The facial expression of pain Better than a thousand words

Abstract A diverse pattern of verbal and nonverbal activity communicates distress to others and permits inferences about the nature and severity of pain. The professional and scientific literature have focused heavily upon self-report measures, despite known limitations, with the potential benefits of nonverbal measures, and the important role of nonverbal communication, left relatively unexamined. Successes in objective description of a relatively specific facial reaction during painful events are described for both adults and infants. Detailed coding of facial activity provides a mechanism for understanding biological, behavioral, cognitive, and social parameters of pain that self-report measures do not address. Facial activity appears to be the most consistent expression of pain in infants. Age-specific patterns are described. In both clinical and nonclinical settings, observers often attach greater credibility to nonverbal expression than to self-report.

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