lournal of Social and Clinical Psychology, Vol.

12,

No.

2, 1993, pp. 182-197

UNMASKING PAIN: DETECTION OF

DECEPTION IN FACIAL EXPRESSIONS
KAREN E. GALIN
VA Medical

Center, Pittsburgh, PA

BEVERLY E. THORN

University of Alabama

facial expressions of subjects in

in
masked
ice
(hand
water),
genuine pain
pain, posed pain, or no pain. Judges
were given facial movement training (based on Facial Action Coding System) plus
limited feedback training, feedback only training, or no training. All judges,
regardless of training, were more accurate in detecting genuine pain in subjects
demonstrating low pain tolerance than in subjects with high tolerance. Relative to
Trained

judges (66 college students) distinguished

no training, feedback training enhanced accuracy in identifying posed and

genuine pain, whereas facial action training plus feedback enhanced accuracy in
identifying posed pain. Results suggest judges can be provided with information
about facial movements to distinguish between genuine and distorted pain

displays.

challenge to clinicians. The fundamental

difficulty
private nature of pain, which can only be
revealed by what the suffering person says or does (Fordyce, 1983).
Several researchers have attempted to identify the behaviors reliably
associated with pain. Keefe and Block (1982) investigated a number of
behaviors associated with low-back pain, including guarded move
ment, bracing, rubbing, sighing, and grimacing. Other researchers (e.g.,
Craig, Hyde, & Patrick, 1991; Craig & Patrick, 1985; LeResche &
Dworkin, 1988; Patrick, Craig, & Prkachin, 1986; Prkachin & Mercer,
1989) have studied specific facial expressions characteristic of pain.
Investigations using the Facial Action Coding System (FACS; Ekman
Pain assessment

represents

involves the

& Friesen,

Address

1969)

indicate that

correspondence
Pittsburgh, PA 15206.

182

to Karen

circumscribed subset of facial actions is

Galin, VA Medical Center,

Highland Drive, 116B,

PAIN AND FACIAL EXPRESSIONS

associated with

183

there is variability in their expression

(Craig et al., 1991). LeResche and Dworkin (1988)
note variability across patients in the frequency, duration, and inten
sity of facial movements in response to a painful clinical examination.
Hyde (1986) suggests "the existence of a constellation of AUs (Action
Units), any one of which might be displayed by an individual in pain"
(p. 98), rather than a unitary or prototypic pain expression.
Variability in the expression of facial actions may be influenced by
display rules and/or secondary gain. Display rules (i.e., norms for
managing emotional expressions) may serve to intensify, deintensify,
mask, or neutralize facial expressions of pain (Ekman & Friesen, 1978).
Similarly, individuals who receive reinforcement for their pain behav
iors may display different facial expressions than individuals for
whom pain has only negative consequences. Attention (Turk, Meichenbaum, & Genest, 1983) and insurance compensation (Fordyce, 1983)
can serve as
potent reinforcers that may shape pain expressions.
Little research has been done to help clinicians identify distortions of
the pain experience, such as willfully minimizing pain displays
(masking) or exaggeration of such behaviors (posing). Craig et al.
(1991) have identified the facial movements associated with simulated
and masked, as well as genuine, pain. However, it is unknown whether
clinicians' knowledge of deceptive pain expressions results in more
accurate assessments. This question was addressed in the present
study.
across

pain, although

individuals

STUDY 1
METHOD

Thirty male and 30 female volunteers underwent Cold-Pressor pain

(Wolf & Hardy, 1941), whereby the subject's hand is immersed in water
maintained at 0-4 degrees Celsius. Subjects were asked to endure the
discomfort as long as they could. After five minutes, the procedure was
discontinued. Subjects rated their pain intensity using a Numeric
Rating Scale (Scott & Huskisson, 1976) upon immersion in the water
and upon withdrawal. The scale was a vertical line with the numbers
0-100 spaced evenly along its length, with adjective anchors "no pain,"

"just noticeable pain," "moderate pain," and "excruciating pain,"

corresponding to the numbers 0, 10, 50, and 100. The amount of time
subjects kept their hands in the water was also recorded.
Participants were informed that the purpose of the experiment was
to provide information about the nature of pain but were not told of the

