Does it Matter if the Resident Being Assessed is Smiling?

Posing effects such as the one that occurs with smiling are inevitable to occur; however, the user needs to do the automated facial analysis component of the Assessment within an acceptable range of distance, and preferably without raising the attention of the Resident.

The way we communicate with our Residents in relation to the PainChek Assessment is also important. Phrases such as “I am going to take a photo of you” should be avoided. Instead, these phrases should be used: “I will be doing a scan of your face to assess your pain”. This scan represents a snapshot of time. Similarly for Residents who can self-report, this piece of information i.e. ‘pain report’ conveys the message of pain experience for a brief period of time, and this experience changes, if they get distracted, (e.g. when watching TV, the presence of too many people), or given something for Pain Relief (e.g. massage therapy, or pain medications). Further, the analysis involves a scan of the face and does not actually take a photo.

Research supports the presence of “smile of pain” as a means by which the sufferer tells the world that they are fine despite the unpleasant experience https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760104/. Therefore, one of the facial features that exist in PainChek is ‘cheek raising’, which is also involved in smiling. There is strong evidence for this facial feature to be associated with the presence of pain.

Pain is a multidimensional experience, that is not influencing the face alone. That’s why PainChek has other pain behaviours distributed across the remaining 5 domains. Some Residents manifest their pain through various non-verbal means of communication. Some Residents express their pain more through changes in their facial expressions, and others through changes in other pain behaviours (e.g. vocalisations, movements and/or behaviours). More importantly, changes in facial expressions alone and without changes in any of the pain behaviours may not indicate the presence of pain. PainChek was built on these scientific bases.

In terms of PainChek pain scoring: No Pain (0-6), Mild Pain (7-11), Moderate Pain (12-15), and Severe Pain (16 plus). So, if a Resident scores a total of up to 6 indicators, this will be recorded as No Pain. Unless there is an exaggeration of facial response (as the case with people who are cognitively intact), the PainChek App won’t be able to record a very high number of facial features (e.g. 5-7). According to the literature, Residents with dementia cannot feign their facial expressions, compared to those with intact cognition. As a reminder, PainChek is only approved and validated for Residents with who cannot verbalise (e.g. those with dementia or cognitive impairment) and should not be used for those who are able to self-report, as this is the current gold standard.