It seems like a pretty straightforward question, but recognizing signs of pain in other people can be tricky.
Not only is this an interesting intellectual question, but the ability to recognize pain can literally have life or death consequences. Many doctors are tasked with diagnosing a problem based only on the expression of pain by the patient, and sometimes the failure to accurately recognize pain leads to misdiagnosis, with severe implications. This is especially relevant with young infants, cognitively impaired patients, or those in post-surgery recovery.
It is by reminding us of those stakes that Drs. Prkachin and Craig ground their landmark 1995 study on the communication and interpretation of pain in facial expressions. While they develop a framework of expression reading for health-care workers, it can also be incredibly useful for anyone who wants to better recognize pain in other people.
Pain can be understood as occurring in “episodes” where a painful stimulus is created in one section of body tissue. This is often acute but can also be chronic, such as with a compressed nerve. The nervous system then “encodes” the episode, automatically leading to subtle changes in facial expressions.
Once encoded, the pain can then be broadcast through more overt expressions, but this is not always the case as people often attempt to conceal their pain from others. Researchers have tried to systematize the many aspects of the pain expression into the Facial Action Coding System or FACS, consisting of 46 unique configurations.
The most reliable of these indicators is the tightening of muscles around the eye, leading to a squint and rise in the cheek. This is accompanied by wrinkling in the bridge of the nose, the rise of the upper lip, and even the outright closure of the eyes. If readers attempt to simulate these indicators, the resulting grimace should feel quite familiar.
The FACS model has even been adapted to infants, though they often present pain in distinctive ways. However, by adapting the model to newborns and other babies, medical professionals have also been able to extend their insights to recognizing subtle signs of pain in those who can’t verbally express it.
As we discussed last week, the pain expression is a unique one. This may seem to conflict with the notion that FACS identified so many configurations, but Drs. Prkachin and Craig emphasize the notion of a “prototypical” expression. There is something in common to various instances of the expression, despite variations in the pain or in the individual.
Finally, all of this must confront the sociocultural factors that encourage us to hide or modulate our experience of pain. While practitioners can attempt to situate the individual within their culture, this approach can often be misleading.
It is up to us when attempting to recognize pain to look closely for these FACS indicators while also keeping in mind the extent to which an individual could be moderating their expression. It is important to note, however, that overall we tend to underestimate other people’s pain.
While there are a lot of ways to get better at reading people, reading pain is especially tricky. Please keep following our blog this month as we delve even further into the subject in recognition of Pain Awareness Month.