Pain behavior observation: current status and future directions

Individuals who have pain engage in certain pain-related behaviors that tend to communicate their pain to others. There is growing recognition that the careful observation of such pain behaviors is an important component of a comprehensive pain assessment. This article provides an overview of the current status of behavioral observation methods used to assess pain behavior. The first half of this article describes and evaluates the most commonly used pain behavior observation methods. These include self-observation methods such as activity diaries, and direct observation methods such as the use of standard behavior sampling methods and naturalistic observation methods. The second half of the article discusses several important future clinical and research applications of pain behavior observation methods. The need to develop practical, clinical methods for incorporating pain behavior observation methods into practice settings is emphasized. Important future research topics include studying the social context of pain behavior (eg, by examining how spouses respond to displays of pain behavior), examining the predictive validity of pain behavior (ie, how observed pain behaviors predict future disability and impairment), and identifying pain behavior subgroups within heterogeneous chronic pain populations. Further development and refinement of pain behavior observation methods is likely to increase our understanding of the varied ways that patients adapt to persistent pain.