Facial expressions of pain may be useful not only for communication, such as soliciting care from others. They may have a more fundamental, direct use as constituents of writhing pain behavior patterns, functioning to remove pain stimuli or to suppress pain sensations:

pain facial expressions are part of more encompassing pain behaviors such as stretching and throwing the head backwards, and bending the head and torso. They accompany overall tensing of the limbs, clenching of the fists, or other spasmodic movements. All these behaviors can be seen as constitutive of an overall pattern of writhing or squirming. Facial expressions of pain appear to be part of a rather primitive pain response of global flexor contraction, which would seem to serve the function of removing the painful stimulus. It might also serve to diminish the pain sensation by diverting attention or by suppressing the pain sensations. Clenching one’s teeth illustrates that latter function, as does digging one’s nails into one’s palms (Frijda, 2002).

Problems with this view:

1. No such whole body behaviors have been reported in the literature specific to pain in humans or in laboratory or domestic animals (Williams, 2002).

2. Various behaviors are described on infant and child acute pain, one of which is the apathetic or tense immobility (freezing) often ignored in children in pain. Whole body responses to pain do not always involve flexor contractions; hence, facial expressions of pain need not accompany patterns of body or limb movement (Williams, 2002).

3. Mere correspondence between the faces of muscular effort and pain is insufficient to establish direct use as the fundamental function of pain facial displays.

4. It seems conceivable that facial activity accompanying muscular effort could be of communicative value. The view under consideration assumes a sharp break between pain behaviors that have an indirect communicative function and pain behaviors that have a direct protective (pain-management) function (Sullivan et al., 2004). Facial expressions of pain can communicate distress to observers and could provide immediate protection by warding off or eliminating threats, for example, from those who might be violent. But they do not function to protect the face and, we argue, do not contribute to the escape or suppressive functions of contortions and tensing in the body. The view that pain facial expression is of direct use in global homeostatic processes therefore neglects the communicative functions of facial displays. By contrast, behaviors such as writhing, tensing, rubbing or holding can serve a pain management function by protecting the affected body area or by minimizing pain through mechanisms associated with tactile stimulation or increased circulation. Note that even these displays can communicate considerable information to the astute observer. The fidelity with which expressions of pain specifically signal communicative or management functions is limited. Pain displays can assimilate both protective and communicative functions. If this is correct, the explanatory accounts that partition nonverbal pain expression into unambiguous communicative and management functions fail to acknowledge the indeterminacy of facial displays of pain.

5. As an interlocutor between the self and other persons, the human face provides an embodied representation of pain to engage others in care provision (Cole, 2001). The object of effective care is not the writhing or tensed body, but the person whose body it is. As Wittgenstein (1958) put it, ‘…if someone has a pain in his hand, then the hand does not say so, and one does not comfort the hand, but the sufferer: one looks into his face’.


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