GALIN AND THORN

184

focus

facial

expressions. Subjects were alone in the room, but were

they were being videotaped.
Participants' facial expressions were videotaped in four conditions:
(a) baseline (the subject placed the hand in room temperature water for
two minutes); (b) genuine pain (standard
cold-pressor procedure); (c)
masked pain (standard cold-pressor procedure but S instructed to
express as little discomfort as possible); and (d) posed pain (baseline
procedure, but S asked to pose an expression of pain). The masked and
posed conditions were counterbalanced for order of presentation
across
subjects. A completely counterbalanced design was sacrificed to
ensure that the
genuine pain condition represented spontaneous
behavior (Lanzetta, Cartwright-Smith, & Kleck, 1976).
Videotapes of 15 male and 15 female participants were selected
randomly for Tape 1. The remaining segments were used for Tape 2.
The videotapes of the conditions were edited so that the tapes
contained four 20-second segments of each subject, one segment from
each of the baseline, posed pain, masked pain, and genuine pain
conditions. For the genuine and masked conditions, the segment began
25 seconds before the subject withdrew their hand (either because they
quit or because the 5-minute ceiling was reached). The 20-second
baseline and posed segments began after one minute of filming. The
on

informed that

order of the segments on the stimulus tape was randomized, with the
limiting condition that no more than two segments of the same subject
would be

presented consecutively.
were two
experienced FACS analysts who were blind to
the pain conditions appearing in each segment. Prior to coding the
videotapes, they demonstrated their expertise in the FACS by passing
the final test developed by Ekman and Friesen (1978). One coder
identified the AUs in every segment on Tape 1 using FACS. The other
coder scored 25% of the data to provide a reliability measure. Using an
occurrence
agreement formula, intercoder reliability was .83. Occur
rence
agreement was defined as: agreements of occurrence divided by
agreements plus disagreements of occurrence multiplied by 100.
The coders

RESULTS

appearing at least 17 times in the videotape segments were

analyses. In addition, AUs with similar muscle movements
and appearance changes were combined (Craig & Patrick, 1985). As
expected on the basis of prior research, a multivariate analysis of
variance demonstrated that the Action Units displayed on the tapes
Action Units

used in the

185

PAIN AND FACIAL EXPRESSIONS

differed

7.73, p < .05;

according to conditions; brow lower, F(l,19)
< .01;
corner
F
13.35,
p
lip
pull, F(l,19)
tighten, (1,19)
5.21, p < .05; dimpler-lips stretch, F(l,19)
8.49, p < .01; lips part,
5.55, p < .05; lips tighten, F(l,19)
9.30, p < .01; jaw drop,
F(l,19)
4.58, p < .05; eyes closed-blink, F(3,58)
10.93, p < .0001.
F(l,19)
more brow lower, cheek raise-lids
Significantly
tighten, lips tighten,
and eyes close-blink occurred in the posed condition. The baseline,
genuine, and masked conditions did not differ significantly from each
other in terms of the frequencies of these movements. The posed and
genuine conditions yielded significantly more lip corner pull than the
baseline condition. The masked condition did not significantly differ
from the posed, genuine, or baseline conditions in the frequency of lip
corner
pull. Significantly more dimpler-lips stretch, lips part, and jaw
drop also occurred in the posed condition than in the masked and
baseline conditions. The genuine condition did not significantly differ
from the posed, masked, or baseline conditions in terms of these
variables. Means used in the pairwise comparisons are listed in Table 1.
Since heterogeneity of variance was highest in the posed condition,
and because identification of differences among genuine pain, masked
pain, and baseline was necessary in order to prepare the training
package used in Study 2, an additional repeated measures MANOVA
was
performed without posed pain. Cheeks raise-lids tighten (F(l,29)
5.40, p < .05), lip corner pull (F(l,29) 5.61, p < .05), dimpler-lips stretch
(F(l,29) 4.96, p < .05), and lips part (F(l,29) 4.78, p < .05) distinguished
among the conditions. Lips part and dimpler-lips stretch occurred
significantly more often in the genuine condition. The masked and
baseline conditions did not differ significantly in the frequency of these
movements. In addition, significantly more cheeks raise-lids tighten
and lip corner pull occurred in the genuine condition than in the
baseline condition. The masked condition yielded a trend toward more
lip corner pull than the baseline condition (p < .10). Baseline yielded a
trend toward more lips tighten than the masked condition (p < .10).
Means used in the pairwise comparisons are listed in Table 1.
=

