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Behavioural Neurology
Volume 2016, Article ID 1984827, 9 pages
Research Article

The Influence of Executive Functioning on Facial and Subjective Pain Responses in Older Adults

1Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 HE Nijmegen, Netherlands
2Section of Gerontology, Department of General Practice, University Medical Center Groningen, University of Groningen, 9700 AD Groningen, Netherlands

Received 8 December 2015; Accepted 5 April 2016

Academic Editor: Luigi Trojano

Copyright © 2016 Joukje M. Oosterman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Cognitive decline is known to reduce reliability of subjective pain reports. Although facial expressions of pain are generally considered to be less affected by this decline, empirical support for this assumption is sparse. The present study therefore examined how cognitive functioning relates to facial expressions of pain and whether cognition acts as a moderator between nociceptive intensity and facial reactivity. Facial and subjective responses of 51 elderly participants to mechanical stimulation at three intensities levels (50 kPa, 200 kPa, and 400 kPa) were assessed. Moreover, participants completed a neuropsychological examination of executive functioning (planning, cognitive inhibition, and working memory), episodic memory, and psychomotor speed. The results showed that executive functioning has a unique relationship with facial reactivity at low pain intensity levels (200 kPa). Moreover, cognitive inhibition (but not other executive functions) moderated the effect of pressure intensity on facial pain expressions, suggesting that the relationship between pressure intensity and facial reactivity was less pronounced in participants with high levels of cognitive inhibition. A similar interaction effect was found for cognitive inhibition and subjective pain report. Consequently, caution is needed when interpreting facial (as well as subjective) pain responses in individuals with a high level of cognitive inhibition.