Feedback improves nonverbal pain assessment by altering social learning dynamics

Accurate recognition of others’ pain is critical for empathy and effective clinical care, yet pain is frequently biased by underestimation. Although feedback can improve emotion recognition, learning dynamics and social factors through which feedback enhances pain assessment from facial expressions remain unclear. Forty-seven participants judged others’ (Targets’) pain based on facial responses, and half (n = 23) received trial-by-trial feedback reflecting Targets’ self-reported pain. Feedback robustly improved accuracy in categorical pain judgments (p < .05) and continuous intensity assessments (p < .001), independent of Targets’ pain. Critically, feedback produced distinct learning dynamics, eliminating the No Feedback Group’s underestimation bias by jointly correcting over- and underestimation over time. Perceived similarity and confidence further dissociated the mechanisms underlying performance with versus without feedback. These findings illustrate that feedback engages a multidimensional learning process that improves pain assessment beyond spontaneous adaptation, highlighting potential for bias-reducing and evidence-based training protocols in clinical pain assessment.