cheeks raise-lids

DISCUSSION

predicted, a subset of action units distinguished among the

(i.e., brow lower, cheeks raise or lids tighten, lips tighten,
close
or blink, dimpler or lips stretch, lips part, jaw drop, and lip
eyes
corner
pull). All of these movements were displayed more during
posed pain than baseline. Genuine pain yielded more dimpler or lips
As

conditions

GALIN AND THORN

186

TABLE 1. Means for Pattern of Action Units

as a

Function of Condition

TUKEY

CONDITION

MEAN

SD*

GROUPINGb

TUKEY
GROUPING^

Action Unit 4 Brow Lower

Posed

.34

.70

Genuine

.10

.36

Masked

.03

.18

No

.02

.13

pain

Action Unit 6-7 : Cheeks Raise-Lids

Posed
158
Genuine
Masked
No

pain

Action Unit 12:

Lip

Tighten
2.57

.51
.27

1.15
.74

A,B

.03

.18

Corner Pulld
.37
.29

.66

Genuine

.53

Masked

.20

.45

A,B

A,B

.22

Posed

No

.05

pain

Action Unit 14-20:

Dimpler-Lips

Stretch

Posed

.53

.70

Genuine

.34

.63

A,B

Masked

.10

.36

No

.14

.39

pain

Action Unit 17 Chin Raise

Posed

.23

.07

.54
.25

Genuine

Masked

.05

.22

No

.05

.22

pain

Action Unit 23

Lips Tightend

Posed

.36

66

No

pain

.12

Genuine

.05

.38
.22

.00

.00

Masked
Action Unit 251

Lips

Part

Posed

.54

.89

Genuine

.41

.77

A,B

Masked

.17

46

No

.15

.45

pain

Action Unit 26:

Jaw Drop

Posed

.46

Genuine
Masked

.24

.75
.63

A,B

.15

.52

No

.12

.42

pain

Action Unit 43^15:

Eyes

Close-Blink

Posed

5.30

3.09

Genuine

3.68

2.47

Masked

3.81

3.01

No

3.29

2.27

pain

Action Unit 1-2 : Inner and Outer Brow Raise

Posed

44

.89

Masked

.32

.93

Genuine
No pain

20

.80
.47

.14

187

PAIN AND FACIAL EXPRESSIONS

TABLE 1. Means for Pattern of Action Units

CONDITION

Genuine
No pain
Masked
Action Unit 24
Posed

Tongue

Lip

(continued)

TUKEY

TUKEY

GROUPINGb

GROUPING'

.20

.55

.19

.57

.07

.03

.25
18

.27

.49

.20
10

.52

.30

10

.36

Out

Press

Masked
Genuine
No

Function of Condition

SD"

MEAN

Action Unit 19:

Posed

as a

pain

Action Unit 41: Lids;

Droop

Posed

.46

.45

Genuine

24

.81

Masked

.15

.56

No

.12

.34

*SD

pain
Standard deviation.

bPost-hoc Tukcy pairwise comparisons for posed, genuine,

Means with the

letter

no

pain, and masked

conditions.

significantly different.
cPost-hoc Tukcy pairwise comparisons for genuine, no pain, and masked conditions only (Posed
condition is removed from analysis).
Means with the same letters are not significantly different
Comparisons of means for masked and no pain conditions yield a trend toward significance (y < .10).

