![]() ![]() have reported that facial expression responding to pain only started when stimulus intensity became strong. On the other hand, it has been implied that facial expression was poor in low grade pain ( Kunz et al., 2004 Lucey et al., 2012). Also, a significant correlation is reported between subjective pain, Visual Analogue Scale (VAS), and categorical scale within an individual ( Wallenstein, Heidrich, Kaiko, & Houde, 1980 Littman, Walker, & Schneider, 1985). Hence, a simple 4-point categorical scale is commonly used on clinical practice ( Abbey et al., 2004 Takai et al., 2010), and such a scale has been believed feasible for evaluating pain in others. It includes micro-analytic coding procedures that may be unsuitable or too cumbersome for clinical use. However, using FACS requires training and it takes times to become certified as a FACS coder. ![]() In previous studies, the facial expression is measured using Facial Action Coding System (FACS) ( LeResche & Dworkin, 1984), which correlates with subjective pain ratings ( Kunz, Mylius, Schepelmann, & Lautenbacher, 2004). It is also a fundamental way of pain communication by displaying and recognizing painful stimuli even in animals ( Mogil, 2015). Moreover, facial expression is considered to be the most prominent way of involuntary communicating affect ( Prkachin, 1992 Williams, 2002). ![]() Facial expression responding to pain has emerged as an important objective pain indicator in experimental research as well as in clinical practice ( Prkachin, 1992). Subjective pain experience is hard to understand by other people, however, objective pain evaluation is useful to understand pain in someone, especially in patients with communication difficulties ( Abbey et al., 2004 Takai et al., 2010 Lord, 2009 Puntillo et al., 1997 Herr et al., 2006). ![]()
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