Social context affects observers' weighting of facial and verbal cues in estimating another’s pain

Observers estimate pain using multiple cues, such as verbal report or facial expression, and weighting them depending on social context. Evolutionary Social Contract Theory proposes that observers assess pain within a framework of cooperative exchanges where benefits such as care should be given only if pain is present, leading to a sensitivity to pain cues and adjustment of pain intensity estimates. Conflicting verbal and behavioral cues may affect observers' judgment difficulty, and observer characteristics may affect pain estimates. 106 participants were cued into different social contexts varying in the possibility of 'social cheating'. Next, participants were provided with verbal reports and facial expressions of women in pain based on which they had to estimate pain intensity and rate judgement difficulty. Last, participants had to judge the likeability of the women they had seen in the videos. When 'social cheating' was possible, more weight was given to facial cues and less weight to verbal cues when estimating pain. Conflicting verbal and facial pain cues were rated more difficult to judge. Women who had shown pain in their faces were perceived as less likeable. Neither observers' empathy nor their pain catastrophizing was associated with their pain estimates. The study highlights the effect of social context on pain estimates, and the dilemma associated with interpreting inconsistent verbal and facial cues of people in pain: verbal report is considered more easily manipulated and therefore taken less seriously, while the expression of facial pain elicits more negative judgements of the person with pain. PERSPECTIVE: This article shows that social context can shape how people judge others' pain. Results highlight that when 'social cheating' is possible, observers give more weight to facial expressions than to verbal reports. Awareness for these effects should be raised in health care professionals and support offered.