Pain Communication Systems

Authors: Jordan Vallejo and the Transformation Management Institute™ Research Group

Status: IFS-1 | December 2025

Scope and boundary

This paper is descriptive and diagnostic rather than clinical or prescriptive. It does not address pain etiology, biomedical measurement, psychotherapy, or treatment decisions. It analyzes pain communication as an interpretation system: how private reference conditions become shared, actionable understanding under constraint.

Abstract

Pain communication is a high-salience interpretive environment where the reference condition is frequently private, costly to misread, and unevenly accessible across participants. This makes it an extreme-case field site for studying how humans stabilize interpretation when direct verification is limited. IFS-1 treats pain communication as an interpretation system: a recurring loop in which an internal pain state is rendered into signals, decoded under constraints, acted upon through role-governed responses, and either stabilized through closure or destabilized through non-resolution.

IFS-1 introduces the Pain Meaning Event (PMEv) as the unit of analysis. A PMEv is defined as a complete interpretive cycle spanning (1) the private reference condition, (2) encoding into communicative output (verbal, behavioral, timing, and channel selection), (3) observer decoding and credibility assignment, (4) response protocol selection (comfort, problem-solving, accommodation, dismissal, surveillance), and (5) closure outcomes that determine whether the event resolves or remains open. The study maps PMEv dynamics onto the MSS variable set—truth fidelity (T), signal alignment (P), structural coherence (C), drift (D), and affective regulation (A)—and identifies recurrent failure signatures, including credibility failure, evidence-threshold mismatch, closure failure, and drift acceleration across repeated episodes.

IFS-1 produces a domain map of pain communication subsystems (encoding, decoding, response, closure), a classification of common interpretive breakdowns, and a set of measurement candidates suitable for field observation in multiple contexts (intimate relationships, clinical encounters, workplaces, and public or online settings). By formalizing pain communication as a repeatable event structure with measurable stability conditions, IFS-1 provides an intuitive on-ramp to MSS and establishes a reusable field-study method for later domains.

1. Introduction

1.1 Why pain communication is a definitive test case for interpretation

Pain is often treated as “subjective,” but contemporary pain science is explicit that pain is a personal experience influenced by biological, psychological, and social factors, and that pain cannot be inferred solely from activity in sensory neurons. The revised IASP definition and notes further state that a person’s report of pain should be respected. These commitments place pain communication directly inside the scientific problem of interpretation under asymmetric access: the relevant reference condition is real for the person experiencing it, but only partially accessible to others.

The consequence is predictable: the system must rely on signals, inference, credibility assignment, and response rules. Errors are costly. Under-reading can delay relief, accommodation, or care. Over-reading can trigger unnecessary escalation, surveillance, or distrust. This paper treats that interpretive loop itself as the system object.

Key foundation from pain science:

• Pain is personal and socially influenced; nociception is not equivalent to pain.

• The report of pain has standing as evidence in the absence of direct verification.

1.2 Where “pain communication” sits in existing research

A core anchor in the field is Kenneth Craig’s Social Communication Model of Pain, which frames pain as a process involving experience, expression, observer inference, and social response. The model describes pain not only as a sensory event but also as a communicative phenomenon shaped by context, relationships, and broader social structures. This paper builds from that foundation and adds two structural elements that are central to Meaning System Science: (1) event closure as an explicit system output, and (2) drift as a measurable rate across repeated unresolved episodes.

1.3 Contribution of this paper

This paper contributes:

1. PMEv as a unit of analysis for pain communication.

2. A protocol-level map of receiver responses (comfort, problem-solving, accommodation, dismissal, surveillance).

3. A closure and non-closure model that links repeated episodes to drift.

4. A measurement candidate set suitable for field observation across multiple interfaces.

2. Research foundations from current pain communication science

2.1 The revised IASP definition and the inference problem

The revised IASP definition and accompanying notes establish three high-impact premises for interpretation:

• Pain is influenced by social context.

• Pain is not reducible to nociceptive activity.

