Which facial movements are pain indicators of patients with traumatic brain injury?

Background and Aim: Although self- reporting of pain considered as the gold standard in evaluation of this sign, many of Traumatic Brain Injury (TBI) patients with variable levels of consciousness are not able to express their pain verbally. This point is an important and basic problem for caregivers and researchers. Therefore, this study was conducted to evaluate the behavioral pain indicators in patients with different levels of consciousness due to TBI.

Method: Thirty-five TBI patients with different consciousness level were selected by convenience sampling method in 2016. Data were collected through observation of patient's behavior in two painful and nonpainful situations. The results of the observation were recorded in a checklist containing 16 facial painrelated behaviors. It was completed through direct observation by the researcher focusing on the patient's face and examining the films recorded from the patient at various directions.

Results: The findings showed that facial expression changes observed more than other behaviors during the painful procedure. These facial expression changes were levator contraction (65.7%), frowning (31.4%), and sudden eye opening (34.3%), and lip changes (31.4%).

Conclusion: The findings of this study indicate that pain behaviors in TBI patients with different levels of consciousness are untypical. Also, changing in facial expressions can be helpful in the pain assessment in these patients. Therefore, it is suggested that specific behavioral tools should be designed and tested to evaluate the pain of TBI patients.