journal article·2025-05-06Open access

Multimodal Model for Automated Pain Assessment: Leveraging Video and fNIRS

Jo Vianto, Anjitha Divakaran, Hyungjeong Yang, Soonja Yeom, Seungwon Kim, Soohyung Kim, Jieun Shin

Applied Sciences· Volume 15· Issue 9

Abstract

Pain assessment is a challenging task for clinicians due to its subjective nature, particularly in individuals with communication difficulties, cognitive impairments, or severe disabilities. Traditional methods such as the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), and Verbal Rating Scale (VRS) rely heavily on patient feedback, which can be inconsistent and subjective. To address these limitations, developing objective and reliable pain assessment tools that incorporate advanced technologies, such as multimodal data integration from video and fNIRS, is important for improving clinical outcomes. However, challenges such as noise susceptibility in fNIRS signals must be carefully addressed to realize their full potential. Recent studies have explored automatic pain assessment using machine learning and deep learning techniques, which require high-quality data that can accurately represent pain categories. In response to the introduction of a new dataset in the AI4Pain Challenge, we proposed a multimodal neural network model utilizing attention-based fusion to improve overall accuracy (MMAPA). Our model leverages video and fNIRS modalities as well as manually extracted statistical features. We also implemented fNIRS signal preprocessing and artifact noise filtering, which significantly improved performance on both the fNIRS and statistical feature branches. On the hidden test set, our model achieved an accuracy of 51.33%, outperforming the official baseline of 43.33%. To evaluate generalizability, we further tested our method on the BioVid Heat Pain Database, where our fusion model achieved the highest accuracy in the 10-fold cross-validation setting, outperforming PainAttNet and unimodal variants. These results highlight the effectiveness of our multimodal attention-based approach in improving pain classification performance across datasets.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Musculoskeletal pain and rehabilitation · EEG and Brain-Computer Interfaces · Pain Management and Opioid Use

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju 61186, Republic of Korea

School of ICT, University of Tasmania, Sandy Bay, TAS 7005, Australia

Department of Psychology, Chonnam National University, Gwangju 61186, Republic of Korea

Funding

Institute of Information & Communications Technology Planning & Evaluation (IITP)-Innovative Human Resource Development for Local Intellectualization program · National Research Foundation of Korea (NRF) · Institute of Information & communications Technology Planning & Evaluation (IITP) under the Artificial Intelligence Convergence Innovation Human Resources Development · IITP (Institute for Information & Communications Technology Planning & Evaluation)

References (34)

