Preprint / Version 1

How is artificial intelligence helping the diagnosis of pain?

A Systematic Review

##article.authors##

  • Jonathan Hsueh Polygence
  • Chao-Tung Yang Distinguished Professor in the Department of Computer Science, Tunghai University, Taichung, Taiwan

DOI:

https://doi.org/10.58445/rars.1162

Keywords:

artificial intelligence, emergency response, facial expression, healthcare

Abstract

Complex decision-making shrouded in uncertainty is at the core of emergency medical treatment. Visits to the emergency department force doctors and nurses to identify patients with life-threatening conditions from the ones with more common benign diagnoses. Doctors currently use self-assessment models to diagnose pain (Visual Analog Scale VAS). Artificial Intelligence has shown promise in streamlining the diagnosis of pain for medical purposes. We used Google Scholar, ScienceDirect, Springer, and Oxford Academic to perform a literature review. Most research papers got their data and sources from volunteers and established medical databases. Some common databases were the UNBC-McMaster database, the MIntPAIN database, and the BioVid database. These databases collected medical images concerning pain and pain expression. The AI models used a variety of pain scales. There were many Machine Learning models and classifiers that researchers used. The basic models were Convolutional Neural Networks (CNN), Support Vector Machines (SVM), K-Nearest Neighbor, Logistic regression and linear regression models etc. The studies researched the model’s capabilities in pain detection and pain intensity estimation. The mean accuracy for the detection of pain among the papers was 85.05%. The mean accuracy for the current pain intensity was 73.90%. The Automatic Coding of the Facial Action Coding System (FACS) is useful for diagnosing pain (7). Developing a pre-trained Machine Learning (ML) model is useful for diagnosing pain. This review confirms that AI/ML technologies can be used to detect pain through facial expressions at a high potential. Artificial intelligence could be a helpful tool in providing objective accurate measurements of pain intensity. It would support doctors and clinicians to make more informed decisions during rush hour emergency moments. An issue of training an Artificial Intelligence model is the need for large amounts of data. The patient’s ethical considerations around privacy and algorithm biases must be addressed. 

Author Biography

Chao-Tung Yang, Distinguished Professor in the Department of Computer Science, Tunghai University, Taichung, Taiwan

He joined the faculty of the Department of Computer Science at Tunghai University as an Associate Professor. He became a full Professor in August 2007, a Distinguished Professor in August 2015, and a Lifetime Distinguished Professorin August 201He received the Outstanding Engineering Professor Award by the Chinese Institute of Engineers (CIE) in May 2021. Dr. Yang was awarded thirteen times (2010~2022) Talent Awards from the National Science and Technology Council (NSTC). His current research interests are in Cloud computing, Big data, Parallel and multicore computing, and Web-based applications. He is a senior member of the IEEE. He is lifetime members of IICM and TACC in Taiwan. 

References

Stewart, Jonathon, et al. “Applications of Machine Learning to Undifferentiated Chest Pain in the Emergency Department: A Systematic Review.” PLOS ONE, Public Library of Science, 24 Aug. 2021, https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0252612.

Zhang, Pei-I, et al. “Real-Time AI Prediction for Major Adverse Cardiac Events in Emergency Department Patients with Chest Pain - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.” BioMed Central, BioMed Central, 11 Sept. 2020, https://sjtrem.biomedcentral.com/articles/10.1186/s13049-020-00786-x.

De Sario, Gioacchino D., et al. “Using AI to Detect Pain through Facial Expressions: A Review.” MDPI, Multidisciplinary Digital Publishing Institute, 2 May 2023, www.mdpi.com/2306-5354/10/5/548.

Fontaine, Denys, et al. “Wiley Online Library | Scientific Research Articles, Journals, ...” Wiley Online Library, European Journal of Pain, 30 Mar. 2022, onlinelibrary.wiley.com/. https://onlinelibrary.wiley.com/doi/abs/10.1002/ejp.1948

Sikka, Karan, et al. Publications.Aap.Org, Pediatrics, 1 July 2015, https://publications.aap.org/pediatrics/article-abstract/136/1/e124/28842/Automated-Assessment-of-Children-s-Postoperative.