stretch and

same

are

not

lips part than masked pain and baseline and also more lip
pull and cheeks raise or lids tighten than baseline (in analysis
with genuine pain, masked pain, and baseline only).
Although there is overlap in the facial movements associated with
pain between this and other investigations, variability between studies
is also evident. For example, in Craig and Patrick's (1985) experiment
and in the present study, cheeks raise-lids tighten, lip corner pull, and
lips part occurred more frequently during cold-pressor exposure than
during baseline. On the other hand, upper lip raise, jaw drop, and eyes
close-blink occurred significantly more often in genuine pain than
baseline in only the Craig and Patrick (1985) study.
It is possible that the videotape segments selected for coding in the
two studies resulted in the differences in action units. The present study
used a segment just prior to quit-point. This segment was selected
because our observations during pilot work suggested that subjects
generally reported the greatest pain intensity and appeared to be most
expressive at quit-point. In addition, we avoided using the first 20
seconds of the videotape procedure (one of the segments used by Craig
corner

GALIN AND THORN

188

& Patrick,

1985)

because

wanted to eliminate other

expressions
orienting behavior.
It is also possible that the participants' awareness of the videotaping
procedure inhibited their expression of pain during the genuine condi
tion in the present experiment. Kleck et al. (1976) demonstrated that
individuals control their facial expressions more when they are ob
served than when they are alone. Yet, participants in several other
investigations (e.g., Craig et al., 1991; Craig & Patrick, 1985; Patrick et
al., 1986) were also informed that they were being videotaped and still
exhibited a variety of facial movements in response to noxious stimula
tion. The variations found across experiments suggest that facial ex
pressions of pain are influenced by a number of variables.
On'y two studies have compared genuine pain, masked pain, posed
pain, and baseline (the present study and Craig et al., 1991), and they
concomitant with

pain,

we

such

as

startle response

suggest similar conclusions about

simulation. In both

of

the facial movements associated with

studies, participants
and

or

were

capable

of

masking

varied and intense facial

expressions
pain,
they displayed
activity when posing pain than in the other conditions. Brow lower and
cheeks raise occurred more frequently in posed pain than genuine pain
in both studies. Thus, it appears that facial expressions of masked and
posed pain can be described using FACS. It remains unclear, however,
whether observers can be trained to distinguish among genuine,
masked, and posed pain displays.
more

STUDY 2
The purpose of

Study 2 was to determine whether training, using either

repeated presentations of the taped segments of the different pain
expressions (masked, posed, genuine) or using those constellations of
facial action units found to distinguish among conditions, is more
useful than a no training condition in improving accuracy in detection
of simulated expressions of pain.
It was expected that judges' accuracy in distiguishing genuine,
masked, and posed pain on a pretraining task (Trial 1) would not differ
significantly across groups. Groups who received either facial move
ment training based on FACS plus limited feedback training or
feedback only training were expected to improve in Trial 2, with the
greatest increase in accuracy occurring in the facial movement training
group. The no training control group was not expected to improve
significantly in Trial 2.
All subjects were expected to be more accurate in recognizing posed

189

PAIN AND FACIAL EXPRESSIONS

pain than

other

accurate

in

pain states. It was expected that judges would be more

detecting genuine and masked pain in subjects who
demonstrate low pain tolerance, because these participants were
expected to be the most expressive. Subjects in the masked condition
who had low pain intensity ratings when they withdrew their hands
from the water were expected to be successful in masking their
discomfort, and thus, the judges were expected to believe that they
were

not in

pain.

METHOD

female

psychology students, tested in groups of four to eight,

judges in Study 2. They viewed the same videotape used in
Study 1. Accuracy in labeling the four conditions (genuine pain,
masked pain, posed pain, and no pain) on the videotape segments
served as the dependent variable. Accuracy was determined by a
frequency count of the number of videotape segments correctly
identified during no pain, genuine pain, masked pain, and posed pain.
Accuracy was calculated separately for the 15 male and 15 female faces
on the videotape. Thus, perfect
accuracy would yield a score of 15
correct for each condition and gender, and chance levels of accuracy
would be at 3.75 segments labeled correctly.
The judges were assigned randomly to a training group (control,
facial movement training plus limited feedback training, or feedback
only training) and trainer. The primary experimenter (Trainer 1) and
an advanced undergraduate psychology student (Trainer 2) served as
the trainers. Trainer 2 was blind to the hypotheses of the study. Each
trainer presented information to one half of the judges in each of the
three judging conditions.
First, all judges viewed Tape 1 (see Study 1) without audio accompa
niment. Following each of 120 segments, judges had five seconds to
indicate whether no pain, posed pain, masked pain, or genuine pain
was portrayed.
Sixty-six
served