Show source-provided references
1. Rojas, R. (2023). Multimodal physiological sensing for the assessment of acute pain. Front. Pain Res., 4.10.3389/fpain.2023.1150264 ↗
3. Walter, S., Gruss, S., Limbrecht-Ecklundt, K., Traue, H.C., Werner, P., Al-Hamadi, A., Walter, S., and Diniz, N. (2013, January 13–15). The BioVid Heat Pain Database: Data for the Advancement and Systematic Validation of an Automated Pain Recognition System. Proceedings of the 2013 IEEE International Conference on Cybernetics (CYBCO), Lausanne, Switzerland.10.1109/CYBConf.2013.6617456 ↗
4. Functional Near-Infrared Spectroscopy (fNIRS) for Assessing Cerebral Cortex Function During Human Behavior in Natural/Social Situations: A Concise Review10.1177/1094428116658959 ↗
5. Assessment of pain10.1093/bja/aen103 ↗
6. Automatic Recognition Methods Supporting Pain Assessment: A Survey10.1109/TAFFC.2019.2946774 ↗
7. Automatic Pain Assessment with Facial Activity Descriptors10.1109/TAFFC.2016.2537327 ↗
8. Alghamdi, T., and Alaghband, G. (2022). Facial Expressions Based Automatic Pain Assessment System. Appl. Sci., 12.10.3390/app12136423 ↗
9. Schwenker, F., and Scherer, S. (2017). Multimodal Pattern Recognition of Social Signals in Human-Computer-Interaction, Lecture Notes in Computer Science; Springer International Publishing.10.1007/978-3-319-59259-6 ↗
10. Fernandez Rojas, R., Hirachan, N., Joseph, C., Seymour, B., and Goecke, R. (2024, January 16–18). The AI4Pain Grand Challenge 2024: Advancing Pain Assessment with Multimodal fNIRS and Facial Video Analysis. Proceedings of the 2024 12th International Conference on Affective Computing and Intelligent Interaction, Glasgow, UK.10.1109/ACIIW63320.2024.00012 ↗
11. Benavent-Lledo, M. (2023). A Comprehensive Study on Pain Assessment from Multimodal Sensor Data. Sensors, 23.10.3390/s23249675 ↗
12. Gkikas, S. (2024). Multimodal automatic assessment of acute pain through facial videos and heart rate signals utilizing transformer-based architectures. Front. Pain Res., 5.10.3389/fpain.2024.1372814 ↗
13. Werner, P., Al-Hamadi, A., Niese, R., Walter, S., Gruss, S., and Traue, H.C. (2013, January 9–13). Towards Pain Monitoring: Facial Expression, Head Pose, a New Database, an Automatic System and Remaining Challenges. Proceedings of the British Machine Vision Conference (BMVC), Bristol, UK.10.5244/C.27.119 ↗
14. Vaswani, A., Shazeer, N., Parmar, N., Uszkoreit, J., Jones, L., Gomez, A.N., Kaiser, L., and Polosukhin, I. (2023). Attention Is All You Need. arXiv.
15. Cai, Z., Ghosh, S., Stefanov, K., Dhall, A., Cai, J., Rezatofighi, H., Haffari, R., and Hayat, M. (2023, January 17–24). MARLIN: Masked Autoencoder for Facial Video Representation LearnINg. Proceedings of the IEEE/CVF Conference on Computer Vision and Pattern Recognition (CVPR), Vancouver, BC, Canada.10.1109/CVPR52729.2023.00150 ↗
16. Liu, Z., Shore, J., Wang, M., Yuan, F., Buss, A., and Zhao, X. (2021). A systematic review on hybrid EEG/fNIRS in brain-computer interface. Biomed. Signal Process. Control, 68.10.1016/j.bspc.2021.102595 ↗
17. Semwal, A., and Londhe, N. (2020, January 3–5). Automated Facial Expression Based Pain Assessment Using Deep Convolutional Neural Network. Proceedings of the 3rd International Conference on Intelligent Sustainable Systems (ICISS 2020), Thoothukudi, India.10.1109/ICISS49785.2020.9316099 ↗
18. Depression Analysis and Recognition Based on Functional Near-Infrared Spectroscopy10.1109/JBHI.2021.3076762 ↗
19. FNIRS Evidence for Distinguishing Patients with Major Depression and Healthy Controls10.1109/TNSRE.2021.3115266 ↗
20. Khan, H., Noori, F., Yazidi, A., Uddin, M., Khan, M., and Mirtaheri, P. (2021). Classification of individual finger movements from right hand using fnirs signals. Sensors, 21.10.3390/s21237943 ↗
21. Hamid, H., Naseer, N., Nazeer, H., Khan, M., Khan, R., and Khan, U. (2022). Analyzing Classification Performance of fNIRS-BCI for Gait Rehabilitation Using Deep Neural Networks. Sensors, 22.10.3390/s22051932 ↗
22. Khalil, K., Asgher, U., and Ayaz, Y. (2022). Novel fNIRS study on homogeneous symmetric feature-based transfer learning for brain–computer interface. Sci. Rep., 12.10.1038/s41598-022-06805-4 ↗
23. Rojas, R., Romero, J., Lopez-Aparicio, J., and Ou, K. (2023, January 24–27). Pain Assessment Based on fNIRS Using Bi-LSTM RNNs. Proceedings of the International IEEE/EMBS Conference on Neural Engineering (NER 2021), Baltimore, MD, USA.10.1109/NER49283.2021.9441384 ↗
24. Fernandez Rojas, R., Huang, X., and Ou, K.L. (2017). Toward a functional near-infrared spectroscopy-based monitoring of pain assessment for nonverbal patients. J. Biomed. Opt., 22.10.1117/1.JBO.22.10.106013 ↗
25. Lu, X., Wu, Z., Lu, B., and Yang, G. (2023). PainAttnNet: Multiscale Convolutional Transformer for Pain Intensity Classification Using Biosignals. arXiv.
26. EEG Conformer: Convolutional Transformer for EEG Decoding and Visualization10.1109/TNSRE.2022.3230250 ↗
27. Qiu, L., Zhong, Y., He, Z., and Pan, J. (2022). Improved classification performance of EEG-fNIRS multimodal brain-computer interface based on multi-domain features and multi-level progressive learning. Front. Hum. Neurosci., 16.10.3389/fnhum.2022.973959 ↗
28. Prajod, P., Schiller, D., Don, D.W., and André, E. (2024). Faces of Experimental Pain: Transferability of Deep Learned Heat Pain Features to Electrical Pain. arXiv.10.1109/ACIIW63320.2024.00009 ↗
29. Gkikas, S., and Tsiknakis, M. (2024). Twins-PainViT: Towards a Modality-Agnostic Vision Transformer Framework for Multimodal Automatic Pain Assessment using Facial Videos and fNIRS. arXiv.10.1109/ACIIW63320.2024.00007 ↗
30. Gouverneur, P., Li, F., Adamczyk, W.M., Szikszay, T.M., Luedtke, K., and Grzegorzek, M. (2021). Comparison of feature extraction methods for physiological signals for heat-based pain recognition. Sensors, 21.10.3390/s21144838 ↗
31. Shi, H., Chikhaoui, B., and Wang, S. (July, January 28). Tree-Based Models for Pain Detection from Biomedical Signals. Proceedings of the International Conference on Smart Homes and Health Telematics, Ames, IA, USA.
32. Long Short-Term Memory10.1162/neco.1997.9.8.1735 ↗
33. Chung, J., Gulcehre, C., Cho, K., and Bengio, Y. (2014). Empirical Evaluation of Gated Recurrent Neural Networks on Sequence Modeling. arXiv.
34. Selvaraju, R.R., Cogswell, M., Das, A., Vedantam, R., Parikh, D., and Batra, D. (2017, January 22–29). Grad-CAM: Visual Explanations from Deep Networks via Gradient-Based Localization. Proceedings of the IEEE International Conference on Computer Vision (ICCV), Venice, Italy.10.1109/ICCV.2017.74 ↗