“Metrological Characterization of a Pain Detection System Based on Transfer Entropy of Facial Landmarks.” IEEE Xplore, IEEE Transactions on Instrumentation and Measurement, 22 Mar. 2022, ieeexplore.ieee.org/Xplore/home.jsp. https://ieeexplore.ieee.org/abstract/document/9382276

Lautenbacher, Stefan, et al. “Automatic Coding of Facial Expressions of Pain: Are We There Yet?” Pain Research and Management, Hindawi, 11 Jan. 2022, www.hindawi.com/journals/prm/2022/6635496/.

Ghazisaeidi, Shahrzad, et al. “Neuropathic Pain: Mechanisms, Sex Differences, and Potential Therapies for a Global Problem.” Annual Reviews, Annual Review of Pharmacology and Toxicology, Jan. 2023, www.annualreviews.org/doi/abs/10.1146/annurev.pharmtox.37.1.239?intcmp=trendmd.

Woolf, Clifford J. “What Is This Thing Called Pain?” The Journal of Clinical Investigation, American Society for Clinical Investigation, 1 Nov. 2010, www.jci.org/articles/view/45178.

Karcioglu, Ozgur, et al. “A Systematic Review of the Pain Scales in Adults: Which to Use?” The American Journal of Emergency Medicine, W.B. Saunders, 6 Jan. 2018, www.sciencedirect.com/science/article/abs/pii/S0735675718300081.

Newman-Toker, David E, et al. “Burden of Serious Harms from Diagnostic Error in the USA.” BMJ Quality & Safety, BMJ Publishing Group Ltd, 1 Feb. 2024, https://qualitysafety.bmj.com/content/33/2/109?rss=1.

Hsueh, Jonathan. “AI Facial Expression Data.” Google Sheets, Google, 25 Feb. 2024, https://docs.google.com/spreadsheets/d/1XwZ-CNZbO2deMnt_fs4oZWfyme9cj8jf7VmDwf1kZDY/edit#gid=0.

Rodriguez, Pau. “Deep Pain: Exploiting Long Short-Term Memory Networks for Facial ...” IEEE Xplore, IEEE Transactions on Cybernetics, 9 Feb. 2017, https://ieeexplore.ieee.org/abstract/document/7849133.

Bartlett, Marian Stewart, et al. “Automatic Decoding of Facial Movements Reveals Deceptive Pain Expressions.” Cell, Current Biology, 31 Mar. 2014, www.cell.com/current-biology/pdf/S0960-9822(14)00829-X.pdf.

Othman, Ehsan, et al. “Automatic vs. Human Recognition of Pain Intensity from Facial Expression on the X-ITE Pain Database.” MDPI, Multidisciplinary Digital Publishing Institute, 10 May 2021, www.mdpi.com/1424-8220/21/9/3273.

Bargshady, Ghazal, et al. “Ensemble Neural Network Approach Detecting Pain Intensity from Facial Expressions.” Artificial Intelligence in Medicine, Elsevier, 7 Sept. 2020, www.sciencedirect.com/science/article/abs/pii/S0933365720312197.

Rathee, Neeru, et al. “A Novel Approach for Pain Intensity Detection Based on Facial Feature Deformations.” Journal of Visual Communication and Image Representation, Academic Press, 30 Sept. 2015, www.sciencedirect.com/science/article/abs/pii/S1047320315001686.

Lucey, Patrick, et al. “Automatically Detecting Pain in Video Through Facial Action Units.” IEEE Xplore, 22 Nov. 2010, https://ieeexplore.ieee.org/abstract/document/5643167.

Bargshady, Ghazal, A.B. Ashraf, et al. “Enhanced Deep Learning Algorithm Development to Detect Pain Intensity from Facial Expression Images.” Expert Systems with Applications, Pergamon, 16 Feb. 2020, www.sciencedirect.com/science/article/abs/pii/S0957417420301305.

Littlewort, Gwen C, et al. “Automatic Coding of Facial Expressions Displayed during Posed and Genuine Pain.” Image and Vision Computing, Elsevier, 26 Jan. 2009, www.sciencedirect.com/science/article/abs/pii/S0262885609000055.