• Reports of pain should be respected as claims about experience.

Within IFS-1, these premises translate to a domain-level truth posture: the system must operate without direct access to the reference condition in many cases, and therefore must manage evidence thresholds and credibility assignment explicitly.

2.2 The Social Communication Model of Pain

Craig’s Social Communication Model provides an inclusive framework for organizing pain as a communicative process with both individual and social components. It makes observer inference and response part of the phenomenon rather than external commentary. PMEv adopts the core flow and adds two system outputs that are central to a repeatable event definition:

• Protocol selection as a discrete interpretive decision by the receiver.

• Closure outcome as the event terminus that determines whether the event resolves or remains open.

2.3 Expression and observation: signal variance is expected, not anomalous

Pain expression has been studied as structured behavior rather than pure leakage. Work on facial expression shows that pain-related expressions have identifiable structure and can be studied for reliability and validity. Research also indicates that social context can modulate expression, which matters because observers often treat expression intensity as a proxy for severity. In short, the signal is not a direct gauge. It is an output shaped by audience, incentives, and regulation.

2.4 Underestimation and invalidation as documented patterns

A comprehensive review reports that professionals tend to underestimate patients’ pain relative to patient self-report, and that the extent of underestimation tends to increase with pain severity. This is not a marginal effect; it is a recurrent pattern with predictable consequences for response selection.

Relatedly, qualitative research describes “medical invalidation” as dismissal, minimization, or failure to take concerns seriously. In IFS-1 terms, invalidation is not only an interpersonal harm claim; it is an identifiable credibility operation that changes evidence thresholds and alters closure probability.

2.5 Validation, empathy, and measurable response classes

The role of validation in pain contexts is studied, including conceptual work that defines pain-validation and empirical work that tests whether empathy and perceived validation influence pain outcomes. This literature also explicitly engages the debate between operant reinforcement accounts and intimacy-process models, with experimental evidence suggesting that empathy and validation do not necessarily increase pain behavior.

In parallel, measurement development work introduces instruments such as the Pain-Invalidation Scale, allowing invalidation to be treated as a measurable construct rather than a vague label.

2.6 Bias and structural distortion

Pain credibility and response are shaped by identity-linked distortions that modify how signals are decoded and what evidence thresholds are applied. Empirical work documents racial bias in pain assessment and treatment recommendations, including effects linked to false beliefs about biological differences. Additional research in clinical contexts reports sex-linked differences in pain management decisions at comparable self-reported intensity. Beyond these two axes, the broader literature on pain communication and care documents systematic distortions associated with weight, cultural and linguistic mismatch, age, and chronic-illness and disability stigma. These findings support a core interpretive claim in IFS-1: the same pain signal does not receive the same decoding, protocol routing, or closure probability across populations because credibility priors and evidence thresholds differ.

3. Domain boundary and system object

3.1 System object

A pain communication system is the bounded interpretive environment in which:

• a person experiences pain,

• produces signals about that pain,

• observers interpret those signals under constraints,

• and responses are selected under role-governed rules and evidence thresholds.

3.2 Roles

Minimum roles:

• Reporter: person experiencing pain.

• Receiver: person interpreting and responding.

Optional roles:

• Adjudicator: party with override authority (clinician, manager, insurer, HR function).

• Witness: additional observers who influence credibility and protocol selection.

3.3 Interfaces treated in this field study

IFS-1 treats these as interfaces with distinct evidence thresholds and authority routing:

• Intimate relationships

• Clinical encounters

• Workplace contexts

• Public or online contexts

4. Unit of analysis: Pain Meaning Event (PMEv)

4.1 Canonical definition

A Pain Meaning Event (PMEv) is a complete interpretive cycle spanning a private reference condition, its encoding into communicative output, observer decoding and credibility assignment, selection of a response protocol, and a closure outcome that resolves the event or leaves it open.

