pain

PAIN CUE

And when you're slapped you'll take it and like it. --Sam Spade (growling, to Joel Cairo), The Maltese Falcon (1929)

Sign. A visible muscle contraction of the face or body in response to unpleasant sensations of suffering due to physical injury, trauma, or emotional distress.

Usage. Painful touches to the skin, e.g., may excite the midbrain's reticular area enough to produce a visible response, such as a facial wince or a frown. A casual touch from someone we dislike can produce the same response (because physical and psychic pain cross paths in Nonverbal World).

Anatomy. Pain may show in a. narrowed or closed eye openings with b. raised cheeks (as the eye-orbit muscles contract); c. eyebrow-lowering with d. wrinkling on the bridge of the nose (as corrugator and associated muscles contract); and e. a raised upper-lip with f. wrinkling at sides of the nose (as levator muscles contract; Prkachin and Craig 1995).

Chest pain. 1. "A clenched fist to the centre of the sternum conveys the gripping quality of the pain (Levine's sign . . .) while a flat hand describes the sensation of crushing heaviness . . . . Tight band-like chest pain may be represented by a movement of the palmar surfaces of both hands laterally from the centre of the chest . . ." (Edmondstone 1995). 2. "This study has shown that if patients admitted to a coronary care unit illustrate the nature of their chest pain by placing a clenched fist [Levine's sign] or a flat hand on the sternum, or by drawing both palms laterally across their chest, there is a 77% chance that their pain is due to cardiac ischaemia. If they do not use these signs there is an even chance that their pain is non-ischaemic. These signs are not discriminatory, but a positive response lends support to a diagnosis of cardiac ischaemia " (Edmondstone 1995).

Culture. In the Middle East, patting the chest over the heart with the palm of the right hand means, "I need help." "The action mimes a fast heartbeat, implying that the gesturer is in a state of panic" (Morris 1994:148).

E-Commentary: "This summer I worked around a burn hospital and happened to see a chart with the 'faces of pain' on it. Because the Shriners Hospitals receive patients from all around the world, language is sometimes a barrier; however, this poster is in each room showing different levels of pain depicted in the facial expression. I have been looking for that poster on the internet but cannot locate it." Debbie (10/27/00 3:00:29 PM Pacific Standard Time)

Wong-Baker FACES Pain Rating Scale. "The success of the Wong-Baker FACES Pain Rating Scale has far exceeded our expectation. We have received numerous requests for the scale and for various types of information, one of them being the development of the instrument. In 1981, Donna Wong, a nurse consultant, and Connie Morain Baker, a child life specialist, were working in the burn center at Hillcrest Medical Center, Tulsa, OK. We frequently saw children who were in pain, and because of their young age, had difficulty communicating how they were feeling. Many times their complaints and cries were misunderstood by the staff, and their pain was not effectively controlled. We believed that we would be able to assess their pain better if the children were given the proper tools to communicate with" (Wong-Baker Faces Foundation).

Neuro-notes. Mirror neurons: So-called "pain neurons" in the human brain's cingulate cortex fire when we are stuck by a needle. They also fire when we see someone else get stuck. "Thus, for these kinds of neurons, [also] known as mirror neurons, there is no boundary between the self and the other" (source: McGill University Web tutorial on the brain [http://thebrain.mcgill.ca/flash/i/i_12/i_12_cr/i_12_cr_con/i_12_cr_con.htm], accessed Dec. 28, 2012).

See also SPECIAL VISCERAL NERVE.