Abstract
First-person pain (the subjective sensory and affective experiences that we associate with tissue damage) motivates changes in the sufferer’s behavior that communicate the experience to others. The ability to infer features of another person’s pain by observing a sufferer’s behavior can be characterized as third-person pain. This chapter reviews research into the nature and determinants of third-person pain, focusing primarily on studies of the interpretation of facial expressions. Existing communication frameworks that attempt to organize thinking in this area are reviewed. Emerging conceptions of empathy and its role in third-person pain processes are described, including neuroimaging studies suggesting that first-person and third-person pain share common features of processing. Based on a review of the existing literature, a new organizing framework focused on the link between encoding of a pain signal by the sufferer and its decoding by the observer is developed. Components of this framework include preattentive processing, detection and registration, evaluation, differential responding (including the fact that the behavioral response to a sufferer may not necessarily be prosocial), and effects upon the observer. Finally, clinical implications of work in this field are considered.
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References
Batson CD (2009) These things called empathy: eight related but distinct phenomena. In: Decety J, Ickes W (eds) The social neuroscience of empathy. MIT Press, Cambridge, MA, pp 3–15
Botvinick M, Jha AP, Bylsma LM, Fabian SA, Solomon PE, Prkachin KM (2005) Viewing facial expressions of pain engages cortical areas involved in the direct experience of pain. Neuroimage 25(1):312–319
Caes L, Uzieblo K, Crombez G, De Ruddere L, Vervoort T, Goubert L (2012) Negative emotional responses elicited by the anticipation of pain in others: psychophysiological evidence. J Pain 13(5):467–476
Cheng Y, Lin CP, Liu HL, Hsu YY, Lim KE, Hung D, Decety J (2007) Expertise modulates the perception of pain in others. Curr Biol 17:1708–17113
Cheng Y, Chen C, Lin CP, Chou KH, Decety J (2010) Love hurts: an fMRI study. Neuroimage 51(2):923–929
Church RM (1959) Emotional reactions of rats to the pain of others. J Comp Physiol Psychol 52:132–134
Craig KD (2006) The construct and definition of pain in developmental disability. In: Symons FJ, Oberlander TF (eds) Pain in individuals with developmental disabilities. Paul H Brooks, Baltimore, pp 7–17
Craig KD (2009) A social communications model of pain. Can Psychol/Psychol Can 50:22–32
Craig KD, Hyde SA, Patrick CJ (1991) Genuine, suppressed and faked facial behavior during exacerbation of chronic low back pain. Pain 46:161–172
Craig KD, Versloot J, Goubert L, Vervoort T, Crombez G (2010) Perceiving pain in others: automatic and controlled mechanisms. J Pain 11:101–108
Craig KD, Prkachin KM, Grunau RVE (2011) The facial expression of pain. In: Turk DC, Melzack R (eds) Handbook of pain assessment, 3rd edn. Guilford, New York
Dalla Costa E, Minero M, Lebelt D, Stucke D, Canali E, Leach MC (2014) Development of the horse grimace scale (HGS) as a pain assessment tool in horses undergoing routine castration. PLoS One 9(3):e92281
Danziger N, Prkachin KM, Willer JC (2006) Is pain the price to pay to feel empathy? Brain 129:2494–2507
Danziger N, Faillenot I, Peyron R (2009) Can we share a pain we never felt? Neural correlates of empathy in patients with congenital insensitivity to pain. Neuron 61:203–212
De Ruddere L, Goubert L, Prkachin KM, Louis Stevens MA, Van Ryckeghem DML, Crombez G (2011) When you dislike patients, pain is taken less seriously. Pain 152(10):2342–2347
Decety J, Yang CY, Cheng Y (2010) Physicians down-regulate their pain empathy response: an event-related brain potential study. Neuroimage 50:1676–1682
Deyo K, Prkachin KM, Mercer SR (2004) Development of sensitivity to facial expressions of pain. Pain 107:16–21
DiMatteo MR, Prince LM, Hays R (1980) Nonverbal communication in the medical context: the physician-patient relationship. In: Blanck PD, Buck R, Rosenthal R (eds) Nonverbal communication in the clinical context. Penn State University Press, University Park, pp 74–98
Drwecki BB, Moore CF, Ward SE, Prkachin KM (2011) Reducing racial disparities in pain treatment: the role of empathy and perspective-taking. Pain 152:1001–1006
Fiscella K, Franks P, Doescher MP, Saver BG (2002) Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care 40(1):52–59
