Improving recognition of pain by calling attention to its various faces

The ability to accurately recognize facial expressions of pain is known to affect clinical decision making and delivery of care. Although recognition accuracy for facial expressions of pain is well above chance level, substantial shortcomings have also been reported which stress the need to look for methods to improve recognition accuracy. Based on findings that pain is encoded in different facial activity patterns, we wanted to investigate whether training observers to recognize these various faces of pain might improve their ability to accurately recognize pain.

Participants (55 male, 65 female) were randomly assigned to one of the three training groups: 'different patterns group' (calling attention to the various faces of pain); 'prototypical group' (calling attention to the prototypical expression of pain); and 'control group' (being informed about pain in general). For outcome assessments, participants viewed videos of individuals experiencing either pain, disgust or a neutral condition and had to infer what the individual in the video was experiencing. These videos were presented twice (before and after the training).

The 'different patterns group' benefited the most from its training, with recognition accuracy for pain increasing significantly more compared to the other groups. The 'prototypical' group also showed improved recognition accuracy for pain, however, this improved recogntition was cancelled out by decreased recognition accuracy for disgust.

Raising awareness in observers that different combinations of facial movements (different faces of pain) are equivalent signals of pain through a brief training procedure can improve recognition accuracy for pain substantially.