@article{levesque-lacasse_relationship_2024,

title = {The Relationship Between the Ability to Infer Another's Pain and the Expectations Regarding the Appearance of Pain Facial Expressions: Investigation of the Role of Visual Perception},

author = {A. Lévesque-Lacasse and M. -C. Desjardins and D. Fiset and C. Charbonneau and S. Cormier and C. Blais},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85171357836&doi=10.1016%2fj.jpain.2023.08.007&partnerID=40&md5=dcfeb2e0eb9f13b42122ddfcbc987fc0},

doi = {10.1016/j.jpain.2023.08.007},

issn = {15265900},

year  = {2024},

date = {2024-01-01},

journal = {Journal of Pain},

volume = {25},

number = {1},

pages = {250–264},

abstract = {Although pain is a commonly experienced and observed affective state, it is frequently misinterpreted, which leads to inadequate caregiving. Studies show the ability at estimating pain in others (estimation bias) and detecting its subtle variations (sensitivity) could emerge from independent mechanisms. While estimation bias is modulated by variables such as empathy level, pain catastrophizing tendency, and overexposure to pain, sensitivity remains unimpacted. The present study verifies if these 2 types of inaccuracies are partly explained by perceptual factors. Using reverse correlation, we measured their association with participants' mental representation of pain, or more simply put, with their expectations of what the face of a person in pain should look like. Experiment 1 shows that both parameters are associated with variations in expectations of this expression. More specifically, the estimation bias is linked with expectations characterized by salient changes in the middle face region, whereas sensitivity is associated with salient changes in the eyebrow region. Experiment 2 reveals that bias and sensitivity yield differences in emotional representations. Expectations of individuals with a lower underestimation tendency are qualitatively rated as expressing more pain and sadness, and those of individuals with a higher level of sensitivity as expressing more pain, anger, and disgust. Together, these results provide evidence for a perceptual contribution in pain inferencing that is independent of other psychosocial variables and its link to observers’ expectations. Perspective: This article reinforces the contribution of perceptual mechanisms in pain assessment. Moreover, strategies aimed to improve the reliability of individuals’ expectations regarding the appearance of facial expressions of pain could potentially be developed, and contribute to decrease inaccuracies found in pain assessment and the confusion between pain and other affective states. © 2023 United States Association for the Study of Pain, Inc.},

note = {Publisher: Elsevier B.V.},

keywords = {anger, article, chronic pain, disgust, emotion, Emotions, Empathy, Estimation bias, expectation, eyebrow, Facial Expression, Facial expressions of pain, human, Humans, mental representation, Mental representations, motivation, Pain, pain assessment, psychology, questionnaire, reliability, reproducibility, Reproducibility of Results, Reverse correlation, sadness, sensitivity, vision, Visual Perception},

pubstate = {published},

tppubtype = {article}

}

@article{dugas_pain_2023,

title = {Pain catastrophizing and worry about health in generalized anxiety disorder},

author = {M. J. Dugas and K. Giguère Marchal and S. Cormier and S. Bouchard and J. -P. Gouin and R. Shafran},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85150514206&doi=10.1002%2fcpp.2843&partnerID=40&md5=2676de0f5a42bcdaea5f10aa5e8e3f55},

doi = {10.1002/cpp.2843},

issn = {10633995},

year  = {2023},

date = {2023-01-01},

journal = {Clinical Psychology and Psychotherapy},

volume = {30},

number = {4},

pages = {852–861},

abstract = {Because the diagnostic criteria of generalized anxiety disorder (GAD) are not tied to specific worry domains (worry is ‘generalized’), research on the content of worry in GAD is lacking. To our knowledge, no study has addressed vulnerability for specific worry topics in GAD. The goal of the current study, a secondary analysis of data from a clinical trial, is to explore the relationship between pain catastrophizing and worry about health in a sample of 60 adults with primary GAD. All data for this study were collected at pretest, prior to randomization to experimental condition in the larger trial. The hypotheses were that (1) pain catastrophizing would be positively related to the severity of GAD, (2) the relationship between pain catastrophizing and the severity of GAD would not be explained by intolerance of uncertainty and psychological rigidity, and (3) pain catastrophizing would be greater in participants reporting worry about health compared to those not reporting worry about health. All hypotheses were confirmed, suggesting that pain catastrophizing may be a threat-specific vulnerability for health-related worry in GAD. The implications of the current findings include a better understanding of the ideographic content of worry, which could help focus treatment interventions for individuals with GAD. © 2023 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.},