Fordyce WE (1976) Behavioral methods for chronic pain and illness. Mosby, St. Louis
Galin KE, Thorn BE (1993) Unmasking pain: detection of deception in facial expressions. J Soc Clin Psychol 12:182–197. doi:10.1521/jscp.1993.12.2.182
Goubert L, Craig KD, Vervoort T, Morley S, Sullivan MJL, de C Williams AC, Cano A, Crombez G (2005) Facing others in pain: the effects of empathy. Pain 118:285–288
Goubert L, Craig KD, Buysse A (2011) 12 Perceiving others in pain: experimental and clinical evidence on the role of empathy. In: Decety J, Ickes W (eds) The social neuroscience of empathy. MIT Press, Cambridge, MA, pp 153–165
Hadjistavropoulos T, Craig KD (2002) A theoretical framework for understanding self-report and observational measures of pain: a communications model. Behav Res Ther 40:551–570
Hadjistavropoulos T, Breau L, Craig KD (2011a) Pain assessment in adults and children with limited ability to communicate. In: Turk DC, Melzack R (eds) Handbook of pain assessment. Guilford Press, New York, pp 260–280
Hadjistavropoulos T, Craig KD, Duck S, Cano A, Goubert L, Jackson PL, Mogil JS, Rainville P, Sullivan MJL, de C Williams AC, Vervoort T, Fitzgerald TD (2011b) A biopsychosocial formulation of pain communication. Psychol Bull 137:910–939
Hein G, Lamm C, Brodbeck C, Singer T (2011) Skin conductance response to the pain of others predicts later costly helping. PLoS One 6(8):e22759
Helson H (1964) Adaptation level theory. Harper & Row, New York
Herbette G, Rime B (2004) Verbalization of emotion in chronic pain patients and their psychological adjustment. J Health Psychol 9:661–676
Hill ML, Craig KD (2002) Detecting deception in pain expressions: the structure of genuine and deceptive facial displays. Pain 98:135–144
Hirsh AT, Alqudah AF, Stutts LA, Robinson ME (2008) Virtual human technology: capturing sex, race and age influences in individual pain decision policies. Pain 140:231–238
Hoffman ML (2001) Empathy and moral development: implications for caring and justice. Cambridge University Press, New York
Kappesser J, de C Williams AC, Prkachin KM (2006) Testing two accounts of pain underestimation. Pain 124:109–116
Kaseweter KA, Drwecki BB, Prkachin KM (2012) Racial differences in pain treatment and empathy in a Canadian sample. Pain Res Manag 17(6):381
Keating SCJ, Thomas AA, Flecknell PA, Leach MC (2012) Evaluation of EMLA cream for preventing pain during tattooing of rabbits: changes in physiological, behavioural and facial expression responses. PLoS One 7:e44437
Konvalinka I, Xygalatas D, Bulbulia J, Schjødt U, Jegindø EM, Wallot S, Van Orden G, Roepstorff A (2011) Synchronized arousal between performers and related spectators in a fire-walking ritual. Proc Natl Acad Sci 108:8514–8519. doi:10.1073/pnas.1016955108
Kunz M, Mylius V, Schepelmann K, Lautenbacher S (2004) On the relationship between self-report and facial expression of pain. J Pain 5(7):368–376
Lamm C, Decety J, Singer T (2011) Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain. Neuroimage 54:2492–2502
Langford DJ, Crager SE, Shehzad Z, Smith SB, Sotocinal SG, Levenstadt JS, Chanda ML, Levitin DJ, Mogil JS (2006) Social modulation of pain as evidence for empathy in mice. Science 312(5782):1967–1970
Langford DJ, Bailey AL, Chanda ML, Clarke SE, Drummond TE, Echols S, Glick S, Ingrao J, Klassen-Ross T, LaCroix-Fralish M, Matsumiya L, Sorge RE, Sotocinal SG, Tabaka JM, Wong D, van den Maagdenberg AMJM, Ferrari MD, Craig KD, Mogil JS (2010) Coding of facial expressions of pain in the laboratory mouse. Nat Methods 7:447–449
Lundquist LM, Higgins NC, Prkachin KM (2002) Accurate pain detection is not enough: contextual and attributional style biasing factors in patient evaluation and treatment choice. J Appl Biobehav Res 7:114–132
Martin GB, Clark RD (1982) Distress crying in neonates: species and peer specificity. Dev Psychol 18:3–9
Martins MJ, Moura BL, Martins IP, Figueira ML, Prkachin KM (2011) Sensitivity to expressions of pain in schizophrenia patients. Psychiatry Res 189:180–184
Masserman JH, Wechkin S, Terris W (1964) “Altruistic” behavior in rhesus monkeys. Am J Psychiatry 121:584–585
Melzack R, Casey KL (1968) Sensory, motivational, and central control determinants of pain: a new conceptual model. In: Kenshalo D (ed) The skin senses. Charles Thomas, Springfield
Miller RE, Banks JH Jr, Ogawa N (1962) Communication of affect in “cooperative conditioning” of rhesus monkeys. J Abnorm Soc Psychol 64:24–30