as

Next, the groups received either the control

or one

of the

experimen

Following their viewing of Tape 1, control group

judges watched videotapes that discussed the nature and treatment of
pain. Judges in the feedback training group viewed Tape 1 again (120
total segments) and were told which condition (no pain, posed,
masked, or genuine) was portrayed in each segment of videotape.
Judges in the facial movement training group received a training
package compiled by the experimenter, which described the facial
tal interventions.

GALIN AND THORN

190

expressions characteristic
derived from

of

genuine, masked, and posed pain

as

1.

Study
Specifically, the training provided

to the facial movement training

had
three
components. First, the trainers presented detailed
group
of
the
descriptions
changes in the face associated with masked, posed,

and

genuine pain. Photographs

from the FACS manual

illustrate these facial movements. Next, the

were

used to

experimenter taught

each

and
judge
on her own face. Finally, the judges viewed segments
genuine pain
from Tape 1, during which they were given feedback regarding which
condition was displayed. In order that the training time provided to all
groups would be equivalent, the total number of segments viewed by
the facial movement training group was limited to 20. Thus, subjects in
the facial movement training group were given only limited feedback
compared to Ss in the feedback training group.
Following a 10-minute recess, all judges viewed Tape 2, which
contained the videotape segments of the 15 male and 15 female
participants from Study 1 that were not included on Tape 1. After each
20-second segment on Tape 2, judges had five seconds to indicate
whether no pain, posed, masked, or genuine pain was displayed.
make the movements associated with masked,

to

posed,

RESULTS
ANALYSIS OF VARIANCE

of variance (ANOVA) was used to assess the effects

(no pain, posed, masked, and genuine), trial (1 and 2), and
training group (control, feedback, facial movement) on judges' accu
A 4

analysis

of condition

labeling the videotape segments. While other variables in the

study (gender of face on videotape and trainer) did interact in small
ways with the condition, trial, and training group variables, relative to
the effects of these variables, the differences were only slight and the
conclusions did not change. Therefore, only the 3-way interaction is
reported.
The condition x trial x training interaction was significant, F(6,387)
5.45, p < .0001. Subsequent Tukey tests revealed that groups did not
significantly differ in Trial 1. (Means reported below are collapsed
across
gender of videotape subject.) In Trial 2, the control group (mean
6.89, SD 2.27) and the facial movement training group (mean 6.84,
SD
2.11) were more accurate in labeling the no pain segments than
was the feedback
training group (mean 5.64, SD 1.69). In addition,
racy in

PAIN AND FACIAL EXPRESSIONS

191

the feedback training group (mean 8.31, SD

2.49) was more accurate
than the facial movement training group (mean
7.11, SD
2.06) and
control group (mean
5.91, SD
2.11) in labeling the posed segments
=

in Trial 2. The facial movement

the control group

training
facial

these

on

group (mean

movement

training

training

group

accurate

than

2.18) was more accurate than the

(mean 3.30, SD
1.80) and control
1.84) in labeling the genuine segments in
6.32, SD
1.85) was more
group (mean
=

group

3.09, SD

was more

segments. Furthermore, the feedback

4.39, SD

group (mean
Trial 2. Finally, the control
-

labeling the masked segments in Trial 2 than were the

feedback training group (mean
4.96, SD
1.74) and facial movement
accurate in

training group (mean 4.73, SD 2.11) (see Figure 1).

Tukey comparisons within training groups (control, feedback, facial
action) across conditions revealed the following: In Trial 1, in all three
=

groups, subjects were more accurate judges of masked, posed, and no

pain conditions than of the genuine condition. The masked, posed, and
no

pain

conditions did not differ in terms of

2, control Ss showed the

for all Ss in Trial 1

same

(masked

trained Ss demonstrated

genuine
a

masked

no

pain

pattern

posed

judges'

of accuracy
no

pain

>

accuracy. In Trial
described above

as

genuine).

