Pain communication through body posture: the development and validation of a stimulus set

Pain can be communicated nonverbally through facial expressions, vocalisations, and bodily movements. Most studies have focussed on the facial display of pain, whereas there is little research on postural display. Stimulus sets for facial and vocal expressions of pain have been developed, but there is no equivalent for body-based expressions. Reported here is the development of a new stimulus set of dynamic body postures that communicate pain and basic emotions. This stimulus set is designed to facilitate research into the bodily communication of pain. We report a 3-phase development and validation study. First 16 actors performed affective body postures for pain, as well as happiness, sadness, fear, disgust, surprise, anger, and neutral expressions. Second, 20 observers independently selected the best image stimuli based on the accuracy of emotion identification and valence/arousal ratings. Third, to establish reliability, this accuracy and valence rating procedure was repeated with a second independent group of 40 participants. A final set of 144 images with good reliability was established and is made available. Results demonstrate that pain, along with basic emotions, can be communicated through body posture. Cluster analysis demonstrates that pain and emotion are recognised with a high degree of specificity. In addition, pain was rated as the most unpleasant (negative valence) of the expressions, and was associated with a high level of arousal. For the first time, specific postures communicating pain are described. The stimulus set is provided as a tool to facilitate the study of nonverbal pain communication, and its possible uses are discussed.