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Only one published study has investigated the effect of a threatening social context on the perception and expression of pain, showing that social threat leads to increased pain reports but reduced nonverbal pain expression. The current study aimed to replicate and extend these findings to further explore the effects of a threatening social context. Healthy, female participants (N = 71) received 10 electrocutaneous stimuli delivered by a confederate. They were led to believe that the confederate was requested to administer 10 painful stimuli (control group) or that the confederate deliberately chose to deliver 10 painful stimuli when given the choice to deliver between 1 to 10 painful stimuli (social threat group). Self-reported pain intensity, unpleasantness, threat value of pain, and painful facial expression were assessed. Additionally, empathy and aggression toward the confederate were investigated. Social threat did not affect painful facial expression or self-reported pain intensity, but led to increased aggression toward the confederate. Moreover, perceived social threat predicted the threat value of pain and reduced empathy toward the confederate. We were not able to replicate the previously reported dissociation between pain reports and pain expression as a result of social threat. However, social threat was associated with an increased threat value of pain, increased aggression, and reduced empathy.Perspective: A threatening social context affects how threatening pain is perceived and has interpersonal consequences such as increased aggression and reduced empathy, thereby creating a double burden on the individual suffering from pain. [ABSTRACT FROM AUTHOR]

Background and aims Pain is a multidimensional experience that is difficult to describe and to assess. To scale current pain, assessment refers to a maximum level of pain, but little is known about this process. Further, clinicians tend to underestimate patients’ pain, with or without patients’ own reports, and to underestimate to a greater extent with more clinical experience, possibly due to recalibration of a personal pain scale with increasing exposure to severe pain. We sought to determine how medical students rated pain in early years of clinical exposure, and in relation to experience of their own and others’ worst pains. Methods An online survey sampled medical students’ rating and description of their own worst pain and of that witnessed in another; also what would cause the maximum level of pain and what behaviours characterised it. Last, they indicated their preference among pain scales. Results Thirty-six medical students provided responses, the majority in their first six months of clinical exposure. Students’ own worst pain was rated a mean of 6.7/10 (s.d. 1.6) on a numerical scale; causes were diverse but with many bone fractures. Mean worst pain observed in another was rated 8.6/10 (s.d. 1.4); causes included fractures, gallstones, and sickle cell crises. Another's worst pain was significantly higher (mean 9.4, s.d. 0.8 vs mean 8.0 s.d. 1.4) when rated after the student's own pain than before it (presentation order randomised). We found no effect of clinical exposure on estimation of worst pain in another person, nor was there a personal tendency to rate pain using more or less extreme values. Students expected pain of 10/10 to be presented with many verbal, facial and whole body behaviours, and signs of physiological stress. Collectively, behavioural descriptions were rich and varied, but with many incompatibilities: for instance, between ‘writhing’ and ‘rigidity’ expected in the person with extreme pain. Most students preferred the numerical rating scale over visual analogue and verbal scales. Conclusions The study requires replication, particularly for clinical experience, where we found no significant difference in estimation of another's pain over the first three years of medical students’ clinical exposure, but the comparison was underpowered. Despite no systematic individual difference in using pain ratings, there was a marked effect of rating another's worst pain higher when the rater had previously rated his/her own worst pain. This suggests anchoring estimate of another's pain in personal pain experience, and a possible way to mitigate clinicians’ underestimation of patients’ pain. Medical students’ recognition of the importance of facial expression in indicating another's pain severity was encouraging, but most students anticipated only a narrow range of behaviours associated with extreme pain, thereby excluding other authentic behaviours. Implications Many clinical guidelines mandate regular pain assessment for hospital inpatients, and encourage routine assessment in community and outpatient settings, in order to decide on and monitor treatment. Replication and elaboration of this study could extend our understanding of how clinicians interpret pain scales completed by patients, and how they estimate patients’ pain. [ABSTRACT FROM AUTHOR]