Feedback-

pattern of accuracy whereby posed >

in Trial 2. Facial Action-trained Ss showed

pattern of accuracy whereby

no

pain

posed

>

masked

genuine

in

Trial 2.

significant main effect for condition was found,

Judges were significantly more accurate in
labeling the posed and no pain segments than the masked and genuine
segments. They were also significantly more accurate in labeling the
masked segments than the genuine segments.
As

hypothesized,

F(3,387)

111.64, p

<

.0001.

MULTIPLE REGRESSION
was
expected that judges would be more accurate in detecting
genuine and masked pain in subjects who report high pain intensity at
quit-point and demonstrate low pain tolerance. To test this hypothesis,
a simultaneous
regression procedure was used to test the interaction
between final pain ratings and pain tolerance. The number of judges
who correctly labeled the segment was the dependent variable.
For the genuine segments in Trial 1 (Tape 1, viewed prior to
training), the interaction was not significant, F(3,26) .05. The test of
final pain intensity + tolerance) was signifi
the overall model (DV
cant, with an R2 of .320, p < .01. For the genuine segments in Trial 2
(Tape 2, viewed after training), the interaction was not significant,

It

GALIN AND THORN

192

;-

,J>

.sea

i-

'-

Genune

M35'rJ

Condition

<
c

as

4-

"

3r

Baseline

Posed

rJlas^ ed

i^

Genuine

Condition

Group
Croup
Group

A
B

Control group
Feedback training gToup
Facial movement training group

FIGURE 1. Mean accuracy

F(3,26)

as a

function of group, condition, and trial.

.484. The test of the overall model

was

significant,

with

of .300, p < .01.

For the masked segments, in Trial 1, the interaction
significant, F(3,26) .210, nor was the overall model (R2
=

an

R2

was

not

.069).

On

Trial 2, although the interaction did not reach statistical significance, it

2.73. The test of the
showed a trend in the expected direction, F(3,26)
=

overall model

was

not

significant (R2

.459).

PAIN AND FACIAL EXPRESSIONS

193

DISCUSSION
EFFECTS OF THE INTERVENTIONS

Relative

training, feedback training enhanced accuracy in

identifying posed and genuine pain, whereas facial action training plus
limited feedback enhanced accuracy in identifying posed pain only.
The feedback training group saw 30 examples of each of the
conditions (120 total segments) with feedback regarding condition.
Simple exposure (with feedback) to numerous samples of posed and
genuine pain may have been sufficient to provide judges with pictures
of what these pain states look like and led to improvement in Trial 2.
Apparently, viewing numerous examples of no pain and masked pain
does not lead to increased accuracy. Perhaps this is the case because the
cues that
help to identify no pain and masked pain are not as salient.
In Trial 2, judges who received facial action training performed
better than judges in the control group only when labeling posed pain.
This is not surprising, since judges in the facial action training group
were
provided with a better description of posed pain than of the other
conditions. A more precise description of the characteristics of posed
pain as compared to the other conditions was possible in the training
program, because Study 1 revealed a group of AUs found significantly
more
frequently in posed pain than in the other conditions. The
differences between masked pain, genuine pain, and no pain were less
distinguishable.
The overall lack of improvement in the facial action training group in
Trial 2 relative to Trial 1 is inconsistent with Ekman and Friesen's study
(1974), which demonstrated that trained FACS coders were more
accurate in distinguishing honest and deceptive facial behaviors than
were untrained observers. However,
judges in the facial movement
were not
comparable to Ekman and Friesen's (1974)
training group
who
were "experienced facial analysts" with hundreds of
participants
hours of practice measuring facial movements. By contrast, judges in
the facial movement training group were undergraduate students who
had less than one hour of training in recognizing facial movements.
During the training, a great deal of information was presented to the
students, and the material may have been too complicated for them to
grasp in one short training session. Thus, it is possible that these judges
did not receive enough exposure to the facial movements characteristic
of genuine and deceptive pain states and did not have enough time to
practice the skills involved in detecting deception.
to

no

GALIN AND THORN

194

In

addition, the training package may not have been comprehensive

enough. Emphasis on microdisplays, asymmetry in simulated facial

expressions,
improve in

identify

or

other

Trial 2.

