Facial expression of pain: An evolutionary account

Abstract

The insights provided by the application of evolutionary psychology to established fields of evidence has clinical relevance in areas such as fears, anxiety, and depression (Dimberg & Ohman 1996; Gilbert 1992; Marks & Nesse 1994). Certain evolved behaviours, such as the attachment behaviour of human and other primate infants, are accepted as orthodoxy. But broader notions of an evolved "human nature," that is, of specialised propensities 1 that generate functional behaviours effective in the social and material world, are still viewed with skepticism or indifference by many in the psychological and medical communities (Andersson 1993; Schaffner 1998). Among the more important reasons for this may be concern about genetic determinism or, at least, a distaste for invoking genetic factors (Crawford 1989; Daly & Wilson 1988; Plomin 1989; Tooby & Cosmides 1992), and suspicion of "Just-So Stories," that is, post hoc explanations from available evidence (Gould & Lewontin 1979). Far from endorsing the over-simple gene explanations that are sporadically revisited in psychiatry (Plomin 1989), evolutionary psychology aims to broaden our understanding of behaviour, in all its flexibility and contingency in relation to the immediate environment and the individual's learning history, by addressing the cognitive adaptations that are part of our heritage (Cronin 1991). 1. The function of pain Pain is the "final mediator" of a wide range of selection pressures (Walters 1994): sublethal injuries that may still threaten survival or reproduction are incurred during predation, intraspecific combat, and competition with conspecifics. By virtue of its aversiveness, pain serves to promote the organism's health and integrity, to the extent that congenital absence of pain on injury significantly shortens human life (Damasio 1999; Wall 1999): "Suffering offers us the best protection for survival" (Damasio 1994, p. 264). The adaptive value of experiencing pain at first seems selfevident: distinguishing harmful from harmless situations, prompting avoidance of harm and its associated cues, giving a high priority to escape from danger, and promoting healing by inhibiting other activities that might cause further tissue damage (Bateson 1991). Research in animals has focussed mainly on immediate escape from pain (e.g.,

A biopsychosocial formulation of pain communication.

“…People can be reasonably successful in suppressing or exaggerating nonverbal pain expression (Crombez & Eccleston, 2002;Hadjistavropoulos, Craig, Hadjistavropoulos, & Poole, 1996a;Hill & Craig, 2002;Larochette et al, 2006;Vervoort et al, 2008b), in accordance with perception of situational demands. As indicated earlier, like other negative facial expressions, expression of pain tends to be inhibited in the presence of strangers, although this inhibition may be lifted when strangers are recognized as (professional) caregivers, potentially able to relieve pain (Williams, 2002). This evidence contrasts with the popular formulation that patients 'exaggerate' pain-related behavior in the presence of actual or potential (Coyne & Fiske, 1992;Lackner & Gurtman, 2004;Lyons, Sullivan, Ritvo, & Coyne, 1995;Taylor et al, 2000).…”

“…More specifically, responses to pain responses (i.e., both self-report and facial behavior as assessed by judges who viewed videos of the participants' responses) to electric shock were attenuated when subjects were being observed. Self-report tends to be exquisitely sensitive to the social context as perceived, with individuals typically using language to optimize situational outcomes and nonverbal expression is demonstrably sensitive to context in both adults and children (Crombez & Eccleston, 2002;Hadjistavropoulos & Craig, 2002;Kleck et al, 1976;Larochette et al, 2006;Prkachin & Craig, 1985;Sullivan et al, 2004;Vervoort et al, 2008b; Pain Communication 37 Williams, 2002;Zeman & Garber, 1996). Levine and De Simone (1991) showed that males report less experimentally-induced pain in the presence of an attractively dressed female experimenter than in the presence of a male.…”

Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods

“…The interactive teaching methods used in several studies fell short of capturing the challenges of nurses' everyday work, which involves shifts in attention, multi-tasking, ad hoc changes to priorities, and interruptions (Bragadóttir, Gunnarsdóttir, Ingason, 2014) These can push nurses towards discounting pain or estimating it from extraneous cues (age, sex, social class, ethnicity) rather than patient self-report (Williams, 2002). Contextual and relational factors have an important impact on pain management behaviors but are difficult to address solely by reference to misconceptions about pain or by training nurses on pain assessment instruments.…”

Impact of parental catastrophizing and contextual threat on parents’ emotional and behavioral responses to their child’s pain

“…Fifth, the coding system we used was limited to verbal behavior. Non-verbal behavior, however, is also an important feature of parent-child communication [42,82].…”

“…There is reason to believe that, in addition to parental characteristics (e.g., catastrophizing), contextual variables such as additional information concerning the situation [55,75] and child characteristics, such as facial pain expression [42,82] may be important in explaining variations in parental responses to child pain. These variables may augment the threat value parents assign to the child's pain experience (i.e., contextual threat), thereby enhancing parental distress and possibly pain-attending responses [5,6,20,67,70,82]. Accordingly, the present study additionally examined whether contextual information or child pain expression interacts with 4" " parental catastrophizing to impact parental emotional and behavioral responses to their child's pain.…”