Measuring Pain Behaviour: Scale of Pain Expression Behaviours (SOPEB)


  • Simmy M Varkey Research Scholar, School of Behavioral Sciences, MG University
  • PK Babu Associate Professor of Statistics, Dept. of Community Medicine, Government Medical College, Manjery.
  • Varghese P Punnoose Professor and Head, Dept. of Psychiatry, Government Medical College, Alappuzha



pain, nonverbal communication, diabetic foot


Nonverbal communication refers to how people communicate, intentionally or unintentionally, without words. A study was conducted in general and taluk hospitals of Kottayam to develop a scale to measure pain behaviour: Scale of Pain Expression Behaviours (SOPEB). Consecutive patients brought to the hospitals with diabetic foot ulcer (n=350) were given SOPEB. They were also given Adult Nonverbal Pain Scale. We determined content validity index. Construct validity for SOPEB was computed through exploratory factor analysis. These factors concentrate and index the dispersed information in the original data and replace 105 characteristics to 25 characteristics in each domain. Kaiser-Meyer-Olkin Test values was 0.602, and it determines suitability of data for factor analysis. After rotation, it identified five linear components which gave eigenvalue of more than 1. A Scree Plot was used to visually assess which components or factors explain most of the variability in the data. Concurrent validity is used to correlate SOPEB scores with adult Nonverbal Pain Scale. The reliability of each item was calculated using percent agreement and the Cohen’s Kappa coefficient. Nonverbal communication has a key role in patient care. Effective communication takes into account nonverbal communication also. Usage of tools such as SOPEB helps to assess the proper quantification of pain behaviour.


Knapp ML, Daly JA, editors. Handbook of interpersonal communication. California: SAGE Publications; 2002.
Albert M. Silent Messages. 1st ed. Belmont(CA): Wadsworth; 1971.
Caris-Verhallen WM, Kerkstra A, Bensing JM. Non-verbal behaviour in nurse-elderly patient communication. J AdvNurs 1999; 29:808–18.
Ashraf AB, Lucey S, Chen T, Cohn JF, Ambadar Z, Prkachin KM, et al. The painful face – pain expression recognition using active appearance models. Image Vis Comput 2009; 27:1788–96.
Turk DC, Meichenbaum D, Genest M. Pain and behavioral medicine: a cognitive-behavioral perspective. New York: Guilford Press; 1983.
Sinha N. Self-other rating discrepancy and personality antecedents [monograph on the internet]. Ann Arbor: ProQuest ETD Collection for FIU; 2003 [cited 2018 Feb 27]. Available from: dissertations/AAI3125051
Block AR, Kremer EF, Gaylor M. Behavioral treatment of chronic pain: The spouse as a discriminative cue for pain behavior. Pain 1980; 9:243–52.
Harrigan JA, O’Connell DM. How do you look when feeling anxious? Facial displays of anxiety. Pers Individ Dif 1996; 21:205–12.
Haidt J, Keltner D. Culture and facial expression: open-ended methods find more expressions and a gradient of recognition. Cogn Emot 1999; 13:225–66.
Darwin C, Ekman P. The expression of the emotions in man and animals. 4th ed. Oxford University Press.
Lundberg M, Grimby-Ekman A, Verbunt J, Simmonds MJ. Pain-related fear: a critical review of the related measures. Pain Research and Treatment [serial on the jul 29]; 2011(494196): [about 26 p.]. Available from
Kappas A. The fascination with faces: are they windows to our soul? J Nonverbal Behav 1997; 21:157–61.
Johnson-Laird PN, Oatley K. Basic emotions, rationality, and folk theory. Cogn & Emot 1992; 6:201–23.
Simon D, Craig KD, Gosselin F, Belin P, Rainville P. Recognition and discrimination of prototypical dynamic expressions of pain and emotions. Pain 2008; 135:55-64.
Walsh J, Eccleston C, Keogh E. Pain communication through body posture: the development and validation of a stimulus set. Pain 2014; 155:2282–90.
Cameron AD. (2011). Personality’s interaction with the pain experience. Available from
Prkachin, KM. Assessing pain by facial expression: facial expression as nexus. Pain Res Manag 2009; 14:53–8.




How to Cite

Varkey, S. M., Babu, P., & Punnoose, V. P. (2018). Measuring Pain Behaviour: Scale of Pain Expression Behaviours (SOPEB). Kerala Journal of Psychiatry, 30(2), 73–78.



Research Report