Understanding pain-related facial behaviors is essential for digital healthcare in terms of effective monitoring, assisted diagnostics, and treatment planning, particularly for patients unable to communicate verbally. Existing data-driven methods of detecting pain from facial expressions are limited due to interpretability and severity quantification. To this end, we propose GraphAU-Pain, leveraging a graph-based framework to model facial Action Units (AUs) and their interrelationships for pain intensity estimation. AUs are represented as graph nodes, with co-occurrence relationships as edges, enabling a more expressive depiction of pain-related facial behaviors. By utilizing a relational graph neural network, our framework offers improved interpretability and significant performance gains. Experiments conducted on the publicly available UNBC dataset demonstrate the effectiveness of the GraphAU-Pain, achieving an F1-score of 66.21% and accuracy of 87.61% in pain intensity estimation.

Improper pain management can lead to severe physical or mental consequences, including suffering, and an increased risk of opioid dependency. Assessing the presence and severity of pain is imperative to prevent such outcomes and determine the appropriate intervention. However, the evaluation of pain intensity is challenging because different individuals experience pain differently. To overcome this, researchers have employed machine learning models to evaluate pain intensity objectively. However, these efforts have primarily focused on point estimation of pain, disregarding the inherent uncertainty and variability present in the data and model. Consequently, the point estimates provide only partial information for clinical decision-making. This study presents a neural network-based method for objective pain interval estimation, incorporating uncertainty quantification. This work explores three algorithms: the bootstrap method, lower and upper bound estimation (LossL) optimized by genetic algorithm, and modified lower and upper bound estimation (LossS) optimized by gradient descent algorithm. Our empirical results reveal that LossS outperforms the other two by providing a narrower prediction interval. As LossS outperforms, we assessed its performance in three different scenarios for pain assessment: (1) a generalized approach (single model for the entire population), (2) a personalized approach (separate model for each individual), and (3) a hybrid approach (separate model for each cluster of individuals). Our findings demonstrate the hybrid approach's superior performance, with notable practicality in clinical contexts. It has the potential to be a valuable tool for clinicians, enabling objective pain intensity assessment while taking uncertainty into account. This capability is crucial in facilitating effective pain management and reducing the risks associated with improper treatment.

Chronic pain is a multi-dimensional experience, and pain intensity plays an important part, impacting the patients emotional balance, psychology, and behaviour. Standard self-reporting tools, such as the Visual Analogue Scale for pain, fail to capture this burden. Moreover, this type of tools is susceptible to a degree of subjectivity, dependent on the patients clear understanding of how to use it, social biases, and their ability to translate a complex experience to a scale. To overcome these and other self-reporting challenges, pain intensity estimation has been previously studied based on facial expressions, electroencephalograms, brain imaging, and autonomic features. However, to the best of our knowledge, it has never been attempted to base this estimation on the patient narratives of the personal experience of chronic pain, which is what we propose in this work. Indeed, in the clinical assessment and management of chronic pain, verbal communication is essential to convey information to physicians that would otherwise not be easily accessible through standard reporting tools, since language, sociocultural, and psychosocial variables are intertwined. We show that language features from patient narratives indeed convey information relevant for pain intensity estimation, and that our computational models can take advantage of that. Specifically, our results show that patients with mild pain focus more on the use of verbs, whilst moderate and severe pain patients focus on adverbs, and nouns and adjectives, respectively, and that these differences allow for the distinction between these three pain classes.

For the more than 300 million surgeries performed worldwide every year, managing post-surgical pain is critical for successful surgical outcomes. Pain is the most prominent post-surgical concern, with an estimated 86% of surgical patients in the United States experiencing pain after surgery, with 75% of these patients reporting at least moderate to extreme pain [1]. Higher postoperative pain is associated with more postoperative complications [2], indicating the importance of pain management. Furthermore, the use of opioid analgesics is a powerful tool for managing pain but can pose risks of adverse drug events (experienced by 10% of surgical patients), leading to prolonged length of stay, high hospitalization costs, and potentially addiction [3]. Thus, regular and careful pain assessment is important for balancing between pain relief and potential side effects of powerful opioid analgesics [4]. However, one of the challenges of pain management is accurately assessing the pain level of patients. Pain is inherently subjective, and the personal experience of pain is difficult to observe and measure objectively by those not experiencing it [5] (e.g., care providers). The standard practice used in clinical care requires patients to self-report their pain intensity level using a numeric or visual scale, such as the popular Numerical Pain Rating Scale [6].

We propose a novel method for automatic pain intensity estimation from facial images based on the framework of kernel Conditional Ordinal Random Fields (KCORF). We extend this framework to account for heteroscedasticity on the output labels(i.e., pain intensity scores) and introduce a novel dynamic features, dynamic ranks, that impose temporal ordinal constraints on the static ranks (i.e., intensity scores). Our experimental results show that the proposed approach outperforms state-of-the art methods for sequence classification with ordinal data and other ordinal regression models. The approach performs significantly better than other models in terms of Intra-Class Correlation measure, which is the most accepted evaluation measure in the tasks of facial behaviour intensity estimation.