PainChek® Assessment Domains and Descriptors

Face

Brow lowering

Anatomical changes in upper face (lower central forehead):

* Lowering down of both eyebrows.

* Movement of eyebrows towards each other.

* Appearance of vertical or oblique wrinkles between eyebrows in the lower central part of the forehead.

Consider this item at the time of assessment.

Face

Cheek raising

Anatomical changes in central face (infraorbital region):

* Pulling of skin towards the eye.

* Pulling the cheeks upward by lifting of the infraorbital triangle.

* Narrowing the eye aperture and wrinkling the skin below the eye.

* Appearance of Crow’s feet lines or wrinkles.

* Deepening of the lower eyelid furrow.

Consider this item at the time of assessment.

Face

Tightening of eyelids

Anatomical changes in upper face:

* Tightening of the eyelids.

* Narrowing of the eye aperture.

* Raising of lower lid.

Consider this item at the time of assessment.

Face

Wrinkling of nose

Anatomical changes in central face:

* Pulling of skin upward along the side of the nose towards the root (top) of the nose.

* Appearance of wrinkles along the side and root of nose.

* Wrinkling of infraorbital furrow.

* Lowering the medial (middle) portion of the eyebrows.

* Pulling the centre of the upper lip upwards.

Consider this item at the time of assessment.

Face

Raising of upper lip

Anatomical changes in central-lower face:

* Prominent deepening or wrinkling of infraorbital furrow.

* Deepening of nasolabial furrow.

* Pouching at upper lip and nasal passages.

* Widening and raising of the nostril wings.

Consider this item at the time of assessment.

Face

Pulling at corner lip

Anatomical changes in lower face:

* Raising or oblique movement of lateral corners of the lips.

Consider this item at the time of assessment.

Face

Horizontal mouth stretch

Anatomical changes in lower face:

* Bilateral stretch of lips.

Consider this item at the time of assessment.

Face

Parting lips

Anatomical changes in lower face:

* Relaxed opening the mouth with downward movement of the jaw.

Consider this item at the time of assessment.

Face

Closing eyes

Anatomical change in upper face:

* Closing of both eyes for at least half a second (eyes do not need to be completely closed).

Consider this item at the time of assessment.

Voice

Noisy pain sounds

Sounds or utterances related to pain (e.g. ouch, ah, mm).

Consider this item at the time of assessment.

Voice

Requesting help repeatedly

Include one or more of the following:

* Expressing numerous verbal requests of help within short periods of time (e.g. “help me, help me”).

* Constant talking.

* Repetitive use of words or phrases (i.e. echophrasia).

* Verbal nonsense.

* Vocalizations with/without discernible meaning.

Exclude verbal requests for ADL purposes.

Consider this item at the time of assessment.

Voice

Groaning

Making a brief, strong, deep-throated, creaking sound - emitted involuntarily.

'Groaning' is often present at the same time as 'Moaning' - please consider both indicators.

Consider this item at the time of assessment.

Voice

Moaning

Producing a prolonged, more or less continuous, low, inarticulate or incomprehensible sound.

'Moaning' is often present at the same time as 'Groaning' - please consider both indicators.

Consider this item at the time of assessment.

Voice

Crying

Weeping, sobbing or whimpering.

Consider this item at the time of assessment.

Voice

Screaming

Using a very loud voice when communicating (e.g. shouting, yelling).

Consider this item at the time of assessment.

Voice

Loud Talk

Communicating by speaking loudly (i.e. with greater volume than usual).

Consider this item at the time of assessment.

Voice

Howling

Producing a long wailing cry sound.

Consider this item at the time of assessment.

Voice

Sighing

Breathing in followed by long audible sound upon breathing out.

Consider this item at the time of assessment.

Movement

Altered or random leg/arm movement

Changed or random movement of any of the limbs.

Consider this item at the time of assessment.

Movement

Restlessness

Unable to relax and/or rest, difficulty concentrating, uneasiness (e.g. fidgeting, rocking, tapping).

Consider this item at the time of assessment.

Movement

Freezing

Sudden stiffening, avoiding movement, holding breath.

An abnormally stiff, rigid or interrupted movement while changing position.

This is not related to the temperature of the person being assessed.

Consider this item at the time of assessment.

Movement

Guarding/touching body part

Protecting affected area by holding body part.

Consider this item at the time of assessment.

Movement

Moving away

Avoiding being touched by moving away (e.g. swaying away) from a physical interaction.

Consider this item at the time of assessment.

Movement

Abnormal sitting/standing/walking

A change to usual posture when sitting or standing, and/or a changed gait when walking (e.g. limping).

Consider this item at the time of assessment.

Movement

Pacing/wandering

Roaming restlessly back and forth.

Consider this item at the time of assessment.

Behavior

Introvert

Being unsocial or socially isolated (e.g. reluctant to be involved in social activities, avoiding social interaction with others).

Consider this behavior over the last 7 days.

Behavior

Verbally abusive

Verbally abusive, swearing, or insulting language.

Consider this behavior at the time of assessment.

Behavior

Aggressive

Involved in combative or violent behavior, physically or verbally aggressive.

Consider this behavior at the time of assessment.

Behavior

Fear or extreme dislike of touch, people

Fearful response to being touched or physical interaction with people including family members, other residents, and/or aged care staff.

Consider this behavior at the time of assessment.

Behavior

Inappropriate behavior

Aberrant or socially unacceptable behavior (e.g. taking things from others, sexually inappropriate behavior, going into other people's rooms without invitation).

Consider this behavior over the last 7 days.

Behavior

Confused

Unclear in thinking or understanding (e.g. unable to follow instructions, asking repetitive questions), may be disoriented to time, place, or person.

Consider this behavior at the time of assessment.

Behavior

Distressed

Anxious, worried and agitated.

Consider this behavior at the time of assessment

Activity

Resisting care

Unwilling and/or refusing to receive care (e.g. any Activities of Daily Living (ADL) care).

Consider this activity over the last 7 days.

Activity

Prolonged resting

Longer than usual periods of physical inactivity.

Consider this activity over the last 7 days.

Activity

Altered sleepcycle

Changed sleep-wake cycles (e.g. long sleeps during the day, changed sleep or wake times).

Consider this activity over the last 7 days.

Activity

Altered routines

Changes to the order or timing of usual activities, or changes in activity preference from usual (e.g. breakfast in room requested instead of usual breakfast in dining room, no longer choosing to read the newspaper each morning).

Consider this activity over the last 7 days.

Body

Profuse sweating

Excessive sweating in various parts of the body excluding circumstances caused by environmental factors (e.g. no air conditioning or lack of proper ventilation).

Consider this item at the time of assessment.

Body

Pale/flushed (red-faced)

Color faded or red-coloured face.

Consider this item at the time of assessment.

Body

Feverish/cold

Changes in body temperature either too hot (e.g. presence of fever or sweats) or too cold (e.g. shivering).

Consider this item at the time of assessment.

Body

Rapid breathing

Fast rate of breathing.

Consider this item at the time of assessment.

Body

Painful injuries

Any active or recent injuries which may result in pain (e.g. falls, pressure areas or injuries, active wounds, skin tears).

Consider injuries over the last 7-14 days

Body

Painful injuries

Previously documented chronic conditions in medical history (e.g. arthritis, chronic pain), or acute conditions known to cause pain (e.g. dental infections, recent surgeries).

Consult the persons medical history.