Automatic pain detection is an emerging area of investigation with convenient applications in health care. The variation in facial expression often provides a clue for occurrence of pain. It provides an important window for the person who cannot verbally describe or rate their level of pain. To meet up the specific necessities, a framework has been designed for extraction of features from the face for automatic pain detection through facial expression. In this framework, Gabor filtering and Principal Component Analysis (PCA) are used as contributive steps that improves the performance of the system in terms of accuracy. To verify the accuracy and robustness of the system, experiments have been conducted on UNBC-McMaster Shoulder Pain Expression Archive Database at both frame level (person dependent) and image level (person independent). The methodology achieves 87.23% accuracy for detection of pain at frame level. Also the methodology achieves 82.43% accuracy for classifying the frames between four pain level (i.e. PSPI of 0, 1, 2 and >=3). The success rate of the methodology for pain detection at image level is 95.5%. [ABSTRACT FROM AUTHOR]

All children experience body pain as a result of medical procedures, vaccinations, and a variety of chronic conditions. Children are a vulnerable population and may be even more at risk to experience pain in under-resourced environments. We know that physical pain in childhood causes suffering to the child, family, and caregivers, and can also cause prolonged physiological and immune effects lasting into adulthood. There is evidence that Aboriginal children and youth experience pain at higher rates than their non-Aboriginal counterparts. First Nations youth report that pain issues have kept them from participating in essential developmental activities such as school and sports. Effective pain care increases a child's ability to participate in activities that are meant to enhance well-being and prepare them to be healthy adults. Currently, there is no reliable way for First Nations children and youth to convey the intensity and quality of their pain. This makes it difficult for health professionals to measure it and likely influences whether it is adequately treated or not. In this paper, we will discuss some of the historical and cultural perspectives that maybe helpful in understanding pain in Aboriginal children. In addition, we will discuss what is known about pain expression, assessment, management, and health professionals' empathy for pain cross-culturally as well as the next logical steps to address some of these issues. [ABSTRACT FROM AUTHOR]

Abstract: The present study investigated the effects of social threat to physical integrity on reported pain and facial pain expression. Predictions of a cognitive appraisal model and a communicative perspective on pain expression were compared. Participants (N = 67) received 5 electric pain stimuli administered by a confederate. They were led to believe that 5 pain stimuli were the minimum, a fixed amount, or the maximum number of pain stimuli allowed, thereby varying the social threat posed by the confederate. Reported pain and facial pain expression were recorded during the delivery of pain stimuli. Increased perceived social threat led to an increase of reported pain, specifically for high pain catastrophizing participants, while it led to a reduction of facial pain expression. This is the first study to demonstrate that a social threat manipulation has opposite effects on reported pain and facial expression, suggesting differences in adaptive function for both forms of pain expression. Perspective: This is the first demonstration showing an increase in verbal pain report and a decrease in nonverbal pain expression at the same time during social threat. This knowledge may contribute to improving pain assessment in different contexts. [Copyright &y& Elsevier]

Abstract: The Neonatal Facial Coding System (NFCS) is widely accepted as a measure of infant pain-related distress in known pain-specific contexts. It has clearly shown the ability to distinguish between facial reactivity in no-pain and pain-related situations. The primary purpose of this study was to explore whether NFCS differentiates between pain-related and non-pain-related distress. Two groups of 35 infants (1 group was distressed before injection whereas the other group was not distressed before injection) were coded using NFCS before and after an immunization procedure. Within-group analyses of infants who were distressed before immunization suggested that NFCS was not able to discriminate between pain-related and non-pain-related distress. However, between-group analyses showed NFCS discriminated between potential gradations of distress in infants after immunization. Results suggest that NFCS has the ability to discriminate between intensities of distress but not between pain–related and non-pain-related distress. Perspective: Adding to the NFCS validity literature, this study suggests that while able to distinguish between no-distress and pain-related distress, facial actions of NFCS may not distinguish between pain-related and non-pain-related distress expressions. However, NFCS was able to discern infants presumed to have higher pain-related distress due to experiencing pre-needle distress. [Copyright &y& Elsevier]