Barua, Prabal Datta, et al. “Automated Detection of Pain Levels Using Deep Feature Extraction from Shutter Blinds-Based Dynamic-Sized Horizontal Patches with Facial Images.” Nature News, Nature Publishing Group, 14 Oct. 2022, www.nature.com/articles/s41598-022-21380-4.

Bargshady, Ghazal, Ashraf, et al. “The Modeling of Human Facial Pain Intensity Based on Temporal Convolutional Networks Trained with Video Frames in HSV Color Space.” Applied Soft Computing, Elsevier, 16 Oct. 2020, www.sciencedirect.com/science/article/abs/pii/S1568494620307432.

Rathee, Neeru, et al. “Multiview Distance Metric Learning on Facial Feature Descriptors for Automatic Pain Intensity Detection.” Computer Vision and Image Understanding, Academic Press, 17 May 2016, www.sciencedirect.com/science/article/abs/pii/S1077314215002684.

Casti, Paola, and d d. “Metrological Characterization of a Pain Detection System Based on Transfer Entropy of Facial Landmarks.” IEEE Xplore, 22 Mar. 2021, https://ieeexplore.ieee.org/abstract/document/9382276. Accessed 20 Jan. 2024.

Tavakolian, Mohammad, et al. “Self-Supervised Pain Intensity Estimation from Facial Videos via Statistical Spatiotemporal Distillation.” Pattern Recognition Letters, North-Holland, 19 Sept. 2020, www.sciencedirect.com/science/article/abs/pii/S0167865520303457.

Sikka, Karan, et al. “Automated Assessment of Children’s Postoperative Pain Using Computer Vision.” American Academy of Pediatrics, American Academy of Pediatrics, 1 July 2015, https://publications.aap.org/pediatrics/article-abstract/136/1/e124/28842/Automated-Assessment-of-Children-s-Postoperative?autologincheck=redirected.

Forte, Castela, et al. “Deep Learning for Identification of Acute Illness and Facial Cues of Illness.” Frontiers, Frontiers, 30 June 2021, www.frontiersin.org/articles/10.3389/fmed.2021.661309/full.

Prkachin, Kenneth M., and Zakia Hammal. “Computer Mediated Automatic Detection of Pain-Related Behavior: Prospect, Progress, Perils.” Frontiers, Frontiers, 15 Nov. 2021, www.frontiersin.org/articles/10.3389/fpain.2021.788606/full.

Liawrungrueang, Wongthawat, et al. “Automatic Detection, Classification, and Grading of Lumbar Intervertebral Disc Degeneration Using an Artificial Neural Network Model.” MDPI, Multidisciplinary Digital Publishing Institute, 10 Feb. 2023, www.mdpi.com/2075-4418/13/4/663.

Zhang, Meina, et al. “Using Artificial Intelligence to Improve Pain Assessment and Pain Management: A Scoping Review.” Journal of the American Medical Informatics Association : JAMIA, U.S. National Library of Medicine, 2 Dec. 2022, https://academic.oup.com/jamia/article/30/3/570/6865111?login=false.

Chan, Hei Kit, et al. “Updated Estimates of Sepsis Hospitalizations at United States Academic Medical Centers.” National Library of Medicine, JACEP Open, 3 Aug. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9288236/.

Harmon, Joanne, et al. “Use of Artificial Intelligence and Virtual Reality within Clinical Simulation for Nursing Pain Education: A Scoping Review.” Nurse Education Today, Churchill Livingstone, 9 Dec. 2020, www.sciencedirect.com/science/article/abs/pii/S0260691720315501?casa_token=JsMtJ7VCia0AAAAA%3AxfLQcR04RhI6ZQ1AWuMDl7Eh4XbJI588iFvsgMwqvD0onWxtOdTl600nQPE5Q0WJRi7nwHPF.

Buolamwini, Joy. “How I’m Fighting Bias in Algorithms | Joy Buolamwini.” YouTube, YouTube, 29 Mar. 2017, www.youtube.com/watch?v=UG_X_7g63rY&t=5s.

