Misdiagnosis can lead to delayed treatments and harm. Robotic patients offer a controlled way to train and evaluate clinicians in rare, subtle, or complex cases, reducing diagnostic errors. We present RoboPatient, a medical robotic simulator aimed at multimodal pain synthesis based on haptic and auditory feedback during palpation-based training scenarios. The robopatient functions as an adaptive intermediary, capable of synthesizing plausible pain expressions vocal and facial in response to tactile stimuli generated during palpation. Using an abdominal phantom, robopatient captures and processes haptic input via an internal palpation-to-pain mapping model. To evaluate perceptual congruence between palpation and the corresponding auditory output, we conducted a study involving 7680 trials across 20 participants, where they evaluated pain intensity through sound. Results show that amplitude and pitch significantly influence agreement with the robot's pain expressions, irrespective of pain sounds. Stronger palpation forces elicited stronger agreement, aligning with psychophysical patterns. The study revealed two key dimensions: pitch and amplitude are central to how people perceive pain sounds, with pitch being the most influential cue. These acoustic features shape how well the sound matches the applied force during palpation, impacting perceived realism. This approach lays the groundwork for high-fidelity robotic patients in clinical education and diagnostic simulation.

-- Diagnostic errors remain a major cause of preventable deaths, particularly in resource-limited regions. Medical training simulators, including robopatients, play a vital role in reducing these errors by mimicking real patients for procedural training such as palpation. However, generating multimodal feedback, especially auditory pain expressions, remains challenging due to the complex relationship between palpation behavior and sound. The high-dimensional nature of pain sounds makes exploration challenging with conventional methods. This study introduces a novel experimental paradigm for pain expressivity in robopatients where they dynamically generate auditory pain expressions in response to palpation force, by co-optimizing human feedback using machine learning. Using Proximal Policy Optimization (PPO), a reinforcement learning (RL) technique optimized for continuous adaptation, our robot iteratively refines pain sounds based on real-time human feedback. This robot initializes randomized pain responses to palpation forces, and the RL agent learns to adjust these sounds to align with human preferences. The results demonstrated that the system adapts to an individual's palpation forces and sound preferences and captures a broad spectrum of pain intensity, from mild discomfort to acute distress, through RL-guided exploration of the auditory pain space. The study further showed that pain sound perception exhibits saturation at lower forces with gender-specific thresholds. These findings highlight the system's potential to enhance abdominal palpation training by offering a controllable and immersive simulation platform. While specific statistics vary by region, diagnostic errors are a universal concern. Misdiagnoses may contribute to the nearly 7 million children who die each year from preventable causes, particularly in low-and middle-income countries [1]. These findings underscore the critical need for systemic improvements in diagnostic processes, enhanced communication among healthcare providers, and increased patient engagement to mitigate the risks associated with diagnostic errors. Palpation is one of the primary examination methods used by physicians to examine patients in various conditions ranging from simple abdominal pain to more serious conditions such as acute appendicitis and breast, soft tissue tumors.

Individuals from minority groups, even with equivalent qualifications, consistently receive fewer opportunities in critical areas such as employment, education, and healthcare. Yet, empirically demonstrating the existence of such pervasive bias, let alone measuring the extent of bias or correcting it, remains a significant challenge. Over several decades, researchers have utilized a range of experimental methodologies to test for biases in real-life situations (Bertrand and Duflo 2017). Audit studies, among the earliest of such methods, match two individuals who are similar in all respects except for sensitive characteristics like race, to test decision-makers' biases (Ayres and Siegelman 1995). A significant limitation of this method, however, is the inherent impossibility of achieving an exact match between two individuals, precluding perfect comparability (Heckman 1998). Correspondence studies have emerged as a predominant experimental approach for measuring biases (Guryan and Charles 2013, Bertrand and Mullainathan 2004). They create identical fictional profiles with manipulated attributes like race to assess differential treatment. However, these studies traditionally manipulate solely textual information, which may not reflect contemporary decision-making scenarios increasingly influenced by visual cues like facial images, as seen in recent hiring processes (Acquisti and Fong 2020, Ruffle and Shtudiner 2015). This reliance on text limits their effectiveness, as modern contexts often involve multimedia elements, making it challenging to measure real-world biases accurately or correct them based on such incomplete information (Armbruster et al. 2015).

