Does Recognition of Emotions Differ in People with and without Chronic Pain when a Lower Face Covering is Used? A Cross Sectional Study

Background: As a result of the Covid panidemic, face masks are routinely used around the world. These could hamper the recognition of (basic) emotions and lead to misunderstandings. People with chronic pain typically struggle with (non-) verbal communication, and their behavior is frequently interpreted differently by their surroundings. This paper examines the variance in emotion recognition (accuracy and speed) between individuals with chronic pain and asymptomatic subjects. Methods: Four validated measures (Central Sensitization Inventory (CSI), Graded Chronic Pain Scale (GCPS), The Brief Pain Inventory (BPI, and the Toronto Alexithymia Scale (TAS-20)) were used to differentiate between the asymptomatic control (CP) and chronic pain group (PG). In addition, a computerized emotion recognition test (ERT) comprised of 42 morphed images depicting six fundamental emotions (with) out lower fase covering was utilized to measure the accuracy and time required for this study. Results: The recruitment and analysis of 170 patients included 98 subjects with chronic pain (PG). There was a statistically significant difference (p<0.01) between CP and PG (with) out lower face covering in the recognition of all basic emotions. In both groups, fear (from 57.1% to 66.3%) and disgust (from 67.1% to 69.1%) were more prevalent in the PG. Sadness and disgust (p<0.0001) in the PG were especially harder to identify when the lower face was concealed. There was no statistically significant difference in time between CG and PG without facial covering (p=0.34, p=0.4). Conclusion: People in a chronic pain state have more difficulty with emotion recognition without lower face covering, but there is no difference in time. Emotion recognition, especially sadness and disgust with face covering are significantly diminished in PG were disgust was frequently confused with anger and fear with astonishment.