The Australian startup PainChek app measures pain and can help people with dementia

To give voice to those who cannot report their suffering, such as people with dementia, PainChek, an Australian startup, has developed an application that uses facial analysis and artificial intelligence (AI) to assess and score pain levels.

A caregiver records a short video of the subject’s face using a smartphone and answers questions about his behavior, movements and speech. The app’s AI recognizes the movements of the facial muscles that are associated with pain and combines this with the caregiver observations to calculate an overall pain score.

According to the company, PainChek can detect pain with more than 90% accuracy and more than 180,000 pain assessments have been completed worldwide in more than 66,000 people. The application is designed for use with the elderly who need care.

Usually, pain assessment in patients with dementia and severe communication impairment involves caregivers and health professionals, observing their facial and behavioral expressions, and interpreting the results according to a standardized scale, such as the Abbey Pain Scale.

A team of Scientists at the pharmacy school at Curtin University, Western Australia, started developing PainChek in 2012. They wanted to find a better alternative to subjective assessments on paper.

“It is very difficult for humans to decode the emotions in a person’s face,” explains Peter Shergill, director of business development at PainChek. “Therefore, the tool applies artificial intelligence and algorithms to decode the face based on decades of research.”

PainChek says that your app can mark the pain with more than 90% accuracy.
A 2017 validation study by the inventors of PainChek, published in the Journal of Alzheimer’s Disease, found that the app provided reliable evidence of the presence of pain. The technology is classified as a medical device in Europe, Australia and Canada and is offered to nursing homes as a monthly subscription for about $ 4 per resident.
The World Health Organization estimates that about 50 million people worldwide have dementia, and there are almost 10 million new cases each year. A 2012 study estimated that up to 80% of people living in nursing homes with dementia regularly experience pain.
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“Overall, pain assessment in people living with dementia is not strong,” says Shergill. “Where pain is not detected or treated in people living with dementia, it can manifest in behaviors that are difficult to control, which subsequently people try to control with antipsychotic drugs, which brings more risks.”

In 2019, the Australian government allocated up to 5 million Australian dollars ($ 3.8 million) to nursing homes in the country to adopt PainChek as part of a two-year trial. “The goal is to improve the diagnosis and treatment of pain, quality of life and health outcomes for people living in residential institutions,” said Richard Colbeck, Federal Minister for Australian Elderly Care Services.

Interpreting feelings

PainChek says its technology is being used in more than 722 nursing homes around the world. Last August, it was launched in the UK, where it has been used by about 1,000 patients so far.

To use PainChek, caregivers record a short video of the subject's face and answer questions about their behavior.

Paul Rowley owns a 24 bed residential home in the UK and has been using PainChek for almost a year. He says 20 of his residents have diagnosed dementia.

“[People with dementia] have difficulty communicating and cannot necessarily articulate what they are feeling, which often leaves the caregiver having to interpret their feelings, “says Rowley. He says the app is helping caregivers to quickly determine if someone is in pain.

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For Rowley, PainChek is also an important tool to show the absence of pain. He gives an example in which he and his team were able to use the app to prevent a woman from being treated unnecessarily.

“We have a lady who is very advanced in her dementia and was showing signs that would be interpreted by most people as physical pain,” he says. “But we knew the lady very well and were convinced that what she was expressing was not really pain, but frustration and anxiety, and we used PainChek to demonstrate that.”

There is an increasing number of technologies that aim to help all types of people to communicate their pain. In the United States, MoxyTech has developed an application called GeoPain that allows users to draw exactly where they are feeling pain in a 3D image of the body. AlgometRx is a portable device that examines a patient’s pupils to measure pain.

PainChek is also looking to develop products for other groups. She is conducting research at a pediatric hospital in Melbourne to help develop an app to identify pain in children under three.

“We are looking at learning disabilities, delirium and end of life, as well as other additions,” says Shergill. “We have a unique solution that can be transferred between ethnicities and backgrounds … users can see the impact they are having.”

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