Encoding and decoding of pain expressions: a judgement study

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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.