerable importance to the context in which information is provided was supported.
A number of facial actions have been found to be associated with pain. However, the consistency with which these actions occur during pain of different types has not been examined. This paper focuses on the consistency of facial expressions during pain induced by several modalities of nociceptive stimulation. Forty-one subjects were exposed to pain induced by electric shock, cold, pressure and ischemia. Facial actions during painful and pain-free periods were measured with the Facial Action Coding System. Four actions showed evidence of a consistent association with pain, increasing in likelihood, intensity or duration across all modalities: brow lowering, tightening and closing of the eye lids and nose wrinkling/upper lip raising. Factor analyses suggested that the facial actions reflected a general factor with a reasonably consistent pattern across modalities which could be combined into a sensitive single measure of pain expression. The findings suggest that the 4 actions identified carry the bulk of facial information about pain. They also provide evidence for the existence of a universal facial expression of pain. Implications of the findings for the measurement of pain expression are discussed.
This study investigated how specific expressive behaviors (verbal report of pain level and the frequency of emitting specific non-verbal facial expressions of pain) may change over the course of a chronic pain condition. Based on the concept of chronic pain behaviors, we hypothesized that both verbal and non-verbal behavior would increase with duration of pain. Thirty-six women with chronic temporomandibular disorder (TMD) pain (duration over 6 months) were compared with 35 recent onset cases (first episode, duration < or = 2 months). Subjects completed questionnaires assessing depression, anxiety, somatization, daily hassles and pain coping strategies. They were videotaped during a resting baseline and 2 painful conditions: experimental cold pressor pain and the clinically relevant pain of palpation of the masticatory muscles and temporomandibular joint; tapes were coded for facial expression using the Facial Action Coding System. Visual analog scale (VAS) ratings of the aversiveness and intensity of ongoing TMD pain were collected at baseline, and similar ratings of cold pressor and clinical examination pain were gathered after the painful stimulus. Recent onset and chronic cases did not differ on self-report measures of anxiety, depression, somatization or daily stress. Coping strategies were also similar, although chronic cases showed a greater tendency to catastrophize. Self-report measures of ambient facial pain, as well as the pain of clinical examination and cold pressor stimulation, revealed no significant differences between the 2 groups. In contrast, rates of pain facial expression were significantly higher for chronic cases under all conditions of the experiment, including baseline.(ABSTRACT TRUNCATED AT 250 WORDS)
The ability to detect lying was evaluated in 509 people including law-enforcement personnel, such as members of the U.S. Secret Service, Central Intelligence Agency, Federal Bureau of Investigation, National Security Agency, Drug Enforcement Agency, California police and judges, as well as psychiatrists, college students, and working adults. A videotape showed 10 people who were either lying or telling the truth in describing their feelings. Only the Secret Service performed better than chance, and they were significantly more accurate than all of the other groups. When occupational group was disregarded, it was found that those who were accurate apparently used different behavioral clues and had different skills than those who were inaccurate.
From research reports published over the last 20 years, it appears that moderate to severe uncontrolled pain may be the norm for hospitalized patients despite recent advances in the management of pain. Research on the extent of under-management of pain and the factors associated with it is examined and summarized in this paper. Methodological imperfections of the research are identified. Several explanations for pain under-management have been proposed and these are reported. A clinical decision making model is also reviewed and it is suggested that this model could be applied to pain management problems. Further, it is suggested that this model may be very useful in developing educational interventions to improve health practitioners' clinical skills in pain management.
This study dealt with the validity and correlates of facial expressions of pain. Twenty-four patients seeking treatment for gleno-humeral joint pain and 12 controls underwent a standardized physiotherapy assessment protocol involving active and passive arm movements, and experimental pain induced by pressure. Subjects rated pain intensity on each trial using categorical, sensory and affective scales. Independent of testing, they completed a questionnaire measure of sickness impact. Facial behavior was measured by an abbreviated version of the Facial Action Coding System. Facial actions that related to pain indices included eyebrow lowering, narrowing and closing of the eyes, lip pulling, nose wrinkling and mouth opening. Facial actions during clinical tests showed consistent relationships with sensory and affective pain scales. Greater physical disability was associated with more intense pain actions on active, but not passive, tests. The results support the validity and generality of facial measures of pain, show that they yield graded sensitive information and suggest that they encode information about the psychosocial context of pain problems. Theoretical implications of these findings are discussed.
In clinical settings concerned with pain problems, the concepts of pain and suffering are often confounded. This article draws distinctions between the two and between suffering and disability. A series of studies is reviewed bearing on these distinctions. Implications for evaluation and management of clinical pain are then discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Non-verbal expressive behaviour may provide important information about pain not available through verbal report. Nevertheless, it has received little attention in pain research. In the present study, changes in expressive behaviour resulting from electric shock were related to shock intensity, self-report of discomfort, observers' judgements of subjects' distress and social modelling influences. Subjects were videotaped while they rated low-, medium- and high-intensity shocks. Simultaneously, they were exposed to a tolerant social model or an inactive companion. Observers then viewed videotapes of subjects and judged the level of shock being delivered on the basis of non-verbal behaviour. Observers' judgements were analysed by signal detection methods to quantify expressive behaviour. Change in expressive reactions to the shocks was directly related to stimulus intensity, self-report of pain, and observers' judgements of subjects' distress. Expressive behaviour resulting from high shocks was diminished by exposure to a tolerant model. These findings establish the feasibility of pain measurement based on expressive behaviour, suggest that expressive behaviour provides a sensitive and valid index of pain, and indicate that tolerant modelling reduces evidence of pain across multiple measures.
The study of facial expression accompanying pain is of both practical and theoretical importance. It has been suggested that nonverbal behavior may provide accurate information on pain states to supplement self-report and that perhaps facial expressions could even serve as accurate measures of pain in the absence of verbal report. Recent studies of specific facial expressions accompanying pain have benefited greatly from the techniques and findings of earlier research on facial expressions of emotion. These research findings also raise a number of questions concerning relationships between pain and emotion expressions, and provide some tools (e.g. direct facial measurement systems) for answering them. A review of empirical research indicates that there are distinct facial expressions which accompany acute painful experiences with some regularity, and that these expressions occur in both infants and adults, at least in Western cultures. Important areas for future research include cross-cultural studies, investigations of the circumstances under which these facial expressions occur and the possibilities for masking or falsifying them and research into facial behaviors related to chronic pain.
The facial expres-sion of pain
- K D Craig
- K M Prkachin
- R V E Grunau
Craig, K.D., Prkachin, K.M. and Grunau, R.V.E.. The facial expres-sion of pain. In: DC. Turk and R. Melzack (Eds.), Handbook of Pain Assessment, Guilford, New York, 1992.
Behavioral Methods for Chronic Pain and Illness, CV Mosby
- W Fordyce
Fordyce, W., Behavioral Methods for Chronic Pain and Illness, CV
Mosby, St. Louis, MO, 1976.
Conducting judgement studies
- Rosenthal
Rosenthal, R., Conducting judgement studies. In: K. Scherer and P.
Ekman (Eds.), Handbook of Methods in Nonverbal Behavior
Research, Cambridge University Press, New York, 1982.