Pain communication through body posture: The many postures of pain

Pain is not just a sensory experience. Of course, there is a key biological element to pain, but there is also a much broader range of factors that may influence how we perceive threatening events and noxious stimuli and may feed into the pain experience. An important factor that influences our pain perception is the social context in which we experience pain; for example, the behaviour and reaction of people around us. Having friends or loved ones close by, who can offer help and support in painful situations, can help to alleviate pain, and can lead to faster recovery.

However, in order to be able to offer this kind of support, we as the person in pain have to be able to effectively communicate information about our pain experience to others. One important way in which we can communicate about our pain is through non-verbal behaviour. Non-verbal behaviour, is a broad term that refers to all the communicative actions and behaviours that we can engage in which do not involve words. Nonverbal behaviour generally communicates through three “channels”: facial expressions, vocalisations, and body postures. To better explain this, take happiness; when we are happy, we do not wander around telling others about our happiness constantly. Instead, we may smile, or laugh more readily, or walk with our heads held high. All these behaviours communicate happiness to others around us, without having to verbalise our feelings.

The same process is true for pain. We do not have to tell others verbally that we are in pain; instead they can use the behaviours that we adopt as cues to identify when we are in the midst of a painful experience. Facial expressions of pain are well documented, and generally take the form of a grimace, with teeth bared and eyes tight. Vocalisations, such as crying out, have also been found to communicate pain to listeners. There is also a lot of work which has looked into how pain influences our body posture; how we stand and move when in pain. There are pain behaviours, such as protectively holding injury sites and moving more cautiously, and these are well documented, but up until now very little research has considered whether these behaviours communicate information to observers. Our research aimed to examine this in more detail by looking at how well people recognise pain communicated through body posture.

To investigate this, we recruited actors and dancers, and asked them to adopt body postures that they believed would be pain-communicative. We filmed them adopting these postures, and, after some editing to keep all the videos the same length and remove facial expressions,we showed the videos to two groups of participants. The participants were asked to identify what was being communicated. The actors also performed postures for other expressions which can be communicated in body posture, including happiness, sadness, fear, anger, disgust, and surprise. The participants rated each video for how unpleasant or pleasant the actor’s experience seemed, and how intense their experience looked.

The data provided by the participants showed that people are very good at recognising pain body postures. In fact, participants were able to accurately identify pain postures in a little over 90% of cases. Pain was also rated as the least pleasant, most negative experience that participants saw actors experience, and it was rated amongst the most intense, second only to anger.

All of the postures which the actors provided were also coded using an objective coding system called the Body Action Posture Coding System (BAP, Dael et al, 2012). This allowed us to take a look at what postures and actions were consistently found in the pain communication videos. It seems that certain actions, most notably hand movements towards injury sites and movements that aim to diminish the overall profile of an individual, like bending the knees and holding the arms close to the body, are frequently present in postures that communicate pain. These actions may be the key cues we look for when identifying pain in others.

Overall, our findings show that we are able to communicate pain through body posture, and more importantly, that observers are able to understand this communication. This ability to recognise the pain of others with a high degree of accuracy underpins our ability to get others to help us; the point of any pain communication is, at least in part, to encourage others to help us, and it seems that body postures and pain behaviours are an effective way to get this message across.

About Joe Walsh

Joe WalshJoe Walsh is a final year PhD student based in the Centre for Pain Research at the University of Bath, and also works as a part time lecturer at Bath Spa University. He works with his supervisors, Dr Ed Keogh and Prof Chris Eccleston, on research which examines how we communicate pain through body posture, and individual factors which can influence this process. He previously completed a degree in Psychology at the University of Hull, before obtaining an MSc in Health Psychology from the University of Bath.

Reference

Dael, N., Mortillaro, M., & Scherer, K. (2012). The Body Action and Posture Coding System (BAP): Development and Reliability Journal of Nonverbal Behavior, 36 (2), 97-121 DOI: 10.1007/s10919-012-0130-0

Walsh J, Eccleston C, & Keogh E (2014). Pain communication through body posture: The development and validation of a stimulus set. Pain PMID: 25168671

Comments

  1. Joe,
    Thank you for the interesting summary of your research. I am curious what you think about the difference between protective and expressive behaviors (Sullivan, 2006). Do you feel such a distinction is warranted or do you feel that any posture adopted in a social domain has the potential to impart information to onlookers?
    Also, what do you believe is driving the gestures: thoughts, feelings, or rewards? As some of the previous comments have noted the behavior that is expressed on both the contextual situation one is immersed and a history of reinforcements. For example, to act “as if” is to behave in ways to expect certain types of reinforcements.

    Sullivan, M. J. L., Thibault, P., Savard, A., Catchlove, R., Kozey, J., & Stanish, W. D. (2006). The influence of communication goals and physical demands on different dimensions of pain behavior. Pain, 125(3), 270–7. doi:10.1016/j.pain.2006.06.019

  2. Of course one of the ways we communicate our pain experience to others is via body postures, which can be effective in gaining attentive responses from others but if utilised too much can also lead to observer fatigue and negative responses. I think too that persistent postural restrictions can act as a positive feed back loop for the individual in maintaining/ exacerbating the pain experience, “acting in pain” exacerbates the pain/suffering experience; we know that in other areas “acting as if” can change emotional and cognitive experiences, hence “acting as if” not in as much pain ( as far as is possible) can change the suffering experience.

  3. Jennifer Gait says:

    I wonder what message someone in pain is sending to themself via their body postures and pain behaviour. It would be interesting to see whether deliberately refraining from pain behaviour, including body postures, would actually help someone feel less, or no, pain. Thoughts and emotions would likely also have to be congruent with lack of pain, which might be a confounding factor, but you could try it both ways, with the person feeling the thoughts and emotions that go along with pain, or with them feeling thoughts and emotions that do not indicate pain.

    I am reminded of a woman in a pool program I go to, who has a congenital disability affecting her muscles, especially her legs, which causes her constant pain – she needs braces and a walker to move. She has two grandchildren, born within two months of one another, and quite frequently looks after both of them together. One day she said to me: ‘When the grand-kids are over, I feel no pain.’ I imagine that is because her positive emotions when she is with the toddlers are so high that she is not even generating pain.