Table 3.

Sources of pain recognition reported by healthcare personnel.

Sources of pain recognition46	Examples as described in included studies
Observation of behavioural changes
Unspecified39,40,43,50 –52
Behaviours suggestive of pain40 –42,44 –50,52	Grimacing, repetitive rubbing or touching body parts, clenching jaw or fist, bracing body part, changing position, reluctance to move, unusual body movements, moaning, wincing when moved, grunting, whining, sudden limping, tossing and turning in chair or bed, moving head back and forth, body stiffens, sad eyes, dark eyes, empty look, mouth movements, hanging mouth, frowning, narrowed eyes, closed eyes, raising upper lip, opened mouth, tightened lips, empty gaze, seeming disinterested, teary eyed, looking tense, looking sad, looking frightened, curled up position
Behaviours highly suggestive of pain41,44 –46,48 –50,52	Crying, intense guarding, suddenly inability to raise arms, painful look, screams, groaning
General behaviour changes40 –42,44 –46,48,49,51	Withdrawal, restless behaviour, agitation, moodiness, irritability, pacing, sleep disturbance, refusal to eat, depression, unusual quietness, negative vocalizations, decreased participation in activities, changes in sociability, desire to be left alone, anxious behaviour, alterations in daily activities
Resident self-report
Verbal self-report43,44,46,48	Spontaneous self-report, resident response to staff asking about pain
Observation of signs of pain
Visible signs of pain41,42,44,45	Skin colour, oedema in joints, blood on diaper or clothing, changes in vital signs, trembling, falls, limited range of motion, perspiration, contractions
Known indicators of pain
Visible/obvious reasons for pain44,45	Surgery, fracture, terminal
Nonvisible/not obvious reason for pain44,46,49	Knowledge of painfull diagnosis, increase in blood pressure