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Facial expressions provide a primary source of inference about a child's pain. Although facial expressions typically appear spontaneous, children have some capacity to fake or suppress displays of pain, thereby potentially misleading caregiver judgments. The present study was designed to compare accuracy of different groups of caregivers in detecting deception in children's facial expressions of pain when voluntarily controlled. Caregivers (15 pediatricians, 15 pediatric nurses, and 15 parents) viewed 48 video clips of children, 12 in each of 4 conditions (genuine pain, faked pain, suppressed pain, neutral baseline), and judged which condition was apparent to them. A 3 (group: pediatrician vs pediatric nurse vs parent)×4 (condition: genuine vs faked vs suppressed vs neutral) mixed analysis of variance (ANOVA) of judgment accuracies revealed a significant main effect of group, with nurses demonstrating higher overall accuracy scores than parents, and pediatricians not differing from either group. As well, all caregivers, regardless of group, demonstrated the lowest accuracy when viewing the genuine condition, relative to the faked and suppressed conditions, with accuracy for the neutral condition not differing significantly from the other conditions. Overall, caregivers were more successful at identifying faked and suppressed than genuine expressions of pain in children, and pediatric nurses fared better overall in judgment accuracy than parents., (Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Children's efforts to hide or exaggerate facial expressions of pain were compared to their genuine expressions using the cold pressor task. Fifty healthy 8- to 12-year-olds (25 boys, 25 girls) submerged their hands in cold and warm water and were instructed about what to show on their faces. Cold 10 degrees C water was used for the genuine and suppressed conditions and warm 30 degrees C water was used for the faked condition. Facial activity was videotaped and coded using the Facial Action Coding System to provide objective, detailed accounts of facial expressions in each condition, as well as during a baseline condition. Parents were subsequently asked to correctly identify each of the four conditions by viewing each video clip twice. Faked expressions of pain in children were found to show more frequent and more intense facial actions compared to their genuine pain expression, indicating that children had some understanding but were not fully successful in faking expressions of pain. Children's suppressed expressions, however, showed no differences from baseline facial actions, indicating that they were able to successfully suppress their expressions of pain. Parents correctly identified the four conditions significantly more frequently than would be expected by chance. They were generally quite successful at detecting faked pain, but experienced difficulty differentiating among the other conditions. The results indicate that children are capable of controlling their facial expressions of pain when instructed to do so, but are better able to hide their pain than to fake it.

Clinicians tend to assign greater weight to nonverbal expression than to patient self-report when judging the location and severity of pain. However, patients can be successful at dissimulating facial expressions of pain, as posed expressions resemble genuine expressions in the frequency and intensity of pain-related facial actions. The present research examined individual differences in the ability to discriminate genuine and deceptive facial pain displays and whether different models of training in cues to deception would improve detection skills. Judges (60 male, 60 female) were randomly assigned to 1 of 4 experimental groups: 1) control; 2) corrective feedback; 3) deception training; and 4) deception training plus feedback. Judges were shown 4 videotaped facial expressions for each chronic pain patient: neutral expressions, genuine pain instigated by physiotherapy range of motion assessment, masked pain, and faked pain. For each condition, the participants rated pain intensity and unpleasantness, decided which category each of the 4 video clips represented, and described cues they used to arrive at decisions. There were significant individual differences in accuracy, with females more accurate than males, but accuracy was unrelated to past pain experience, empathy, or the number or type of facial cues used. Immediate corrective feedback led to significant improvements in participants' detection accuracy, whereas there was no support for the use of an information-based training program.

Clinicians tend to assign greater weight to non-verbal expression than to patients' self-report when judging the location and severity of pain. Judgments can misrepresent the actual experience because patients can successfully alter their pain expressions. The present research provides a basis for discriminating genuine and deceptive pain expressions by expanding detailed accounts of facial expressions to include previously unexamined variables, including study of temporal patterns and contiguity of facial actions as well as the occurrence of specific deception cues. Low back patients' facial expressions (n=40) were videotaped at rest and while undergoing a painful straight leg raise with instructions to: (1) genuinely express their pain, or (2) pretend that it did not hurt. As well, they were asked to fake pain without moving. The Facial Action Coding System was used to describe and quantify facial activity. The different types of expression were compared on the frequency, type, intensity, temporal pattern and contiguity of facial actions, as well as on the frequency of specific deception cues. Findings confirmed the difficulty of discriminating the facial expressions, but indicated that faked pain expressions show a greater number of pain-related and non-pain-related actions, have a longer peak intensity and overall duration, and the facial actions observed tend to be less temporally contiguous than are those in genuine pain expressions. The differences between masked pain and neutral expressions were subtle, with a greater frequency of mouth opening and residual eyebrow movement in masked pain expressions. Thus, there is an empirical basis for discriminating genuine and deceptive facial displays.

The process of discriminating among genuine, suppressed, and faked expressions of pain was examined. Untrained judges estimated the severity of pain being experienced when viewing videotaped facial expressions of chronic pain patients undergoing a painful diagnostic test or dissimulating reactions. Verbal feedback as to whether pain was experienced also was provided, so as to be either consistent or inconsistent with the facial expression. Judges were able to distinguish genuine pain faces from baseline expressions but, relative to genuine pain faces, attributed more pain to faked faces and less pain to suppressed ones. Advance warning of deception did not improve discrimination but led to a more conservative or nonempathic judging style. Verbal feedback increased or decreased judgments, as appropriate, but facial information consistently was assigned greater weight. An augmenting model of the judgment process that attaches considerable importance to the context in which information is provided was supported. [ABSTRACT FROM AUTHOR]