Efficient Pain Recognition via Respiration Signals: A Single Cross-Attention Transformer Multi-Window Fusion Pipeline

Pain is a complex condition affecting a large portion of the population. Accurate and consistent evaluation is essential for individuals experiencing pain, and it supports the development of effective and advanced management strategies. Automatic pain assessment systems provide continuous monitoring and support clinical decision-making, aiming to reduce distress and prevent functional decline. This study has been submitted to the \textit{Second Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4PAIN)}. The proposed method introduces a pipeline that leverages respiration as the input signal and incorporates a highly efficient cross-attention transformer alongside a multi-windowing strategy. Extensive experiments demonstrate that respiration is a valuable physiological modality for pain assessment. Moreover, experiments revealed that compact and efficient models, when properly optimized, can achieve strong performance, often surpassing larger counterparts. The proposed multi-window approach effectively captures both short-term and long-term features, as well as global characteristics, thereby enhancing the model's representational capacity.

Multi-Representation Diagrams for Pain Recognition: Integrating Various Electrodermal Activity Signals into a Single Image

Pain is a multifaceted phenomenon that affects a substantial portion of the population. Reliable and consistent evaluation benefits those experiencing pain and underpins the development of effective and advanced management strategies. Automatic pain-assessment systems deliver continuous monitoring, inform clinical decision-making, and aim to reduce distress while preventing functional decline. By incorporating physiological signals, these systems provide objective, accurate insights into an individual's condition. This study has been submitted to the \textit{Second Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4PAIN)}. The proposed method introduces a pipeline that leverages electrodermal activity signals as input modality. Multiple representations of the signal are created and visualized as waveforms, and they are jointly visualized within a single multi-representation diagram. Extensive experiments incorporating various processing and filtering techniques, along with multiple representation combinations, demonstrate the effectiveness of the proposed approach. It consistently yields comparable, and in several cases superior, results to traditional fusion methods, establishing it as a robust alternative for integrating different signal representations or modalities.

Tiny-BioMoE: a Lightweight Embedding Model for Biosignal Analysis

Pain is a complex and pervasive condition that affects a significant portion of the population. Accurate and consistent assessment is essential for individuals suffering from pain, as well as for developing effective management strategies in a healthcare system. Automatic pain assessment systems enable continuous monitoring, support clinical decision-making, and help minimize patient distress while mitigating the risk of functional deterioration. Leveraging physiological signals offers objective and precise insights into a person's state, and their integration in a multimodal framework can further enhance system performance. This study has been submitted to the \textit{Second Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4PAIN)}. The proposed approach introduces \textit{Tiny-BioMoE}, a lightweight pretrained embedding model for biosignal analysis. Trained on $4.4$ million biosignal image representations and consisting of only $7.3$ million parameters, it serves as an effective tool for extracting high-quality embeddings for downstream tasks. Extensive experiments involving electrodermal activity, blood volume pulse, respiratory signals, peripheral oxygen saturation, and their combinations highlight the model's effectiveness across diverse modalities in automatic pain recognition tasks. \textit{\textcolor{blue}{The model's architecture (code) and weights are available at https://github.com/GkikasStefanos/Tiny-BioMoE.

A Pain Assessment Framework based on multimodal data and Deep Machine Learning methods

From the original abstract: This thesis initially aims to study the pain assessment process from a clinical-theoretical perspective while exploring and examining existing automatic approaches. Building on this foundation, the primary objective of this Ph.D. project is to develop innovative computational methods for automatic pain assessment that achieve high performance and are applicable in real clinical settings. A primary goal is to thoroughly investigate and assess significant factors, including demographic elements that impact pain perception, as recognized in pain research, through a computational standpoint. Within the limits of the available data in this research area, our goal was to design, develop, propose, and offer automatic pain assessment pipelines for unimodal and multimodal configurations that are applicable to the specific requirements of different scenarios. The studies published in this Ph.D. thesis showcased the effectiveness of the proposed methods, achieving state-of-the-art results. Additionally, they paved the way for exploring new approaches in artificial intelligence, foundation models, and generative artificial intelligence.

PainFormer: a Vision Foundation Model for Automatic Pain Assessment

Pain is a manifold condition that impacts a significant percentage of the population. Accurate and reliable pain evaluation for the people suffering is crucial to developing effective and advanced pain management protocols. Automatic pain assessment systems provide continuous monitoring and support decision-making processes, ultimately aiming to alleviate distress and prevent functionality decline. This study introduces PainFormer, a vision foundation model based on multi-task learning principles trained simultaneously on 14 tasks/datasets with a total of 10.9 million samples. Functioning as an embedding extractor for various input modalities, the foundation model provides feature representations to the Embedding-Mixer, a transformer-based module that performs the final pain assessment. Extensive experiments employing behavioral modalities-including RGB, synthetic thermal, and estimated depth videos-and physiological modalities such as ECG, EMG, GSR, and fNIRS revealed that PainFormer effectively extracts high-quality embeddings from diverse input modalities. The proposed framework is evaluated on two pain datasets, BioVid and AI4Pain, and directly compared to 73 different methodologies documented in the literature. Experiments conducted in unimodal and multimodal settings demonstrate state-of-the-art performances across modalities and pave the way toward general-purpose models for automatic pain assessment.

A Full Transformer-based Framework for Automatic Pain Estimation using Videos

The automatic estimation of pain is essential in designing an optimal pain management system offering reliable assessment and reducing the suffering of patients. In this study, we present a novel full transformer-based framework consisting of a Transformer in Transformer (TNT) model and a Transformer leveraging cross-attention and self-attention blocks. Elaborating on videos from the BioVid database, we demonstrate state-of-the-art performances, showing the efficacy, efficiency, and generalization capability across all the primary pain estimation tasks.

Synthetic Thermal and RGB Videos for Automatic Pain Assessment utilizing a Vision-MLP Architecture

Pain assessment is essential in developing optimal pain management protocols to alleviate suffering and prevent functional decline in patients. Consequently, reliable and accurate automatic pain assessment systems are essential for continuous and effective patient monitoring. This study presents synthetic thermal videos generated by Generative Adversarial Networks integrated into the pain recognition pipeline and evaluates their efficacy. A framework consisting of a Vision-MLP and a Transformer-based module is utilized, employing RGB and synthetic thermal videos in unimodal and multimodal settings. Experiments conducted on facial videos from the BioVid database demonstrate the effectiveness of synthetic thermal videos and underline the potential advantages of it.

Twins-PainViT: Towards a Modality-Agnostic Vision Transformer Framework for Multimodal Automatic Pain Assessment using Facial Videos and fNIRS

Automatic pain assessment plays a critical role for advancing healthcare and optimizing pain management strategies. This study has been submitted to the First Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4PAIN). The proposed multimodal framework utilizes facial videos and fNIRS and presents a modality-agnostic approach, alleviating the need for domain-specific models. Employing a dual ViT configuration and adopting waveform representations for the fNIRS, as well as for the extracted embeddings from the two modalities, demonstrate the efficacy of the proposed method, achieving an accuracy of 46.76% in the multilevel pain assessment task.

Multi-task Neural Networks for Pain Intensity Estimation using Electrocardiogram and Demographic Factors

Pain is a complex phenomenon which is manifested and expressed by patients in various forms. The immediate and objective recognition of it is a great of importance in order to attain a reliable and unbiased healthcare system. In this work, we elaborate electrocardiography signals revealing the existence of variations in pain perception among different demographic groups. We exploit this insight by introducing a novel multi-task neural network for automatic pain estimation utilizing the age and the gender information of each individual, and show its advantages compared to other approaches.