Pictured
Social communication model of pain
Kenneth D. Craig*
C linicians and researchers are challenged to understand the
dynamic interplay among biological, psychological, and
social determinants of pain. The social communication model,2,8
Decoding pain expression Displays of pain command the
attention of observers, leading to spontaneous neurophysiological
reactions,4 reflexive distress, reflective appraisal, and the
(Fig. 1), provides an inclusive framework for organizing and con- potential for empathy and clinical judgment.7,9 Experience
sidering these facets and their relationships. Understanding any with pain, professional histories, and personal characteristics,
episode of pain, acute or chronic, requires grasping the broad including biases, influence dispositions to attend, recognize, and
picture and details at biological, psychological, and social levels understand the experience of others.3,5
of analysis. The social communication model of pain specifies
necessary domains to be attended to in the education of re- Action The appraisal of pain drives decisions to deliver care.
searchers and practitioners.1,16 Clinicians with personal commitments, indifferent bystanders,
and enemies would be expected to react differently. Professional
Innovative features training and institutional best practices invariably constrain
(1) A painful event chronology is provided: episodes of pain service delivery.
unfold over time, involving status of the individual before
the event, perception of pain, personal expression, and Social, economic, and physical ecological contexts of
the appraisal and actions of observers, with each phase care delivery The contexts of community caring, professional
responsive to preceding events. Reciprocal, recursive, and standards of practice, institutional structures and policies, health
dynamic influences are acknowledged. Different colors are care delivery systems, the research enterprise, and political
used to attract attention to the importance of each phase. systems all have powerful influences on how people care for
(2) Social determinants of pain are explicitly acknowledged in others in pain.
human and nonhuman animals.10
(3) A clear distinction is made between historical and current References
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(a) Intrapersonal: people bring dispositions to react based 2014;120:12–4.
[2] Craig KD. The social communication model of pain. Can Psychol 2009;50:22–32.
on their biological, psychological, and social histories. [3] Craig KD, Versloot J, Goubert L, Vervoort T, Crombez G. Perceiving others in
(b) Current setting: the immediate social and physical envi- pain: automatic and controlled mechanisms. J Pain 2010;11:101–8.
[4] Decety J, Jackson PL. The functional architecture of human empathy. Behav
ronment within which pain is suffered has a powerful im- Cogn Neurosci Rev 2004;3:71–100.
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Healthcare professional reactions to patient pain: impact of knowledge about
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Timeline with illustrations of research [6] Goubert L, Vlaeyen JWS, Crombez G, Craig KD. Learning about pain from
others: an observational learning account. J Pain 2011;12:167–74.
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ways when in pain, for example, through biological priming or self-report and observational measures of pain: a communications model. Be-
hav Res Ther 2002;40:551–70.
adaptation, and trait-like dispositions, including fear of pain and [8 Hadjistavropoulos T, Craig KD, Duck S, Cano AM, Goubert L, Jackson P,
catastrophising.15 Pain prevention or amelioration strategies are Mogil J, Rainville P, Sullivan M, de C Williams A, Vervoort T, Dever Fitzger-
ald T. A biopsychosocial formulation of pain communication. Psychol Bull
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Smith JH. Pain assessment in elderly adults with dementia. Lancet Neurol
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Glick S, Ingrao J, Klassen-Ross T, LaCroix-Fralish ML, Matsumiya L, Sorge
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ethnic environments determines the meaning and affective MD, Craig KD, Mogil JS. Coding of facial expressions of pain in the laboratory
mouse. Nat Methods 2010;7:447–9.
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[14] Prkachin KM, Craig KD. Expressing pain: the communication and interpreta-
(eg, enhanced or suppressed) with considerable sensitivity to the tion of facial pain signals. J Nonverbal Behav 1995;19:191–205.
audience and social milieu.3,12 [15] Schiavenato M, Craig KD. Pain assessment as a social transaction: beyond the
“Gold Standard”. Clin J Pain 2010;26:667–76.
The author has no conflicts of interest to declare. [16] von Baeyer CL, Stevens BJ, Chambers CT, Craig KD, Finley GA, Grunau RE,
Johnston CC, Pillai Riddell R, Stinson JN, Dol J, Campbell-Yeo M, McGrath
*Corresponding author. Department of Psychology, University of British Columbia,
PJ. Training highly qualified health research personnel: the pain in child health
2136 West Mall, Vancouver, B.C., Canada, V6T 1Z4. kcraig@[Link] consortium. Pain Res Manag 2014;19:267–74.
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