Pain management and severity detection are crucial for effective treatment, yet traditional self-reporting methods are subjective and may be unsuitable for non-verbal individuals (people with limited speaking skills). To address this limitation, we explore automated pain detection using facial expressions. Our study leverages deep learning techniques to improve pain assessment by analyzing facial images from the Pain Emotion Faces Database (PEMF). We propose two novel approaches1: (1) a hybrid ConvNeXt model combined with Long Short-Term Memory (LSTM) blocks to analyze video frames and predict pain presence, and (2) a Spatio-Temporal Graph Convolution Network (STGCN) integrated with LSTM to process landmarks from facial images for pain detection. Our work represents the first use of the PEMF dataset for binary pain classification and demonstrates the effectiveness of these models through extensive experimentation. The results highlight the potential of combining spatial and temporal features for enhanced pain detection, offering a promising advancement in objective pain assessment methodologies.

Knee osteoarthritis (OA) is a widespread chronic condition that impairs mobility and diminishes quality of life. Despite the proven benefits of exercise therapy and patient education in managing the OA symptoms pain and functional limitations, these strategies are often underutilized. Personalized outcome prediction models can help motivate and engage patients, but the accuracy of existing models in predicting changes in knee pain remains insufficiently examined. To validate existing models and introduce a concise personalized model predicting changes in knee pain before to after participating in a supervised education and exercise therapy program (GLA:D) for knee OA patients. Our models use self-reported patient information and functional measures. To refine the number of variables, we evaluated the variable importance and applied clinical reasoning. We trained random forest regression models and compared the rate of true predictions of our models with those utilizing average values. We evaluated the performance of a full, continuous, and concise model including all 34, all 11 continuous, and the six most predictive variables respectively. All three models performed similarly and were comparable to the existing model, with R-squares of 0.31-0.32 and RMSEs of 18.65-18.85 - despite our increased sample size. Allowing a deviation of 15 VAS points from the true change in pain, our concise model and utilizing the average values estimated the change in pain at 58% and 51% correctly, respectively. Our supplementary analysis led to similar outcomes. Our concise personalized prediction model more accurately predicts changes in knee pain following the GLA:D program compared to average pain improvement values. Neither the increase in sample size nor the inclusion of additional variables improved previous models. To improve predictions, new variables beyond those in the GLA:D are required.

Machine learning (ML) models trained on subjective self-report scores struggle to objectively classify pain accurately due to the significant variance between real-time pain experiences and recorded scores afterwards. This study developed two devices for acquisition of real-time, continuous in-session pain scores and gathering of ANS-modulated endodermal activity (EDA).The experiment recruited N = 24 subjects who underwent a post-exercise circulatory occlusion (PECO) with stretch, inducing discomfort. Subject data were stored in a custom pain platform, facilitating extraction of time-domain EDA features and in-session ground truth scores. Moreover, post-experiment visual analog scale (VAS) scores were collected from each subject. Machine learning models, namely Multi-layer Perceptron (MLP) and Random Forest (RF), were trained using corresponding objective EDA features combined with in-session scores and post-session scores, respectively. Over a 10-fold cross-validation, the macro-averaged geometric mean score revealed MLP and RF models trained with objective EDA features and in-session scores achieved superior performance (75.9% and 78.3%) compared to models trained with post-session scores (70.3% and 74.6%) respectively. This pioneering study demonstrates that using continuous in-session ground truth scores significantly enhances ML performance in pain intensity characterization, overcoming ground truth sparsity-related issues, data imbalance, and high variance. This study informs future objective-based ML pain system training.