D’Antoni, Federico, et al. “Artificial Intelligence and Computer Aided Diagnosis in Chronic Low Back Pain: A Systematic Review.” MDPI, Multidisciplinary Digital Publishing Institute, 14 May 2022, www.mdpi.com/1660-4601/19/10/5971.

Borna, Sahar, et al. “A Review of Voice-Based Pain Detection in Adults Using Artificial Intelligence.” MDPI, Multidisciplinary Digital Publishing Institute, 21 Apr. 2023, www.mdpi.com/2306-5354/10/4/500.

Wu, Chieh-Chen, et al. “An Artificial Intelligence Approach to Early Predict Non-St-Elevation Myocardial Infarction Patients with Chest Pain.” Computer Methods and Programs in Biomedicine, Elsevier, 31 Jan. 2019, www.sciencedirect.com/science/article/abs/pii/S0169260718316936?casa_token=SgZQCscCHCgAAAAA%3Aq0lw9tO8DgW_6HXwnUa3KWY8cpqtGdgpnSb6UWa0WefSUMRQ9_lV5wI5HT4a2xantDfXaquLlQ.

Madanu, Ravichandra, et al. “Explainable AI (XAI) Applied in Machine Learning for Pain Modeling: A Review.” MDPI, Multidisciplinary Digital Publishing Institute, 14 June 2022, www.mdpi.com/2227-7080/10/3/74.

Dawson, Luke P, and a a. “Care Models for Acute Chest Pain That Improve Outcomes and Efficiency: JACC State-of-the-Art Review.” JACC Journals, 6 June 2022, www.jacc.org/doi/full/10.1016/j.jacc.2022.03.380.

Brown, Chris. “Breaking Bias: The Role of Artificial Intelligence in Improving Clinical Decision-Making.” Cureus, 20 Mar. 2023, https://assets.cureus.com/uploads/case_report/pdf/143345/20230419-10303-6p9zmp.pdf.

Nagireddi, Jagadesh N, and a s. “The Analysis of Pain Research through the Lens of Artificial Intelligence and Machine Learning.” Pain Physician Journal, 2022, www.painphysicianjournal.com/current/pdf?article=NzQyOQ%3D%3D&journal=142.

Chang, Victor, et al. “An Artificial Intelligence Model for Heart Disease Detection Using Machine Learning Algorithms.” Healthcare Analytics, Elsevier, 31 Jan. 2022, www.sciencedirect.com/science/article/pii/S2772442522000016.

Chen, Ke-Wei, et al. “Artificial Intelligence-Assisted Remote Detection of St-Elevation Myocardial Infarction Using a Mini-12-Lead Electrocardiogram Device in Prehospital Ambulance Care.” Frontiers, Frontiers, 29 Sept. 2022, www.frontiersin.org/articles/10.3389/fcvm.2022.1001982/full.

Liu, Wei-Ting, et al. “A Deep-Learning Algorithm-Enhanced System Integrating Electrocardiograms and Chest X-Rays for Diagnosing Aortic Dissection.” Canadian Journal of Cardiology, Elsevier, 4 Oct. 2021, www.sciencedirect.com/science/article/abs/pii/S0828282X21007492?casa_token=1hk6OpCh41AAAAAA%3ASJmvxiweQKHnH5Rn8EmjKbbw_d9M2_CfG0ACouMdIILrqkVaT_HzzME3ku6WQOPDF26HXffRpw.

Bunney, Gabrielle, et al. “Beyond Chest Pain: Incremental Value of Other Variables to Identify Patients for an Early ECG.” The American Journal of Emergency Medicine, W.B. Saunders, 8 Feb. 2023, www.sciencedirect.com/science/article/abs/pii/S0735675723000712.

S, Nirmala. “Heart Disease Prediction Using Artificial Intelligence Ensemble Network.” IEEE Xplore, 16 Oct. 2022, https://ieeexplore.ieee.org/document/9972493.