4.2 PMEv phases

1. Private reference condition (pain state known primarily to the reporter).

2. Encoding (verbal report, expression, behavior, timing, channel).

3. Decoding and credibility assignment (observer inference and trust decision).

4. Response protocol selection (comfort, problem-solving, accommodation, dismissal, surveillance).

5. Closure outcome (resolved vs open; recurrence conditions).

4.3 PMEv boundaries

A PMEv begins when pain becomes salient enough to initiate encoding or when an observer initiates inquiry that triggers encoding. A PMEv ends when a closure operator occurs (see Section 7) or when the system enters an explicit open state (non-closure) that drives recurrence.

4.4 PMEv typology (minimal)

• Acute vs chronic

• Spontaneous vs prompted disclosure

• Single-receiver vs multi-receiver

• Documented vs undocumented contexts

• Adjudicated vs non-adjudicated contexts

5. Credibility assignment and evidence thresholds

5.1 Credibility as a system operation

Credibility assignment is the observer’s decision about whether the reporter’s signal is treated as a reliable indicator of the private reference condition. In pain contexts, this operation is unusually central because direct verification is often unavailable.

5.2 Evidence threshold mismatch

Evidence thresholds differ across roles:

• Reporters often treat internal experience plus functional impact as sufficient.

• Receivers may require visible cues, consistency over time, or external corroboration.

• Adjudicators may require documentation, diagnosis, or standardized measures.

Mismatch produces predictable outcomes: the same encoding can be treated as adequate evidence in one interface and inadequate in another.

5.3 Underestimation as a recurring empirical pattern

In clinical settings, professional underestimation of pain relative to patient self-report is widely documented. Underestimation is more pronounced with greater pain severity, which increases the probability that high-severity events receive inadequate response selection and delayed closure.

5.4 Invalidation as credibility denial or credibility discounting

Medical invalidation has been described as dismissal, minimization, or failure to take concerns seriously. In PMEv terms, invalidation is a decoding outcome that sets a higher evidence threshold for subsequent cycles, raising recurrence probability and accelerating drift.

6. Signal ecology: encoding, channel selection, and observer cue-weighting

6.1 Encoding channels

Common encoding outputs include:

• Verbal report (intensity, location, duration, qualifiers)

• Facial expression and vocalization

• Guarding, reduced activity, altered gait, posture

• Timing signals (latency to report, repetition, escalation)

• Channel selection (in-person, message, third-party, silence)

6.2 Social modulation

Evidence suggests that social context influences the expression of pain, including facial expression. This implies that expression variance can be expected even when the reference condition remains stable.

6.3 Observer cue-weighting

Observers integrate multiple cues when judging pain, and weighting can shift based on context and incentives. This matters because it determines how much the system relies on verbal report versus visible expression versus functional impact.

6.4 Signal-related failure patterns

• Treating expression intensity as a direct severity gauge

• Discounting verbal report in favor of visual cues

• Substituting a narrative about character or motive for the pain claim

7. Response protocol families

7.1 Protocol definition

A response protocol is the receiver’s selected action class and stance in response to the decoded claim, given their role constraints and evidence threshold.

7.2 Protocol families

• Comfort protocol: support and co-regulation oriented response.

• Problem-solving protocol: repair or fix oriented response.

• Accommodation protocol: adjustment of demands, schedule, environment, or workload.

• Dismissal protocol: minimization, disbelief, deferral without pathway.

• Surveillance protocol: increased evidence demands, monitoring, proof escalation.

7.3 Validation and invalidation as measurable protocol features

Validation is a response feature that communicates that the pain claim is understood as legitimate within the relationship or system context. Contemporary work defines pain-validation and treats it as a protective factor in chronic pain contexts. Measurement work develops tools to capture perceived invalidation across domains and sources.

Experimental work comparing operant and intimacy-process models suggests that increased empathy and perceived validation can be associated with reduced pain in controlled settings, challenging the assumption that validation necessarily reinforces pain behavior.

