• M Kunz and S Lautenbacher.
• Physiological Psychology, Otto-Friedrich University Bamberg, Germany; Biological Psychology, Ludwig Maximilian University, Munich, Germany.
• Eur J Pain. 2014 Jul 1;18(6):813-23.

BackgroundThere is general agreement that facial activity during pain conveys pain-specific information but is nevertheless characterized by substantial inter-individual differences. With the present study we aim to investigate whether these differences represent idiosyncratic variations or whether they can be clustered into distinct facial activity patterns.MethodsFacial actions during heat pain were assessed in two samples of pain-free individuals (n = 128; n = 112) and were later analysed using the Facial Action Coding System. Hierarchical cluster analyses were used to look for combinations of single facial actions in episodes of pain. The stability/replicability of facial activity patterns was determined across samples as well as across different basic social situations.ResultsCluster analyses revealed four distinct activity patterns during pain, which stably occurred across samples and situations: (I) narrowed eyes with furrowed brows and wrinkled nose; (II) opened mouth with narrowed eyes; (III) raised eyebrows; and (IV) furrowed brows with narrowed eyes. In addition, a considerable number of participants were facially completely unresponsive during pain induction (stoic cluster). These activity patterns seem to be reaction stereotypies in the majority of individuals (in nearly two-thirds), whereas a minority displayed varying clusters across situations.ConclusionThese findings suggest that there is no uniform set of facial actions but instead there are at least four different facial activity patterns occurring during pain that are composed of different configurations of facial actions. Raising awareness about these different 'faces of pain' might hold the potential of improving the detection and, thereby, the communication of pain.© 2013 European Pain Federation - EFIC®

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