Perceiving Pain in Others: Automatic and Controlled Mechanisms

Recent developments in clinical, cognitive, and behavioral sciences as well as in social neuroscience can provide new perspectives on our understanding of different forms of pain expression and the social reactions of observers to various types of pain expression. Studies indicate that pain expression is governed by both automatic (unintentional, reflexive) and controlled (intentional, purposive) neuroregulatory systems. Reciprocal mechanisms in observers responsible for automatic (unintentional, reflexive) and controlled (intentional, reflective) reactions also are important. Observers appear more likely to display immediate visceral emotional reactions to unintentional, reflexive expression, whereas controlled expression characterized by purposive behavior appears more likely to elicit reflection on the nature and origins of the person's pain. This review summarizes research within the context of a theoretical model for understanding how pain is perceived in others. Perspective: People attempting to understand another person's pain may have access to the person's spontaneous behavioral reaction as well as verbal report and other purposive communications. The former instigates reflexive and emotional reactions, whereas the latter tends to be perceived as confounding expression of experience with response to situational demands. (C) 2010 by the American Pain Society