note = {Publisher: John Wiley and Sons Ltd},

keywords = {adult, Anxiety, Anxiety disorder, Anxiety Disorders, Catastrophization, catastrophizing, human, Humans, Pain, psychology, uncertainty},

pubstate = {published},

tppubtype = {article}

}

@article{gingras_pain_2023,

title = {Pain in the eye of the beholder: Variations in pain visual representations as a function of face ethnicity and culture},

author = {F. Gingras and D. Fiset and M. -P. Plouffe-Demers and A. Deschênes and S. Cormier and H. Forget and C. Blais},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85149411004&doi=10.1111%2fbjop.12641&partnerID=40&md5=eb36c9f5071b30edaff22935109abcea},

doi = {10.1111/bjop.12641},

issn = {00071269},

year  = {2023},

date = {2023-01-01},

journal = {British Journal of Psychology},

volume = {114},

number = {3},

pages = {621–637},

abstract = {Pain experienced by Black individuals is systematically underestimated, and recent studies have shown that part of this bias is rooted in perceptual factors. We used Reverse Correlation to estimate visual representations of the pain expression in Black and White faces, in participants originating from both Western and African countries. Groups of raters were then asked to evaluate the presence of pain and other emotions in these representations. A second group of White raters then evaluated those same representations placed over a neutral background face (50% White; 50% Black). Image-based analyses show significant effects of culture and face ethnicity, but no interaction between the two factors. Western representations were more likely to be judged as expressing pain than African representations. For both cultural groups, raters also perceived more pain in White face representations than in Black face representations. However, when changing the background stimulus to the neutral background face, this effect of face ethnic profile disappeared. Overall, these results suggest that individuals have different expectations of how pain is expressed by Black and White individuals, and that cultural factors may explain a part of this phenomenon. © 2023 The Authors. British Journal of Psychology published by John Wiley & Sons Ltd on behalf of The British Psychological Society.},

note = {Publisher: John Wiley and Sons Ltd},

keywords = {Caucasian, emotion, Emotions, Ethnicity, human, Humans, Pain, psychology, White People},

pubstate = {published},

tppubtype = {article}

}

@article{le_du_new_2023,

title = {A New Option for Pain Prevention Using a Therapeutic Virtual Reality Solution for Bone Marrow Biopsy (REVEH Trial): Open-Label, Randomized, Multicenter, Phase 3 Study},

author = {K. Le Du and A. -L. Septans and F. Maloisel and H. Vanquaethem and A. Schmitt and M. Le Goff and A. Clavert and M. Zinger and H. Bourgeois and O. Dupuis and F. Denis and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85148250546&doi=10.2196%2f38619&partnerID=40&md5=e27bfbd3d4c42f8850daf70bdf60b384},

doi = {10.2196/38619},

issn = {14388871 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Journal of Medical Internet Research},