deception
Providing

the conditions

in the

was

cues

may have

helped

the

judges

to

the

judges with additional ways to

needed because the pattern of AUs found

did not

present study
clearly
masked, and no pain conditions.

distinguish

among the

genuine,

DIFFERENCES AMONG THE CONDITIONS

hypothesized, judges identified posed pain with greater accuracy

genuine pain and masked pain. This is consistent with LaRusso's
(1978) demonstration that subjects were better at judging posed than
genuine facial expressions. An additional finding of Study 2, not
previously investigated, is that judges correctly recognized subjects in
no
pain more frequently than genuine and masked pain, and they were
more accurate in
labeling masked pain than genuine pain. Since the
of
the
no
majority
pain segments reveal minimal facial movement, they
apparently clearly represent no pain.
As

than

ACCURACY OF

JUDGMENT COMPARED TO GUESSING

Accuracy of judgments was greater than chance for all conditions,

except genuine, both before and after training (see Table 2 for a
contingency table of "hits" and "misses" for each condition). Because
many of the subjects in genuine pain showed little facial expression,
genuine segments may be the most difficult to label accurately. In fact,
in Trial 1, the genuine segments were judged less frequently than
would occur at chance levels of guessing. Before training Ss were using
a
strategy that seemed to involve guessing "masked" or "no pain" a
greater proportion of the time. In both the feedback and facial action
training groups, Ss tendency to "over guess" the masked and no pain
categories was corrected with training. Nevertheless, the feedbacktrained group was the only training paradigm that increased the
identification of genuine pain at greater than chance levels in Trial 2.
PAIN INTENSITY,

TOLERANCE,

AND ACCURACY

predicted that judges would be more accurate in detecting

genuine pain in subjects who demonstrated low-pain tolerance and
It

was

195

PAIN AND FACIAL EXPRESSIONS

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GALIN AND THORN

196

high-pain intensity. Although this interaction was expected, results of

the analysis showed that for the genuine condition, although pain
intensity and tolerance times were important predictors of accuracy,
their relationship to each other with respect to the dependent variable
was not
clearly interactive. It appears that individuals who did not last
long may have been more expressive of pain, and likewise, individuals
who had relatively high pain intensity ratings were also more expres
sive of pain (and thus easier to detect).
It appears that while pain intensity and tolerance time are both
important variables in measuring coping with pain, they do not
necessarily act in a simple interactive way when it comes to improving
accuracy of labeling genuine pain. Given the limited number of
subjects available per analysis, it would be interesting to attempt to
replicate these results with a larger N.
For the masked segments (in Trial 1 only), tolerance time predicted
judges' accuracy. Subjects who lasted a relatively short amount of time
were
judged to be in the masked condition with more accuracy than
were
subjects with high tolerance. Subjects who had low final pain
ratings were successful in masking their pain. Judges believed that
these participants were not in pain.
CONCLUSION
It appears unlikely that clinicians can be provided with
facial movements that consistently accompany posed,

masked
can

be

pain.

checklist of

genuine,

and

On the other hand, information about facial behaviors

provided

that

an

that

posed pain

to

clinicians, which may alert them

individual is
is

masking

more

posing pain.

or

vivid

or

to the possibility
example, the finding
genuine pain may be

For

intense than

useful to clinicians.
Information about nonverbal

cues to
deception may be used to
that target individuals for whom closer
observation and assessment would be warranted. While this would be

develop screening procedures

an

expensive undertaking

in terms of the

limit the overmedication of

some

use

of clinician time, it may

might affect the

individuals and

payment of disability claims. If screening suggests the possibility of

deception, more in-depth assessment might include a precise behavior

analysis (Keefe & Block, 1982), as well as an assessment of secondary
reinforcers (Fordyce, 1983). The clinician who is relatively confident
about whether the patient is genuinely in pain or is distorting pain
behaviors may be more effective in treating that individual, since the

197

PAIN AND FACIAL EXPRESSIONS

clinician

can

should be

better gauge the amount of attention and medication that

provided

to

pain complaints.

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