How pain affects your facial expression

In Pain Management

Much of our world is socially and culturally constructed, from our goals to the language we use and experiences we consider everyday life. However, a few universal experiences can be shared cross-culturally and at every age in life. One of those, unfortunately, is pain. 

We learn to express pain from a very young age. Children are reliant upon their caretakers to address and relieve sources of pain, so they cry and frown to shape the actions of the adults around them. Crying and laughing are a child’s most essential tools and stay with us as we grow into adults. This is why pain is one of the most accessible feelings to communicate without words and automatically draws the attention of those around us. 

Expressions of pain are often used in classical paintings because they draw the viewer in and are easy to read without any other understanding context of the artwork itself. The facial expressions in a state of pain are most recognizable and captivate the viewer with empathy and anguish. However, it is not just artists interested in the efficacy of facial expressions to communicate pain. Scientists of the earliest decades have been documenting and trying to understand how to quantify the individual experience of pain. 

Charles Darwin studied facial expressions of pain in humans and across species, noting that:

“…[in pain] the mouth may be closely compressed, or more commonly, the lips are retracted, with the teeth clenched or ground together…the eyes stare wildly as if in horrified astonishment.”

Later in scientific history, researchers Chapman and Jones used heat tolerance to observe common facial expressions linked to pain. They noted a specific eyelid movement that was nearly impossible to prevent: 

“[t]he pains reaction end-point was readily observed by watching for the beginning contraction of the eyelids at the outer canthus…Only a small number [of participants] could make any appreciable alteration…even when asked to keep from wincing as long as possible.”

Therefore, it is the eyes in which we most commonly see the pain in others and express it ourselves. However, there are many other ways to communicate pain without using words, some voluntary and some involuntary.

Other common expressions of pain include: 

  • Burrowing of brow 
  • Eyes squeezing 
  • Nose wrinkling and nostrils flaring
  • Lips either become tight or mouth opens
  • Cheeks raising
  • Chin quivering

We recognize these expressions in others, but quantifying them is a different story. The closest physicians have been able to come to clinical practice is the pain chart, which uses visual representations and a numeric rating system to categorize pain. However, this is still largely subjective and can only qualify pain based on self-reporting coupled with symptoms. 

Your doctor uses these expressions and your self-reported symptoms to understand your pain. The more information you can give them, which is why we encourage you to learn how to communicate your pain with a physician. 


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