High levels of vicarious exposure bias pain judgments.

UNLABELLED: The present study evaluated the effects of exposure to facial expression of pain, on observers' perceptions of pain expression. Participants were undergraduates shown brief video clips of the facial expressions of shoulder-pain patients displaying no pain or moderate pain. Participants were randomly allocated to either a high preexposure condition in which each clip was preceded by 10 other clips showing strong pain or a no-exposure control. On each test trial, participants indicated whether they thought the person they saw was in pain or not. Data were analyzed using signal detection theory methods. High prior exposure to pain was unrelated to sensitivity to pain expression, but did significantly diminish the likelihood of judging the other to be in pain. Results are discussed in terms of their implications for pain judgments of health-care professionals, adaptation-level theory, and the psychophysical method of selective adaptation. PERSPECTIVE: This paper provides an experimental demonstration that, when people have large amounts of exposure to others' expressions of pain, their estimation of others' pain is reduced. The findings offer 1 explanation for the widely observed underestimation bias in pain judgments and may suggest ways of changing it.

Temperament and pain reactivity predict health behavior seven years later.

OBJECTIVE: Minor illnesses and major diseases are affected by individual, environmental, and social factors. We sought to determine if children's temperament and pain reactivity (individual response styles) measured in kindergarten are related to future health behavior. METHODS: Seven-year follow-up measures of health behavior were gathered in 42 children (mean age M = 11 years) who participated in a previous study of pain reactivity and somatization. Current health behavior was compared with children's pain reactivity and temperament measured in kindergarten. RESULTS: Pain reactivity in kindergarten was associated with children's self-reports of somatization 7 years later, independent of their temperament. Temperament was related to children's self-reports of somatization and to maternal reports of health care utilization and psychosocial health status. CONCLUSIONS: Early response styles (i.e., heightened pain reactivity and difficulty adjusting) may indicate risk for increased health care utilization and poorer health and well-being later in childhood.

Children's memory for pain: overview and implications for practice.

UNLABELLED: Children's memories of painful experiences can have long-term consequences for their reaction to later painful events and their acceptance of later health care interventions. This review surveys research on children's memory for pain, emphasizing implications for clinical practice. Topics reviewed include consequences of children's memories of pain; the development of memory; differences between explicit (declarative, verbal, autobiographic) memory and implicit (nondeclarative, nonverbal) memory; and individual differences, situational, and methodologic factors affecting memories of pain. Methods to prevent the adverse consequences of remembered pain are addressed with reference to current research on editing or reframing memories. PERSPECTIVE: This review covers topics of value to clinicians providing care to children undergoing painful procedures. Specific recommendations are offered regarding the importance of acknowledging and assessing children's previous memories of painful experiences, the type of information that benefits children before and after procedures, and the most appropriate questioning strategies. It might be possible to prevent or reduce the adverse effects of memories of pain.

Pain reactivity and somatization in kindergarten-age children.

OBJECTIVE: To evaluate predictors of somatization and pain reactivity in childhood. METHODS: Facial expressions of children undergoing inoculation were scored for pain reactivity. Measures of temperament, pain experience, pain models, parental behavior, and parental ability to decode pain were examined for their ability to predict pain reactivity and somatization in a structural modeling analysis. RESULTS: Pain reactivity was associated positively with parental reports of their child's somatization. Child temperament, previous negative experiences with medical procedures, and maternal responses to their children's pain were positively associated with pain reactivity. CONCLUSIONS: Temperament and pain experience may play a role in children's pain reactivity, and reactivity may contribute to the development of somatization. Although the model that guided the analysis proved to be a reasonable description of the outcomes, several anticipated relationships were not significant. We discuss implications for a refined model of somatization and for early identification and prevention.