8. Closure, non-closure, recurrence, and drift

8.1 Closure definition

Closure is the event-level outcome in which:

• the receiver’s interpretation is stable enough to select a response,

• the response is executed to completion,

• and the system transitions out of active signaling demand for that event.

Closure does not require elimination of pain. It requires interpretive stability and completed response relative to the selected protocol.

8.2 Closure operators (examples by interface)

• Credibility grant plus completed support action

• Accommodation implemented and acknowledged

• Clinical documentation that establishes a stable pathway for future events

• A shared plan with follow-through criteria

8.3 Non-closure loops

Non-closure occurs when:

• credibility remains contested,

• response selection is delayed or inconsistent,

• or response is partial and does not reduce signaling demand.

Non-closure increases recurrence probability and changes subsequent encoding behavior (escalation, withdrawal, channel switching).

8.4 Drift as a rate across repeated PMEv sequences

Within MSS, drift (D) is treated as the rate at which misalignment accumulates when truth fidelity, signal alignment, or structural coherence cannot keep pace with system demands. In pain contexts, drift can increase when repeated PMEv cycles produce underestimation, invalidation, protocol mismatch, or unresolved closure.

Recent work suggests that prior invalidation can alter subsequent reporting behavior, including under-reporting when seeking care, which can further destabilize decoding and response selection.

9. Bias and structural distortion layers

Bias functions as a structural distortion layer that changes how identical pain signals are interpreted and acted upon across populations. In PMEv terms, bias reshapes decoding by shifting credibility priors, evidence thresholds, protocol selection, and closure probability.

9.1 Racial bias

Evidence links false beliefs about biological differences to systematic underestimation of Black patients’ pain and to downstream treatment differences. In PMEv terms, this primarily appears as a credibility prior shift that makes self-report less sufficient, increasing threshold demands before the system will route to relief-oriented protocols.

9.2 Sex bias

Evidence from emergency department contexts reports sex-linked differences in pain management that disadvantage women relative to men at comparable self-reported intensity. In PMEv terms, this most visibly distorts protocol routing: the same claim more often produces conservative treatment pathways and delayed closure rather than immediate response execution.

9.3 Weight bias

Weight-based bias often reframes pain as an expected consequence of body size rather than as a distinct claim requiring investigation. In PMEv terms, this is a causal reclassification move that converts the pain report into lifestyle attribution, increasing surveillance and deferral while lowering closure probability.

9.4 Cultural and linguistic mismatch

Cross-cultural and language discordance effects often arise even without disbelief: the reporter’s encoding conventions do not match the receiver’s signal dictionary. In PMEv terms, this is primarily a signal alignment (P) failure that increases misclassification risk and drives channel switching, repetition, or escalation as the reporter attempts to restore interpretability.

9.5 Age-related bias (pediatric and geriatric)

Age distortions commonly take opposite forms: pediatric pain is treated as unreliable expression, while geriatric pain is treated as normal background. In PMEv terms, both are category-default substitutions that compress the individual reference claim into a stereotype baseline, reducing the system’s sensitivity to severity shifts and delaying closure.

9.6 Disability and chronic illness stigma

Chronic and disability-associated pain can trigger a longitudinal credibility inversion: recurrence itself becomes treated as evidence against legitimacy. In PMEv terms, the distortion accumulates across episodes as prior non-closure is imported into future decoding, escalating proof demands and accelerating drift through repeated open-event cycles.

9.7 Transgender bias

Research documents that transgender and gender-diverse individuals experience systematic disparities in pain assessment and treatment, including higher rates of dismissal, misattribution of symptoms, and delayed care. These effects are observed even when controlling for reported pain severity and clinical presentation.

In PMEv terms, transgender bias primarily operates as a credibility instability triggered by identity incongruence with normative gender expectations. Pain reports are more likely to be reframed as psychosomatic, hormone-related, or non-specific, increasing evidence thresholds and routing events into surveillance or deferral protocols rather than resolution-oriented responses. The result is reduced closure probability and elevated recurrence across repeated events.

