Decoding Pain from the Facial Display of Patients with Dementia: A Comparison of Professional and Nonprofessional Observers

Abstract

Patients with dementia, whose ability to provide self-report of pain is often impaired, are in crucial need of observers who can detect and judge the patients' pain-indicative behaviors appropriately, in order to initiate treatment. The facial display of pain promises to be especially informative for that purpose. The major aim of the study was to investigate, whether facial pain displays of patients with dementia can be as easily interpreted as facial displays of individuals without cognitive impairment and whether nurses have learned-through their professional training and work experience-to better read the facial display of pain compared with a control group. For that purpose, 21 nurses and 21 age-matched controls watched 120 video clips, showing facial expressions of young and old individuals with and without dementia during slight and moderate noxious stimulation. After each clip, subjects were asked to rate how much pain the observed individual might have experienced. The observer ratings did not differ between nurses and controls as regards pain level and concordance. On the other hand, level and concordance of the pain judgments were strongly influenced by the cognitive status, age, and gender of the observed individuals, with higher and more accurate pain judgments for older and for female individuals. Without further contextual information, "professional" observers do not show a superior competence in inferring pain in others by reading their facial display. Therefore, additional training seems needed to reliably prevent that pain goes unnoticed in patients with dementia.