Physiological responses to pain have received increasing attention among researchers for developing an automated pain recognition sensing system. Though less explored, Blood Volume Pulse (BVP) is one of the candidate physiological measures that could help objective pain assessment. In this study, we applied machine learning techniques on BVP signals to device a non-invasive modality for pain sensing. Thirty-two healthy subjects participated in this study. First, we investigated a novel set of time-domain, frequency-domain and nonlinear dynamics features that could potentially be sensitive to pain. These include 24 features from BVP signals and 20 additional features from Inter-beat Intervals (IBIs) derived from the same BVP signals. Utilizing these features, we built machine learning models for detecting the presence of pain and its intensity. We explored different machine learning models, including Logistic Regression, Random Forest, Support Vector Machines, Adaptive Boosting (AdaBoost) and Extreme Gradient Boosting (XGBoost). Among them, we found that the XGBoost offered the best model performance for both pain classification and pain intensity estimation tasks. The ROC-AUC of the XGBoost model to detect low pain, medium pain and high pain with no pain as the baseline were 80.06 %, 85.81 %, and 90.05 % respectively. Moreover, the XGboost classifier distinguished medium pain from high pain with ROC-AUC of 91%. For the multi-class classification among three pain levels, the XGBoost offered the best performance with an average F1-score of 80.03%. Our results suggest that BVP signal together with machine learning algorithms is a promising physiological measurement for automated pain assessment. This work will have a national impact on accurate pain assessment, effective pain management, reducing drug-seeking behavior among patients, and addressing national opioid crisis.

Pain is a serious worldwide health problem that affects a vast proportion of the population. For efficient pain management and treatment, accurate classification and evaluation of pain severity are necessary. However, this can be challenging as pain is a subjective sensation-driven experience. Traditional techniques for measuring pain intensity, e.g. self-report scales, are susceptible to bias and unreliable in some instances. Consequently, there is a need for more objective and automatic pain intensity assessment strategies. In this paper, we develop PainAttnNet (PAN), a novel transfomer-encoder deep-learning framework for classifying pain intensities with physiological signals as input. The proposed approach is comprised of three feature extraction architectures: multiscale convolutional networks (MSCN), a squeeze-and-excitation residual network (SEResNet), and a transformer encoder block. On the basis of pain stimuli, MSCN extracts short- and long-window information as well as sequential features. SEResNet highlights relevant extracted features by mapping the interdependencies among features. The third module employs a transformer encoder consisting of three temporal convolutional networks (TCN) with three multi-head attention (MHA) layers to extract temporal dependencies from the features. Using the publicly available BioVid pain dataset, we test the proposed PainAttnNet model and demonstrate that our outcomes outperform state-of-the-art models. These results confirm that our approach can be utilized for automated classification of pain intensity using physiological signals to improve pain management and treatment.

The outbreak of the COVID-19 pandemic revealed the criticality of timely intervention in a situation exacerbated by a shortage in medical staff and equipment. Pain-level screening is the initial step toward identifying the severity of patient conditions. Automatic recognition of state and feelings help in identifying patient symptoms to take immediate adequate action and providing a patient-centric medical plan tailored to a patient's state. In this paper, we propose a framework for pain-level detection for deployment in the United Arab Emirates and assess its performance using the most used approaches in the literature. Our results show that a deployment of a pain-level deep learning detection framework is promising in identifying the pain level accurately.

Recent studies have found that pain in infancy has a significant impact on infant development, including psychological problems, possible brain injury, and pain sensitivity in adulthood. However, due to the lack of specialists and the fact that infants are unable to express verbally their experience of pain, it is difficult to assess infant pain. Most existing infant pain assessment systems directly apply adult methods to infants ignoring the differences between infant expressions and adult expressions. Meanwhile, as the study of facial action coding system continues to advance, the use of action units (AUs) opens up new possibilities for expression recognition and pain assessment. In this paper, a novel AuE-IPA method is proposed for assessing infant pain by leveraging different engagement levels of AUs. First, different engagement levels of AUs in infant pain are revealed, by analyzing the class activation map of an end-to-end pain assessment model. The intensities of top-engaged AUs are then used in a regression model for achieving automatic infant pain assessment. The model proposed is trained and experimented on YouTube Immunization dataset, YouTube Blood Test dataset, and iCOPEVid dataset. The experimental results show that our AuE-IPA method is more applicable to infants and possesses stronger generalization ability than end-to-end assessment model and the classic PSPI metric.