Although we have lost the reference, a nursing pain specialist wrote an article where she commented on the fact that so many Central Pain patients giggled or smiled when she interviewed them. About one third did this. Another author made similar comments about some of the Viet Nam boat people. What do you do when you are nobody, and somebody is interviewing you. They were embarassed about the loss of humanity which their torture and/or rape had inflicted. They were not sure how the doctor would feel about them, listening to what they had been through, the degredation. They were hoping not to be rejected as human beings.
The smile does not reflect well being. It has meaning but is meaningless as far as a measure of what severe chronic pain is like. Recently I observed an innocent child who had gone into a bedroom where someone was asleep. His mother, not wanting him in the sleeping area, challenged him and asked,
