Most healthcare professionals can recognise pain in the face of a patient. But although 59% of doctors and nurses were able to correctly identify the facial signs of pain, other emotions scored more highly.
Sadness was the most recognised emotion, with a 92% hit rate. Surprise, with 81% came next, then embarrassment (79%), anger (73%), disgust (67%), and fear (61%).
“Overall, the results supported the hypothesis of a distinct and identifiable pain face,” say researchers from the Inpatient Pain Unit at St Thomas's Hospital, London, in a report of the study (Pain 2002:99;197-206).
The researchers looked at how accurately pain was identified, the other emotions with which pain was confused, which other emotions were misread as pain, and how confident doctors and nurses felt in identifying pain.
Medical and nursing staff working in accident and emergency departments in two London hospitals were asked to imagine that a series of photos they were shown represented a patient. They were also given a scale on which to rate their confidence.
The results showed that the emotion most confused with pain was disgust. The report says, “One reason for the misidentification could be that disgust and pain share some facial action units—nose-wrinkler and upper lip raiser. Although recognition for the pain face is far higher than chance level, both hit rates are the lowest when compared to the other facial expressions.”
The report says that systematic underestimation of pain by health professionals is of concern because of the widespread undertreatment of pain in many settings.
It cites research showing that observers with experience of pain in their own families attributed greater pain to the patients than did observers with no family experience of pain.
“It may be that sensitivity to pain expression is enhanced by repeated exposure to a family member in pain, where judgements can be confirmed or disconfirmed, but not by multiple exposure to strangers and little feedback on the quality of judgements made,” says the report.
Figure.
KOBAL COLLECTION
Doctors can confuse disgust (shown by Edith Evans, left) with pain (shown by actor Lawrence Tierney, whose character has backache)