Kreiner, Marcelo, and Jesus Viloria. “A Novel Artificial Neural Network for the Diagnosis of Orofacial Pain and Temporomandibular Disorders.” Wiley Online Library, 20 June 2022, https://onlinelibrary.wiley.com/doi/abs/10.1111/joor.13350.

Hwang, Eui Jin, et al. “Conventional versus Artificial Intelligence-Assisted Interpretation of Chest Radiographs in Patients with Acute Respiratory Symptoms in Emergency Department: A Pragmatic Randomized Clinical Trial.” Korean Journal of Radiology, U.S. National Library of Medicine, 2023, www.ncbi.nlm.nih.gov/pmc/articles/PMC9971841/.

Mohan, H M, and S Anitha. “Real Time Audio-Based Distress Signal Detection as Vital Signs ... - Jait.” Journal of Advances in Information Technology Vol. 13, No. 2, Apr. 2022, www.jait.us/uploadfile/2022/0228/20220228060030772.pdf.

D’Ancona, Giuseppe, et al. “Deep Learning to Detect Significant Coronary Artery Disease from Plain Chest Radiographs AI4CAD.” International Journal of Cardiology, Elsevier, 5 Nov. 2022, www.sciencedirect.com/science/article/abs/pii/S0167527322016655.

Karthick, K., et al. “Implementation of a Heart Disease Risk Prediction Model Using Machine Learning.” Computational and Mathematical Methods in Medicine, Hindawi, 2 May 2022, www.hindawi.com/journals/cmmm/2022/6517716/.

Gouverneur, Philip, et al. “Explainable Artificial Intelligence (XAI) in Pain Research: Understanding the Role of Electrodermal Activity for Automated Pain Recognition.” MDPI, Multidisciplinary Digital Publishing Institute, 9 Feb. 2023, www.mdpi.com/1424-8220/23/4/1959.

Gangadhar, Mandadi Sai. “Machine Learning and Deep Learning Techniques on Accurate Risk Prediction of Coronary Heart Disease.” IEEE Xplore, 4 Apr. 2023, https://ieeexplore.ieee.org/abstract/document/10083756?casa_token=ueh2qTd84KQAAAAA:VnRhQacCebkmO8nOiawLrX_ApsQyo19w6nWNuJ_vVIfSxdl6sk9HnKqpr1HHga7pi-U_na13VA.

Koul, Apeksha, et al. “Artificial Intelligence in Medical Image Processing for Airway Diseases.” SpringerLink, Springer International Publishing, 6 May 2022, https://link.springer.com/chapter/10.1007/978-3-030-97929-4_10.

Amer, Syed Saad. “BioLearner: A Machine Learning-Powered Smart Heart Disease Risk Prediction System Utilizing Biomedical Markers.” Journal of Interconnection Networks Vol. 22, No. 03, World Scientific, 24 Dec. 2021, www.worldscientific.com/doi/abs/10.1142/S0219265921450031.

Huang, Kai, and Zeyu Jiao. “Artificial Intelligence-Based Intelligent Surveillance for Reducing Nurses’ Working Hours in Nurse–Patient Interaction: A Two-Wave Study.” Wiley Online Library, 3 Sept. 2022, https://onlinelibrary.wiley.com/doi/10.1111/jonm.13787.

E. Backus, B., et al. “Risk Scores for Patients with Chest Pain: Evaluation in the Emergency Department.” Latest TOC RSS, Bentham Science Publishers, 1 Jan. 1970, www.ingentaconnect.com/content/ben/ccr/2011/00000007/00000001/art00002#.

Kontos, Michael C, et al. “Emergency Department and Office-Based Evaluation of Patients with Chest Pain.” Mayo Clinic Proceedings, Elsevier, 20 Oct. 2011, www.sciencedirect.com/science/article/abs/pii/S0025619611604151.

Aalam, Ahmad A, and Awad Alsabban. “National Trends in Chest Pain Visits in US Emergency Departments (2006-2016).” Emergency Medicine Journal : EMJ, U.S. National Library of Medicine, 8 Sept. 2020, https://pubmed.ncbi.nlm.nih.gov/32900857/.

Additional Files

Posted

2024-05-16