A NOVEL TASK TO ASSESS SOCIAL COGNITION IN CHRONIC PAIN: EXPLORING THE VALIDITY OF THE FACE TEST

F. Ferrara, A. Telesca, V. Faltracco, E. Dalla Bella, L. Grazzi, N. Riva, G. Devigili, S. Usai, M. Consonni | Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano

AIMS This study investigates the construct validity and the diagnostic value of the FAcial Complex Expressions (FACE) test, a novel measure designed to assess recognition of complex mental states from facial cues. As this test has not been previously used in individuals with chronic pain, we investigated whether it reliably reflects social cognition abilities.
MATERIALS
A total of 58 consecutive patients were administered the 18-items version of the FACE test [i.e., FACE – Version A (FACE-A)]. They also completed the Story-Based Empathy Task (SET) for social cognition, including Causal Inference (SET-CI), Emotion Attribution (SET-EA), Intention Attribution (SET-IA); global cognitive screening [the Montreal Cognitive Assessment (MoCA)]; executive functions [Stroop task, backward digit span, symbol digit modalities test (SDMT)]; language [naming]; visuospatial skills [Rey-Osterrieth Complex Figure (copy)]; memory [Rey-Osterrieth Complex Figure (recall)]. Mood [Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI)], social functioning [Lubben Social Network Scale (LSNS), UCLA-3items-Loneliness scale (UCLA-3)] and pain severity [Pain Detect, 10-item Numeric Rating Scale (NRS)] were also assessed.
METHODS
Descriptive statistics and correlation analyses tested the convergent and divergent validity of FACE-A with other psychometric measures. Exploratory correlations examined associations with mood, social functioning, and cognitive performances.
RESULTS
Results showed that 75.86% of patients performed within the normal range on the FACE-A, 17.24% had borderline scores while 6.9% showed impaired performance. These findings are comparable to those on the SET, where 86.21% scored within normal limits and 5.17% showed impairment. The highest overlap in altered performance was found between the SET-EA subscale and the FACE test (8.62%). Divergent validity analyses (FACE-A vs. language, visuospatial, and recognition memory tasks) showed no significant correlations (p > .05). Convergent validity analyses revealed significant associations with executive function tasks—specifically, Digit Span Backward and the SDMT (p < .05). Surprisingly, no significant correlations were found between FACE-A and SET scores. Interestingly, FACE-A scores showed a weak but statistically significant correlation with the HADS global score (ρ = 0.294, p =.031).
DISCUSSION
This is the first study addressing the use of the FACE-A test, a new and highly recommended task to evaluate the affective theory of mind, in individuals with chronic pain. Our findings suggest that only a small percentage of patients had difficulties in emotion recognition (8.62%) and that performance at this task was associated with executive functions, suggesting relative preservation of frontal-lobe processes. Furthermore, our results highlight that the FACE-A test and the SET are not interchangeable, as they assess distinct components of social cognition: the FACE-A test targets emotional decoding from facial cues, while the SET involves narrative and contextual inference. This dissociation may reflect engagement of different neural circuits.
CONCLUSIONS Our findings suggest that social cognition is not a core feature of the cognitive profile in individuals with chronic pain. We recommend the use of both the FACE-A test and the SET for a comprehensive assessment of the social cognition domain.