volume = {25},

abstract = {Background: Evidence regarding the analgesic effect of distraction through immersion in virtual reality (VR) for care-induced pain has been documented in several phase 2 trials, but comparison with standard treatments in large, randomized studies is needed. Objective: In this open-label, multicenter, randomized, phase 3 trial, we evaluated the safety and efficacy of a novel VR therapy solution for distraction in the context of bone marrow biopsy. Methods: Bliss is a VR software with 4 imaginary interactive environments in 3 dimensions with binaural sound (head-mounted display). Efficacy regarding pain intensity was evaluated using a visual analog scale (VAS; score from 0 to 10) immediately after the biopsy. Secondary end points were anxiety and tolerance. Modified intention-to-treat analysis was performed. Results: Overall, 126 patients with previously documented untreated or suspected malignant hemopathy between September 6, 2018, and May 18, 2020, were randomly assigned in a 1:1 ratio to receive pain prevention with a mixture of nitrous oxide/oxygen (MEOPA; n=63) or VR (n=63) before and during the bone marrow biopsy. We excluded 8 patients from the final analysis (3 in the MEOPA group and 5 in the VR group). All patients received local anesthesia (lidocaine) before biopsy. Follow-up was limited to 1 month after the biopsy. Participants' median age was 65.5 (range 18-87) years, and 54.2% (64/118) of patients were male. The average pain intensity was 3.5 (SD 2.6, 95% CI -1.6 to 8.6) for the MEOPA group and 3.0 (SD 2.4, 95% CI -1.7 to 7.7) for the VR group, without any significant differences in age, sex, center, and hemopathy (P=.26). Concerning anxiety, 67.5% (79/117; fear of pain questionnaire) of the patients were afraid before the biopsy, and anxiety scores were moderate to very high in 26.3% (30/114; revised Spielberger State-Trait Anxiety Inventory questionnaire) of the patients before the biopsy and 9.0% (10/114) after the biopsy for all patients, without a significant difference between the 2 groups (P=.83). Immersion in VR was well tolerated by the majority (54/57, 95%) of patients in the VR group. Conclusions: The intensity of pain did not significantly differ between both arms. VR was well tolerated, and the satisfaction of patients, nurses, and physicians was very high. VR could be an alternative treatment in case of contraindication or intolerance to MEOPA. © 2023 Journal of Medical Internet Research. All rights reserved.},

note = {Publisher: JMIR Publications Inc.},

keywords = {80 and over, Adolescent, adult, aged, alprazolam, Anxiety, article, Biopsy, blood pressure measurement, Bone Marrow, bone marrow biopsy, clinical trial, controlled study, demographics, digital health, digital therapeutics, Distraction, Effectiveness, efficacy, eHealth, female, follow up, head-mounted display, hematologic disease, human, human tissue, Humans, hypertension, imagery, imaginary, imagination, Immersive environment, Intention to Treat Analysis, interactive environment, leukemia, lidocaine, local anesthesia, lymphoma, major clinical study, male, medical procedure, Meopa, Middle Aged, monoclonal immunoglobulinemia, multicenter study, myelodysplastic syndrome, myeloma, myeloproliferative disorder, myeloproliferative neoplasm, nitrous oxide plus oxygen, open study, Pain, pain intensity, pain measurement, paracetamol, phase 3 clinical trial, prospective study, questionnaire, randomized controlled trial, RCT, relaxation training, safety, satisfaction, solid malignant neoplasm, State Trait Anxiety Inventory, very elderly, virtual reality, visual analog scale, VR, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{plouffe-demers_facial_2022,

title = {Facial Expression of Pain: Sex Differences in the Discrimination of Varying Intensities},

author = {M. -P. Plouffe-Demers and C. Saumure and D. Fiset and S. Cormier and C. Blais},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85138214204&doi=10.1037%2femo0001156&partnerID=40&md5=d5063c7ab05722c16694952ac5d53027},

doi = {10.1037/emo0001156},

issn = {15283542 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Emotion},

volume = {23},

number = {5},

pages = {1254–1266},

abstract = {It has been proposed that women are better than men at recognizing emotions and pain experienced by others. They have also been shown to be more sensitive to variations in pain expressions. The objective of the present study was to explore the perceptual basis of these sexual differences by comparing the visual information used by men and women to discriminate between different intensities of pain facial expressions. Using the data-driven Bubbles method, we were able to corroborate the woman advantage in the discrimination of pain intensities that did not appear to be explained by variations in empathic tendencies. In terms of visual strategies, our results do not indicate any qualitative differences in the facial regions used by men and women. However, they suggest that women rely on larger regions of the face that seems to completely mediate their advantage. This utilization of larger clusters could indicate either that women integrate simultaneously and more efficiently information coming from different areas of the face or that they are more flexible in the utilization of the information present in these clusters. Women would then opt for a more holistic or flexible processing of the facial information, while men would rely on a specific yet rigid integration strategy. © 2022 American Psychological Association},

