The expression of pain in infants with developmental delays

The Clinical Suitability of an Artificial Intelligence-Enabled Pain Assessment Tool for Use in Infants: Feasibility and Usability Evaluation Study

BACKGROUND

Infants are unable to self-report their pain, which, therefore, often goes underrecognized and undertreated. Adequate assessment of pain, including procedural pain, which has short- and long-term consequences, is critical for its management. The introduction of mobile health-based (mHealth) pain assessment tools could address current challenges and is an area requiring further research.

OBJECTIVE

The purpose of this study is to evaluate the accuracy and feasibility aspects of PainChek Infant and, therefore, assess its applicability in the intended setting.

METHODS

By observing infants just before, during, and after immunization, we evaluated the accuracy and precision at different cutoff scores of PainChek Infant, which is a point-of-care mHealth-based solution that uses artificial intelligence to detect pain and intensity based solely on facial expression. We used receiver operator characteristic analysis to assess interpretability and establish a cutoff score. Clinician comprehensibility was evaluated using a standardized questionnaire. Other feasibility aspects were evaluated based on comparison with currently available observational pain assessment tools for use in infants with procedural pain.

RESULTS

Both PainChek Infant Standard and Adaptive modes demonstrated high accuracy (area under the curve 0.964 and 0.966, respectively). At a cutoff score of ≥2, accuracy and precision were 0.908 and 0.912 for Standard and 0.912 and 0.897 for Adaptive modes, respectively. Currently available data allowed evaluation of 16 of the 17 feasibility aspects, with only the cost of the outcome measurement instrument unable to be evaluated since it is yet to be determined. PainChek Infant performed well across feasibility aspects, including interpretability (cutoff score defined), ease of administration, completion time (3 seconds), and clinician comprehensibility.

CONCLUSIONS

This work provides information on the feasibility of using PainChek Infant in clinical practice for procedural pain assessment and monitoring, and demonstrates the accuracy and precision of the tool at the defined cutoff score.

Pain assessment during a vaso-occlusive crisis in the pediatric and adolescent patient: rethinking practice

Pain assessment of the child and adolescent with sickle cell disease is complex and challenging. We present a paradigm of pain assessment during a vaso-occlusive crisis in children and adolescents based on the Pain Assessment as a Social Transaction model. Using this model, the assessment of pain severity in sickle cell disease is uniquely highlighted as comprising at least 4 key factors: the limitations of current pain assessment tools, the existence of acute pain of various origins and the emergence and coexistence of chronic pain, the prevalence of cognitive deficits, and the sociocultural dynamics in America. Improved tools for pain assessment and targeted practitioner education are warranted.

Finding the evidence to change practice for assessing pain in children who are cognitively impaired

We report on a quality improvement project whose purpose was to systematically review behavioral pain assessment tools for children who are cognitively impaired, with the goal of identifying a valid and reliable tool for clinical practice. In addition, we sought to partner with parents and/or caregivers to expand their role in pain assessment. The project team conducted an extensive synthesis of the literature to examine the availability and quality of published pain assessment tools for use with children with cognitive impairment (CI) or developmental disability. Once completed, we identified 2 of the available 10 tools to test in the clinical setting. Data from this quality improvement project provided evidence to support the adoption of the revised Faces, Legs, Activity, Cry, and Consolability pain assessment tool for children with CI into clinical practice.

Pain assessment and management in children with neurologic impairment: a survey of pediatric physical therapists

PURPOSE

This study explored pain assessment measures and interventions used by physical therapists in the treatment of children with neurologic impairment.

METHODS

Following extensive literature review on pain assessment and intervention, a survey was developed, pilot tested, and posted on the listserv of the Pediatric Section of the American Physical Therapy Association.

RESULTS

Eighty percent of the respondents used subjective measures to assess pain, 70% used self-report scales, and 41% used behavioral and physiological measures. Behaviors frequently used included vocalizations, facial expression, and irritability. Rarely used cues included decreased attention, withdrawal, and changes in sleeping and eating behaviors. Therapists used research-supported pain interventions such as distraction and praise as well as potentially harmful distress producing measures such as procedural talk and reassurance.

CONCLUSION

Further research is needed to determine the feasibility of using behavioral pain assessment measures during physical therapy sessions. Physical therapist continuing education regarding nonpharmaceutical pain interventions is indicated.

Facial expression and pain assessment in the pediatric patient: the primal face of pain

PURPOSE

This paper aims to explore the role of facial expression in pediatric pain assessment. A comparison of tools employing facial expression methodology is presented. The concept of the primal face of pain (PFP) is introduced.

CONCLUSION

The PFP offers an explanation to the utility and deficiency of facial pain scales and facial expression in pain assessment.

PRACTICE IMPLICATIONS

The complexities of pain measurement should preclude the clinical application of untested instruments. For reported tools, a careful evaluation of the psychometric properties and the clinical context must precede application. The concept of the PFP warns against the application of facial pain scales as proxy measures in their intended population. Reliance on facial expression to assess pain in the school-age child is imprecise.

Pain assessment in profound cognitive impaired children using the Checklist Pain Behavior; is item reduction valid?

There are both commonalities and idiosyncratic features in the reaction of pain children with profound cognitive impairment (CI), and that there is no evidence to suggest that idiosyncratic behavior is more characteristic of this population than of any other population. The main objective of this study was to identify whether the 23-item version of the Checklist Pain Behavior could be reduced to 10 items. Previous research demonstrated that only these 10 items discriminated between absence and presence of pain. Second, we wanted to explore the underlying structure of these 10 selected items including its performance. Data of 477 observations in 73 children were used. All these children were video-taped while they were admitted to the Sophia Children's Hospital for surgery, twice before and five times after surgery. These video-tapes were scored by an independent observer. A visual analogue scale (VAS) by a researcher was used to assess the presence of pain. We tested whether the underlying structure was unidimensional, and whether it had differential qualities between pain and no pain, and to which degree. Using a modern psychometric method, i.e., Mokken scaling model, we unraveled the interdependency of the pain response in CI-children, in that the structure turned out to be unidimensional. In addition, these behaviors could be hierarchically ordered in terms of frequency of occurrences. Finally, these behaviors had to a high degree the potentialities to estimate the likelihood of occurrence of pain.