Morley S, Doyle K, Beese A (2000) Talking to others about pain: suffering in silence. In: Devor M, Rowbotham MC, Wiesenfeld-Hallin Z (eds) Proceedings of the Ninth World Congress on Pain, Progress in pain research and management. International Association for the Study of Pain, Seattle
Patrick CJ, Craig KD, Prkachin KM (1986) Observer judgements of acute pain: facial action determinants. J Pers Soc Psychol 50:1291–1298
Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R (2008) Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA 299:70–78
Poole GD, Craig KD (1992) Judgments of genuine, suppressed, and faked facial expressions of pain. J Pers Soc Psychol 63(5):797
Preis MA, Kroener‐Herwig B (2012) Empathy for pain: the effects of prior experience and sex. Eur J Pain 16(9):1311–1319
Preston SD, De Waal F (2002) Empathy: its ultimate and proximate bases. Behav Brain Sci 25(01):1–20
Prkachin KM (1992a) Dissociating deliberate and spontaneous expressions of pain. Pain 51:57–65
Prkachin KM (1992b) The consistency of facial expressions of pain: a comparison across modalities. Pain 51:297–306
Prkachin KM (2005) Effects of deliberate control on verbal and facial expressions of pain. Pain 114:328–338
Prkachin KM (2009) Assessing pain by facial expression: facial expression as nexus. Pain Res Manag 14:53–58
Prkachin KM, Craig KD (1985) Influencing nonverbal expressions of pain: signal detection analyses. Pain 21:399–409
Prkachin KM, Craig KD (1995) Expressing pain: the communication and interpretation of facial pain signals. J Nonverbal Behav 19:191–205
Prkachin KM, Mercer S (1989) Pain expression in patients with shoulder pathology: validity, coding properties and relation to sickness impact. Pain 39:257–265
Prkachin KM, Rocha EM (2010) High levels of vicarious exposure bias pain judgements. J Pain 11:904–909
Prkachin KM, Solomon PE (2008) The structure, reliability and validity of pain expression: evidence from patients with shoulder pain. Pain 139:267–274
Prkachin KM, Berzins S, Mercer S (1994) Encoding and decoding of pain expressions: a judgment study. Pain 58:253–259
Prkachin KM, Solomon P, Hwang T, Mercer SR (2001) Does experience affect judgements of pain behaviour? Evidence from relatives of pain patients and health-care providers. Pain Res Manag 6:105–112
Prkachin KM, Mass H, Mercer SR (2004) Effects of exposure on perception of pain expression. Pain 111:8–12
Prkachin KM, Solomon P, Ross J (2007) Underestimation of pain by health-care providers: towards a model of the process of inferring pain in others. Can J Nurs Res 39:88–106
Rosenthal R (1982) Conducting judgment studies. In: Scherer K, Ekman P (eds) Handbook of methods in nonverbal behaviour research. Cambridge University Press, New York, pp 287–361
Solomon P (2001) Congruence between health professionals’ and patients’ pain ratings: a review of the literature. Scand J Caring Sci 15:174–180
Sotocinal SG, Sorge RE, Zaloum A, Tuttle AH, Martin LJ, Wieskopf JS, Mapplebeck CS, Wei P, Zhan S, Zhang S, McDougall JJ, King OD, Mogil JS (2011) The rat grimace scale: a partially automated method for quantifying pain in the laboratory rat via facial expression. Mol Pain 7:55
Sullivan MJL, Bishop S, Pivik J (1995) The pain catastrophizing scale: development and validation. Psychol Assess 7:524–532
Vervoort T, Goubert L, Eccleston C, Verhoeven K, De Clercq A, Buysse A, Crombez G (2008) The effects of parental presence upon the facial expression of pain: the moderating role of child pain catastrophizing. Pain 138(2):277–285
Vervoort T, Trost Z, Prkachin K, Mueller SC (2013) Attentional processing of other's facial display of pain: an eye tracking study. Pain 154:836–844
Williams ACDC (2002) Facial expression of pain, empathy, evolution, and social learning. Behav Brain Sci 25(04):475–480
Wojakiewicz A, Januel D, Braha S, Prkachin K, Danziger N, Bouhassira D (2013) Alteration of pain recognition in schizophrenia. Eur J Pain 17:1385–1392
Yamada M, Decety J (2009) Unconscious affective processing and empathy: an investigation of subliminal priming on the detection of painful facial expressions. Pain 143:71–75
Acknowledgment
The authors’ research described in this chapter was supported by grants from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada.
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Prkachin, K.M., Kaseweter, K.A., Browne, M.E. (2015). Understanding the Suffering of Others: The Sources and Consequences of Third-Person Pain. In: Pickering, G., Gibson, S. (eds) Pain, Emotion and Cognition. Springer, Cham. https://doi.org/10.1007/978-3-319-12033-1_4
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