note = {Publisher: American Psychological Association},

keywords = {adult, article, controlled study, data-driven methods, effect size, Empathy, Facial Expression, facial expressions, female, human, human experiment, information processing, male, normal human, Pain, pain intensity, qualitative research, sample size, sex difference, sex differences, vision, visual acuity, visual information, Visual Perception},

pubstate = {published},

tppubtype = {article}

}

@article{boutet_criminality_2022,

title = {Criminality labelling influences reactions to others’ pain},

author = {I. Boutet and J. -C. Goulet-Pelletier and S. Maslouhi and D. Fiset and C. Blais},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85144950088&doi=10.1016%2fj.heliyon.2022.e12068&partnerID=40&md5=99b82ededc48e7fba9d5d234fd98962d},

doi = {10.1016/j.heliyon.2022.e12068},

issn = {24058440 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Heliyon},

volume = {8},

number = {12},

abstract = {Disparities in healthcare for underrepresented and stigmatized groups are well documented. Current understanding is that these inequalities arise, at least in part, from psychosocial factors such as stereotypes and in-group/out-group categorization. Pain management, perhaps because of the subjective nature of pain, is one area of research that has spearheaded these efforts. We investigated how observers react to the pain of individuals labelled as criminals. Face models expressing pain of different levels of intensity were portrayed as having committed a crime or not (control group). A sample of n = 327 college students were asked to estimate the intensity of the pain expressed by face models as well as their willingness to help them. Trait empathy was also measured. Data was analyzed using regression, mediation and moderation analyses. We show for the first time that observers were less willing to help individuals with a criminal history. Moreover, a moderation effect was observed whereby empathic participants were more willing to help control face models compared to less empathic participants. However, criminality history did not influence participant's pain estimation. We conclude that negative stereotypes associated with criminality can reduce willingness to help individuals in pain even when pain signals are accurately perceived. © 2022},

note = {Publisher: Elsevier Ltd},

keywords = {Criminality, Empathy, Healthcare inequalities, Pain, Psychosocial influences},

pubstate = {published},

tppubtype = {article}

}

@article{le_may_immersive_2021,

title = {Immersive virtual reality vs. non-immersive distraction for pain management of children during bone pins and sutures removal: A randomized clinical trial protocol [沉浸式虚拟现实与非沉浸式分心治疗儿童骨钉和缝合线疼痛的比较:随机临床试验方案]},

author = {S. Le May and A. Tsimicalis and M. Noel and P. Rainville and C. Khadra and A. Ballard and E. Guingo and C. Cotes-Turpin and S. Addab and K. Chougui and M. Francoeur and N. Hung and M. Bernstein and S. Bouchard and S. Parent and M. Hupin Debeurme},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85093928841&doi=10.1111%2fjan.14607&partnerID=40&md5=57256b68253aa1c6288a603f795aceb4},

doi = {10.1111/jan.14607},

issn = {03092402},

year  = {2021},

date = {2021-01-01},

journal = {Journal of Advanced Nursing},

volume = {77},

number = {1},

pages = {439–447},

abstract = {Aims: To examine the efficacy of an immersive virtual reality distraction compared with an active non-immersive distraction, such as video games on a tablet, for pain and anxiety management and memory of pain and anxiety in children requiring percutaneous bone pins and/or suture removal procedures. Design: Three-centre randomized clinical trial using a parallel design with two groups: experimental and control. Methods: Study to take place in the orthopaedic department of three children hospital of the Montreal region starting in 2019. Children, from 7–17 years old, requiring bone pins and/or suture removal procedures will be recruited. The intervention group (N = 94) will receive a virtual reality game (Dreamland), whereas the control group (N = 94) will receive a tablet with video games. The primary outcomes will be both the mean self-reported pain score measured by the Numerical Rating Scale and mean anxiety score, measured by the Child Fear Scale. Recalls of pain and anxiety will be measured 1 week after the procedure using the same scales. We aim to recruit 188 children to achieve a power of 80% with a significance level (alpha) of 5%. Discussion: While multiple pharmacological methods have previously been tested for children, no studies have evaluated the impact of immersive virtual reality distraction for pain and anxiety management in the orthopaedic setting. Impact: Improved pain management can be achieved using virtual reality during medical procedures for children. This method is innovative, non-pharmacological, adapted to the hospital setting, and user-friendly. Trial Registration: NCT03680625, registered on clinicaltrials.gov. © 2020 John Wiley & Sons Ltd},

