Abstract
Pain is common in people living with dementia (PLWD), including those with limited verbal skills. Facial expressions are key behavioral indicators of the pain experience in this group. However, there is a lack of real-world studies to report the prevalence and associations of pain-relevant facial micro-expressions in PLWD. In this observational retrospective study, pain-related facial features were studied in a sample of 3,144 PLWD [mean age 83.3 years (SD = 9.0); 59.0% female] using the Face domain of PainChek®, a point-of-care medical device application. Pain assessments were completed by 389 users from two national dementia-specific care programs and 34 Australian aged care homes. Our analysis focused on the frequency, distribution, and associations of facial action units [AU(s)] with respect to various pain intensity groups. A total of 22,194 pain assessments were completed. Of the AUs present, AU7 (eyelid tightening) was the most frequent facial expression (48.6%) detected, followed by AU43 (closing eyes; 42.9%) and AU6 (cheek raising; 42.1%) during severe pain. AU20 (horizontal mouth stretch) was the most predictive facial action of higher pain scores. Eye-related AUs (AU6, AU7, AU43) and brow-related AUs (AU4) were more common than mouth-related AUs (e.g., AU20, AU25) during higher pain intensities. No significant effect was found for age or gender. These findings offer further understanding of facial expressions during clinical pain in PLWD and confirm the usefulness of artificial intelligence (AI)-enabled real-time analysis of the face as part of the assessment of pain in aged care clinical practice.
Highlights
Pain is a common experience in older people living with dementia (PLWD) because of aged-related physical and functional decline and their associated multimorbidity [1]
This study aimed to investigate the association of the presence of particular pain-related facial actions (AUs) with respect to pain intensity, using an artificial intelligence (AI)-enabled pain assessment system “PainChek R .”
Using a “big data” approach [41], we have demonstrated that anatomically oriented facial expressions are strong and responsive indicators of pain experience in PLWD in everyday clinical practice
Summary
Pain is a common experience in older people living with dementia (PLWD) because of aged-related physical and functional decline and their associated multimorbidity [1]. If it remains un(der)treated, pain may lead to multiple adverse health outcomes including behavioral disturbances (e.g., agitation), physical decline (increased frailty), cognitive decline, inappropriate pharmacotherapy, hospitalizations, institutionalization, disabilities, and premature death [2,3,4]. Facial expressions are known to be dynamic, spontaneous, versatile, and encodable behaviors [6] These criteria allow facial expressions to be contextually meaningful and unique, and well placed as a prime target for pain assessments in clinical settings
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