Clinical Guide for Identifying PainChek Assessment Facial Features – PainChek Support

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When performing a manual PainChek® assessment of the face, you will need to determine if the 9 facial features that indicate pain are present or not.

The following table describes how those 9 features are identified and displays a sample image of a person displaying the feature.

Feature	Description and example image
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
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
Tightening of eyelids	Anatomical changes in upper face Tightening of the eyelids Narrowing of the eye aperture Raising of lower lid
Wrinkling of nose	Anatomical changes in central face Pulling of skin upward along the side of the nose towards the root of the nose Appearance of wrinkles along the side and root of nose Wrinkling of infraorbital furrow Lowering the medial portion of the eyebrows Pulling the centre of the upper lip upwards
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
Pulling at corner lip	Anatomical changes in lower face Drooping or oblique movement of lateral corners of the lips.
Horizontal mouth stretch	Anatomical changes in lower face Bilateral stretch of lips.
Parting lips	Anatomical changes in lower face Relaxed opening of the mouth i.e. jaw drop
Closing eyes	Shutting both eyes for at least half a second

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