note = {Publisher: Blackwell Publishing Ltd},

keywords = {Adolescent, analgesia, bone nail, Bone Nails, Child, human, Humans, Pain, Pain Management, randomized controlled trial (topic), Randomized Controlled Trials as Topic, suture, Sutures, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{khadra_effects_2020,

title = {Effects of a projector-based hybrid virtual reality on pain in young children with burn injuries during hydrotherapy sessions: A within-subject randomized crossover trial},

author = {C. Khadra and A. Ballard and D. Paquin and C. Cotes-Turpin and H. G. Hoffman and I. Perreault and J. -S. Fortin and S. Bouchard and J. Théroux and S. Le May},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85084390816&doi=10.1016%2fj.burns.2020.04.006&partnerID=40&md5=07c94e6c0d5a26e5c2ead8068f0f7f0c},

doi = {10.1016/j.burns.2020.04.006},

issn = {03054179 (ISSN)},

year  = {2020},

date = {2020-01-01},

journal = {Burns},

volume = {46},

number = {7},

pages = {1571–1584},

abstract = {Aim: The aim of this study was to examine the effect of a water-friendly Projector-Based Hybrid Virtual Reality (VR) dome environment combined with standard pharmacological treatment on pain in young children undergoing burn wound care in hydrotherapy. Methods: This study was a prospective, within-subject crossover trial of 38 children aged 6 months to 7 years old (mean age = 1.8 years old). Each hydrotherapy procedure was divided into two equivalent wound care segments (No hybrid VR during one segment vs. Hybrid VR during the other segment, treatment order was randomized). Pain was measured using the 0–10 FLACC (Face, Legs, Activity, Cry Consolability scale) and the 0–10 NRS-obs (Numerical Rating Scale-obs). Results: Projector-Based Hybrid VR significantly reduced procedural pain levels measured by the FLACC (p = 0.026) and significantly increased patients' comfort levels (p = 0.002). Patients' pain levels rated by the nurses using the NRS-obs were non-significant between both groups (p = 0.135). No side effects were reported. Conclusion: Projector-Based Hybrid VR helped in reducing the pain related to hydrotherapy procedures in young children with burn wound injuries. This is the first study using virtual reality distraction with young children, and our findings are especially important because a large percentage of pediatric burn patients are very young. Additional research and development are recommended. Trial registration: ClinicalTrials.gov, NCT02986464, registered on June 12, 2016. © 2020 Elsevier Ltd and ISBI},

note = {Publisher: Elsevier Ltd},

keywords = {article, burn, Burns, Child, clinical article, clonidine, complication, controlled study, Cross-Over Studies, crossover procedure, Distraction, Face Legs Activity Cry Consolability scale, female, human, Humans, hydromorphone, hydrotherapy, infant, ketamine, male, midazolam, morphine, numeric rating scale, Pain, pain measurement, paracetamol, Preschool, preschool child, procedural pain, Prospective Studies, prospective study, randomized controlled trial, rating scale, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{dumoulin_are_2020,

title = {Are cognitive load and focus of attention differentially involved in pain management: An experimental study using a cold pressor test and virtual reality},

author = {S. Dumoulin and S. Bouchard and C. Loranger and P. Quintana and V. Gougeon and K. L. Lavoie},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85090185237&doi=10.2147%2fJPR.S238766&partnerID=40&md5=38278e890412e4529b0a740f4a6a881e},

