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Table 5 Rationale for inclusion of pain assessment items in PAIC

From: An international road map to improve pain assessment in people with impaired cognition: the development of the Pain Assessment in Impaired Cognition (PAIC) meta-tool

 

Frequency of use in published tools

Item explanation derived from published tools

FACIAL EXPRESSION

Pained expression

1

Facial display of pain

Frowning

7

Lowering and drawing brows together

Narrowing eyes

1

Grimacing, narrowed eyes with tension around the eyes

Closing eyes

3

Not just blinking

Raising upper lip

1

Grimacing, upper lip raised, nose may be wrinkled

Opened mouth

1

The lips are parted, jaw is dropped

Tightened lips

2

Lips are pressed together and appear more narrow

Clenched teeth

3

Teeth are pressed together with tension

Empty gaze

1

Eyes do not reflect any emotion or thinking activity (“blank expression”)

Seeming disinterested

1

Face does not reflect any interest in the environment

Pale face

1

Pale skin colour

Teary eyed

5

Watery eyes

Looking tense

3

Facial display of strain or worry

Looking sad

6

Facial display of unhappiness, sorrow or low mood

Looking frightened

6

Facial display of fear, alarm or heightened anxiety

BODY MOVEMENTS

Freezing

2

Tense, sudden stiffening, rigid, avoiding movement, holding breath

Curling up

3

Curling up the body tightly, pulling in arms and legs

Clenching hands

4

Tensing hands, making fists, grabbing objects tightly

Resisting care

5

Resisting being moved or resisting care, being uncooperative

Pushing

2

Actively pushing somebody or something away

Guarding

7

Protecting affected area, holding body part, avoiding touch, moving away

Rubbing

3

Tugging or massaging affected area

Limping

3

Avoiding pain while walking in an uneven way

Restlessness

9

Fidgeting, agitation, rocking back and forth

Pacing

2

Wandering restlessly back and forth (might also be in a wheelchair)

VOCALISATION

Using offensive words

2

Cursing, swearing, or using foul language

Using pain-related words

5

Using pain words, like “ouch”, “ow”, or “that hurts

Repeating words

2

Repeating words or phrases again and again (not stuttering)

Complaining

3

Expressing being unhappy, sick, uncomfortable, and/or in pain

Shouting

1

Using a loud voice to express words

Mumbling

3

Uttering words and/or sounds indistinctly

Screaming

4

Using a loud and/or high-pitched voice to express sounds

Groaning

10

Moaning, making a deep, inarticulate sound

Crying

10

Whimpering, sobbing, wailing, or weeping

Gasping

4

Breathing sharply, laboriously, and/or loudly

Sighing

3

Taking in and letting out a long, loud breath