The assessment of pain behavior: implications for applied psychophysiology and future research directions

Persons who have pain engage in behaviors such as resting in bed, taking medication, moving in a guarded fashion, or grimacing that communicate the fact that pain is being experienced. Pain-related behaviors increasingly are viewed as an important target in pain assessment. Traditionally, pain behavior has been assessed through interview or self-recording methods (e.g. diary records). Pain behaviors, however, are overt and can be recorded through direct observation. Over the past 20 years, observation methods have been developed to assess pain behavior in patients having persistent pain conditions. Although these methods are not widely used in applied psychophysiological settings, they potentially could be quite useful. The purpose of this paper is to review the literature on such observation methods. The paper is divided into five parts. The first part provides a description of the basic elements of pain behavior observation protocols. The second part presents information on the psychometric properties of the most commonly used protocols. The third part highlights applications of pain behavior observation protocols. The fourth part briefly describes the strengths and limitations of pain behavior observation. The paper concludes with a discussion of the implications of pain behavior observation for applied psychophysiology and future directions for research and practice in this area.