9.8 Structural synthesis

These bias layers are distinct not because they are “different prejudices,” but because they distort different PMEv operators: credibility priors, protocol selection bias, causal reclassification, signal dictionary mismatch, category-default substitution, history-weighted decoding, and identity-based credibility instability triggered by norm incongruence. The system-level consequence is predictable: unequal closure rates and unequal drift trajectories for equivalent reference conditions.

9.9 Implication for interpretation

Bias functions as a structural distortion layer that changes:

• credibility assignment rates

• evidence thresholds

• protocol routing

• closure probability

10. MSS variable mapping for PMEv

This section maps PMEv dynamics onto the MSS variable set.

10.1 Truth Fidelity (T)

In PMEv, T concerns whether the system treats the pain claim as a legitimate reference report given asymmetric access. The IASP notes that the report should be respected, while empirical findings on underestimation and invalidation demonstrate systematic departures from that posture in practice.

Candidate observables: credibility grant rate, downgrade frequency, explicit disbelief markers, documentation requirement escalation.

10.2 Signal Alignment (P)

P concerns alignment between encoding and decoding: whether the signal produced is interpreted as intended.

Candidate observables: mismatch rate between reported severity and perceived severity; cue-weight shifts across contexts; channel misfit patterns.

10.3 Structural Coherence (C)

C concerns the stability and clarity of rules that govern response and closure.

Candidate observables: role clarity, predictable pathways to accommodation, consistency of evidence thresholds across episodes, presence of adjudication escalation paths.

10.4 Drift (D)

D concerns the rate of accumulated misalignment across repeated PMEv cycles.

Candidate observables: recurrence interval shortening, escalation intensity increases, channel switching frequency, documentation burden increases, trust deterioration markers.

10.5 Affective Regulation (A)

A concerns regulation conditions that affect encoding, decoding, and response stability. Research on validation and empathic behavior in couples provides a social mechanism pathway for regulation in chronic pain contexts.

Candidate observables: escalation frequency, interruption patterns, repair latency, post-event stability window length.

11. Measurement candidates

11.1 Field-observable metrics (non-instrumented)

• PMEv closure rate (per sample window)

• Time-to-response latency (report → response initiation)

• Protocol mismatch rate (requested vs delivered protocol)

• Evidence-threshold escalation rate (proof demands over time)

• Channel switching frequency

• Recurrence interval (days between open-event reactivation)

• Stratified closure rate (closure rate segmented by demographic or identity-linked categories where available)

11.2 Artifact sources by interface

• Relationships: message threads, calendars, task logs (when present)

• Clinical: intake forms, visit summaries, chart notes (availability varies)

• Workplace: accommodation requests, attendance artifacts, meeting notes

• Online: posts, comment threads, moderation actions

11.3 Anchoring instruments (for reference)

• Pain-Invalidation Scale development work provides an example of operationalizing invalidation as a measurable construct.

11.4 Limits

No metric directly measures the private reference condition. The target of measurement here is interpretive stability: credibility operations, protocol selection, closure probability, and drift patterns.

12. Generalization beyond pain

Pain communication illustrates a broader class of meaning problems: high-salience claims with asymmetric access and consequential response selection. The PMEv approach is designed to transfer to other domains with similar structure (for example disability accommodation and triage), while preserving domain-specific evidence thresholds and protocol families.

Institute Signature

Pain communication is a definitive case for Meaning System Science because the reference condition is real and consequential, yet unevenly accessible across participants. The system must therefore rely on encoded signals, inference, credibility assignment, and role-governed response protocols. This is not a moral defect in the participants. It is the structural condition of shared action under asymmetric access.

The PMEv model clarifies why pain becomes negotiated. A private condition can only enter shared reality through interpretation. That interpretation is constrained by evidence thresholds, prior beliefs, role authority, and available closure pathways. When these constraints align, response becomes reliable and closure becomes repeatable. When they do not, the same event cycles repeatedly through contested credibility, mismatched protocols, and unfinished response. Drift then becomes visible as a rate of accumulating misalignment across episodes.

