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Table 6 Pain assessment by observer ratings in PAIC tool: Facial Expressions items*

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

FACIAL EXPRESSIONS

MEANING OF ITEMS

Not at all

Slight degree

Moderate degree

Great degree

Not scored

a = Item is not clear

b = Situation is unsuitable

c = Physical status of person not suitable for scoring

d = Other

Pained expression a

Facial display of pain

0

1

2

3

a b c d

Frowning a

Lowering and drawing brows together

0

1

2

3

a b c d

Narrowing eyes c

Narrowed eyes with tension around the eyes

0

1

2

3

a b c d

Closing eyes c

Not just blinking

0

1

2

3

a b c d

Raising upper lip c

Upper lip raised, nose may be wrinkled

0

1

2

3

a b c d

Opened mouth c

The lips are parted, jaw is dropped

0

1

2

3

a b c d

Tightened lips c

Lips are pressed together and appear more narrow

0

1

2

3

a b c d

Clenched teeth c

Teeth are pressed together with tension in the jaw

0

1

2

3

a b c d

Empty gaze b

Eyes do not reflect any emotion or active thought (“blank expression”)

0

1

2

3

a b c d

Seeming disinterested b

Face does not reflect any interest in the environment

0

1

2

3

a b c d

Pale face d

Pale skin colour

0

1

2

3

a b c d

Teary eyed d

Watery eyes

0

1

2

3

a b c d

Looking tense e

Facial display of strain or worry

0

1

2

3

a b c d

Looking sad e

Facial display of unhappiness, sorrow or low mood

0

1

2

3

a b c d

Looking frightened e

Facial display of fear, alarm or heightened anxiety

0

1

2

3

a b c d

  1. *Instructions to users: Please record the appearance of each facial expression described in the table below. Rate the intensity of the expression from ‘not at all’ to ‘a great degree’. If an item is not scored please indicate why not.
  2. Subcategories: aemotion, bcognition, canatomical orientation, dautonomic reaction, equalitative judgment of expression.