Table 1

Modified TPPPS

1 Verbal expression of pain
Verbal pain complaint—any word, phrase or statement that refers to pain, hurt or discomfort.
Examples: “It hurts”, “Ow”, “Oh”, “You're hurting me”.
2Cry—tears in the eyes or running down the face and/or making sobbing sounds.
Examples: sobbing, tears in the eyes, tears falling down cheeks.
3Groan, moan, grunt—deep, low-pitched vocalisations expressing pain, hurt or discomfort.
Examples: non-intelligible, low-pitched sounds. May be drawn out (moan) or abrupt (grunt).
4Scream—acute, loud, high pitched cry.
Examples: sharp, shrill, harsh, high-pitched vocalisation, shriek.
5 Facial expression of pain
Open mouth, lips pulled back at corners—open mouth, lips pulled back at corners with a downward pull on the jaw.
6Squint/close eyes—eyelids taut, stiff, closed or nearly closed with wrinkling of the skin at the lateral aspect of the eyes.
7Brow bulge/forehead furrow—bulging, creasing, or furrows above and/or between the eyebrows.
8 Bodily expression of pain
Restless motor behaviour—rub/touch painful area, or unrestrained activity. May appear random or to lack goal direction. The body and/or head is never still.
Examples: twisting and turning of torso and/or head while lying down, flailing of arms and/or legs, arching, repetitive fine motor activity. Child touches incisional area, iv site.