This is the human cost that the paper formalizes without reducing it to intent. Many pain failures are not primarily failures of empathy. They are failures of interpretive architecture. People can care and still misread. They can believe and still choose the wrong protocol. They can respond and still fail to close the event because the pathway is incomplete, the threshold is unstable, or authority routing blocks resolution.

This framing does not minimize suffering, but it makes the failure legible. It also clarifies what “validation” is in system terms. Validation is not agreement about cause, diagnosis, or severity. It is the decision to treat the report as legitimate enough to trigger a coherent response pathway with explicit closure conditions. When that decision is inconsistent, the system trains the reporter to escalate, withdraw, switch channels, or stop reporting. The resulting instability is a predictable output of the system.

IFS-1 closes with this claim: Pain communication shows that meaning is not only created by what is true inside a person. Meaning is also created by what a system can recognize, route, and close together. When systems cannot do that reliably, suffering becomes harder to resolve because it must repeatedly pass through uncertainty before it can be met.

The most lasting suffering arises when pain remains real for one person and unreal for everyone else.

Citation

Vallejo, J. (2025). Pain Communication Systems (IFS-1). Transformation Management Institute.

References

• International Association for the Study of Pain (IASP). “IASP Announces Revised Definition of Pain.” 2020.

• Raja, S. N., et al. “The revised IASP definition of pain: concepts, challenges, and compromises.” 2020.

• Craig, K. D. “Social communication model of pain.” Pain. 2015.

• Seers, T., et al. “Professionals underestimate patients’ pain: a comprehensive review.” Pain. 2018.

• Sebring, J. C. H., et al. “Medical invalidation in the clinical encounter.” CMAJ Open. 2023.

• Nicola, M., et al. “Defining pain-validation: The importance of validation in reducing the stresses of chronic pain.” Frontiers in Pain Research. 2022.

• Nicola, M., et al. “The Pain-Invalidation Scale: Measuring patient perceptions of invalidation toward chronic pain.” The Journal of Pain. 2022.

• Edmond, S. N., & Keefe, F. J. “Validating pain communication: Current state of the science.” 2015.

• Leong, L. E. M., et al. “A perspective-taking manipulation leads to greater empathy and less pain during the cold pressor task.” The Journal of Pain. 2015.

• Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. “Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.” PNAS. 2016.

• Guzikevits, M., et al. “Sex bias in pain management decisions.” PNAS. 2024.

• Kappesser, J., & Williams, A. C. de C. “The facial expression of pain in humans considered from an evolutionary perspective.” 2019.

• Prkachin, K. M., & Solomon, P. E. “The structure, reliability and validity of pain expression.” 2008.

• Teichmüller, K., et al. “Empathy and validation in chronic pain couples.” 2025.

• Phelan, S. M., et al. “Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.” Obesity Reviews, 2015.

• Sabin, J. A., et al. “Physicians’ implicit and explicit attitudes about weight and race and treatment of pain.” Medical Care, 2012.

• Anderson, K. O., et al. “Racial and ethnic disparities in pain: causes and consequences.” Journal of Pain, 2009.

• Green, C. R., et al. “The unequal burden of pain: confronting racial and ethnic disparities in pain.” Pain Medicine, 2003.

• Herr, K., et al. “Pain assessment in the patient unable to self-report.” Pain Management Nursing, 2011.

• Makris, U. E., et al. “Management of persistent pain in the older patient.” JAMA, 2014.

• Werner, A., & Malterud, K. “It is hard work behaving as a credible patient.” Social Science & Medicine, 2003.

• De Ruddere, L., et al. “Patients’ experiences with pain communication in chronic pain.” Health Psychology, 2012.

• Romanelli, M., & Lindsey, J. (2020). Patterns of healthcare discrimination among transgender adults reporting pain-related conditions. Journal of General Internal Medicine.

• Kcomt, L., et al. (2020). Health care avoidance due to anticipated discrimination among transgender people. American Journal of Preventive Medicine.