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Although facial pain expressions are considered to be the most visible pain behaviors, it is known that the association between pain intensity and facial pain expression is weak for chronic pain. The authors hypothesized that the facial pain expressiveness was altered in chronic pain and investigated it with a mental rotation task using various facial expression, which seems to be associated with actual facial movements. As a task stimulus, 4 types of facial expression stimuli consisted of upper (tightening of eye and furrowed brows) and lower (raising upper lip) pain-specific facial expressions, and upper (eyeball deviation) and lower (tongue protrusion) facial movements not using facial muscles were used. Participants were asked to judge whether a stimulus presented at various rotation angles was left- or right-sided. The authors tested 40 patients with complex regional pain syndrome (CRPS) (12 women, age range 21-60) and 35 healthy controls (15 women, age range 26-64). In an analysis of reaction time (RT) using a linear mixed model, patients were slower to react to all types of stimuli (P = .001) and a significant interaction between group (patient or control) and type of facial expression was observed (P = .01). In the post hoc analysis only patients showed longer RTs to raising upper lip than other types of facial expressions. This reflects a deficit in mental rotation tasks especially for lower facial region pain expressions in CRPS, which may be related to the psychosocial aspects of pain. However, comprehensive intra- and interpersonal influences should be further investigated.

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