What Do the PainChek Descriptors Mean?

Descriptor

Explanation

Time frame to consider upon recording items

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

At the time of assessment

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

At the time of assessment

Tightening of eyelids

Anatomical changes in upper face:

· Tightening of the eyelids

· Narrowing of the eye aperture

· Raising of lower lid

At the time of assessment

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

At the time of assessment

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

At the time of assessment

Pulling at corner lip

Anatomical changes in lower face:

· Raising or oblique movement of lateral corners of the lips

At the time of assessment

Horizontal mouth stretch

Anatomical changes in lower face:

· Bilateral stretch of lips

At the time of assessment

Parting lips

Anatomical changes in lower face:

· Relaxed opening the mouth with downward movement of the jaw

At the time of assessment

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)

At the time of assessment

Descriptor

Explanation

Time frame to consider upon recording items

Noisy pain sounds

Sounds or utters related to pain e.g. ouch, ah, mm.

At the time of assessment

Requesting help repeatedly

Include one or more of the followings:

· 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.

At the time of assessment

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.

At the time of assessment

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.

At the time of assessment

Crying

Weeping, sobbing or whimpering

At the time of assessment

Screaming

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

At the time of assessment

Loudtalk

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

At the time of assessment

Howling

Producing a long wailing cry sound.

At the time of assessment

Sighing

Breathing in followed by long audible sound upon breathing out.

At the time of assessment

Descriptor

Explanation

Time frame to consider upon recording items

Altered or random leg/arm movement

Changed or random movement of any of the limbs.

At the time of assessment

Restlessness

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

At the time of assessment

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.

At the time of assessment

Guarding/touching body part

Protecting affected area by holding body part.

At the time of assessment

Moving away

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

At the time of assessment

Abnormal sitting/standing/walking

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

At the time of assessment

Pacing/wandering

Roaming restlessly back and forth.

At the time of assessment

Descriptor

Explanation

Time frame to consider upon recording items

Introvert

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

Over the last 7 days

Verbally abusive

Verbally abusive, swearing, or insulting language.

At the time of assessment

Aggressive

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

At the time of assessment

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

At the time of assessment

Inappropriate behaviour

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

Over the last 7 days

Confused

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

At the time of assessment

Distressed

Anxious, worried and agitated.

At the time of assessment

Descriptor

Explanation

Time frame to consider upon recording items

Resisting care

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

Over the last 7 days

Prolonged resting

Longer than usual periods of physical inactivity.

Over the last 7 days

Altered sleep cycle

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

Over the last 7 days

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).

Over the last 7 days

Descriptor

Explanation

Time frame to consider upon recording items

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).

At the time of assessment

Pale/flushed (red-faced)

Colour faded or red-coloured face.

At the time of assessment

Feverish/cold

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

At the time of assessment

Rapid breathing

Fast rate of breathing.

At the time of assessment

Painful injuries

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

Over the last 7-14 days

Painful medical conditions

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 medical history