doi = {10.2147/JPR.S238766},

issn = {11787090 (ISSN)},

year  = {2020},

date = {2020-01-01},

journal = {Journal of Pain Research},

volume = {13},

pages = {2213–2222},

abstract = {Objective: The aim of this study is to assess whether distraction (lack of attentional focus) and attention (cognitive load) are differentially involved in the analgesic effect of virtual reality (VR) immersions during a cold pressor test (CPT). Methods: Thirty-one participants were randomly assigned to four experimental conditions (high and low cognitive load, attention with or without a reminder of the pain stimuli) and performed three CPTs. Pain was assessed based on the duration of the CPT (pain tolerance), a visual analog rating scale of perceived pain intensity during the CPT and the subjective pain scale of the Short form McGill Pain Questionnaire (SF-MPQ). Results: The statistical analyses revealed that VR immersions were associated with less pain compared to the baseline (all p <0.001), but for the experimental manipulations, only the conditions where there was an increase in cognitive load (ie, from low cognitive load at Immersion 1 to high cognitive load at Immersion 2) were effective for increasing pain tolerance (significant Time X Conditions interaction). The interactions were not significant for pain intensity assessed with the VAS or the SF-MPQ. Conclusion: The results suggest that increases in cognitive load play an important role in the analgesic effect of VR immersion, although the combination of attentional focus and cognitive load may be important. Suggestions are given for designing a replication study. © 2020 Dumoulin et al.},

note = {Publisher: Dove Medical Press Ltd},

keywords = {adult, analgesia, analgesic activity, article, attention, clinical article, Cognitive load, cold pressor test, controlled study, CPT, Distraction, experimental study, female, human, immersion, male, McGill Pain Questionnaire, Pain, pain intensity, pain threshold, randomized controlled trial, rating scale, replication study, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{blais_facial_2019,

title = {Facial Features Underlying the Decoding of Pain Expressions},

author = {C. Blais and D. Fiset and H. Furumoto-Deshaies and M. Kunz and D. Seuss and S. Cormier},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85060707205&doi=10.1016%2fj.jpain.2019.01.002&partnerID=40&md5=2d2dd305de430a7ce8973644f57a4996},

doi = {10.1016/j.jpain.2019.01.002},

issn = {15265900 (ISSN)},

year  = {2019},

date = {2019-01-01},

journal = {Journal of Pain},

volume = {20},

number = {6},

pages = {728–738},

abstract = {Previous research has revealed that the face is a finely tuned medium for pain communication. Studies assessing the decoding of facial expressions of pain have revealed an interesting discrepancy, namely that, despite eyes narrowing being the most frequent facial expression accompanying pain, individuals mostly rely on brow lowering and nose wrinkling/upper lip raising to evaluate pain. The present study verifies if this discrepancy may reflect an interaction between the features coding pain expressions and the features used by observers and stored in their mental representations. Experiment 1 shows that more weight is allocated to the brow lowering and nose wrinkling/upper lip raising, supporting the idea that these features are allocated more importance when mental representations of pain expressions are stored in memory. These 2 features have been associated with negative valence and with the affective dimension of pain, whereas the eyes narrowing feature has been associated more closely with the sensory dimension of pain. However, experiment 2 shows that these 2 features remain more salient than eyes narrowing, even when attention is specifically directed toward the sensory dimension of pain. Together, these results suggest that the features most saliently coded in the mental representation of facial expressions of pain may reflect a bias toward allocating more weight to the affective information encoded in the face. Perspective: This work reveals the relative importance of 3 facial features representing the core of pain expressions during pain decoding. The results show that 2 features are over-represented; this finding may potentially be linked with the estimation biases occurring when clinicians and lay persons evaluate pain based on facial appearance. © 2019 the American Pain Society},

note = {Publisher: Churchill Livingstone Inc.},

keywords = {adult, article, attention, decoding, Eye, Facial Expression, facies, female, human, human experiment, Humans, lip, male, Memory, Nose, Pain, pain assessment, pain dimensions, pain measurement, sensory analysis, wrinkle, Young Adult},

pubstate = {published},

tppubtype = {article}

}