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Pain is a significant public health problem as the number of individuals with a history of pain globally keeps growing. In response, many synergistic research areas have been coming together to address pain-related issues. This work reviews and analyzes a vast body of pain-related literature using the keyword co-occurrence network (KCN) methodology. In this method, a set of KCNs is constructed by treating keywords as nodes and the co-occurrence of keywords as links between the nodes. Since keywords represent the knowledge components of research articles, analysis of KCNs will reveal the knowledge structure and research trends in the literature. This study extracted and analyzed keywords from 264,560 pain-related research articles indexed in IEEE, PubMed, Engineering Village, and Web of Science published between 2002 and 2021. We observed rapid growth in pain literature in the last two decades: the number of articles has grown nearly threefold, and the number of keywords has grown by a factor of 7. We identified emerging and declining research trends in sensors/methods, biomedical, and treatment tracks. We also extracted the most frequently co-occurring keyword pairs and clusters to help researchers recognize the synergies among different pain-related topics. 

Automatic pain intensity assessment from physiological signals has become an appealing approach, but it remains a largely unexplored research topic. Most studies have used machine learning approaches built on carefully designed features based on the domain knowledge available in the literature on the time series of physiological signals. However, a deep learning framework can automate the feature engineering step, enabling the model to directly deal with the raw input signals for real-time pain monitoring. We investigated a personalized Bidirectional Long short-term memory Recurrent Neural Networks (BiLSTM RNN), and an ensemble of BiLSTM RNN and Extreme Gradient Boosting Decision Trees (XGB) for four-category pain intensity classification. We recorded Electrodermal Activity (EDA) signals from 29 subjects during the cold pressor test. We decomposed EDA signals into tonic and phasic components and augmented them to original signals. The BiLSTM-XGB model outperformed the BiLSTM classification performance and achieved an average F1-score of 0.81 and an Area Under the Receiver Operating Characteristic curve (AUROC) of 0.93 over four pain states: no pain, low pain, medium pain, and high pain. We also explored a concatenation of the deep-learning feature representations and a set of fourteen knowledge-based features extracted from EDA signals. The XGB model trained on this fused feature set showed better performance than when it was trained on component feature sets individually. This study showed that deep learning could let us go beyond expert knowledge and benefit from the generated deep representations of physiological signals for pain assessment. 

In current clinical settings, typically pain is measured by a patient’s self-reported information. This subjective pain assessment results in suboptimal treatment plans, over-prescription of opioids, and drug-seeking behavior among patients. In the present study, we explored automatic objective pain intensity estimation machine learning models using inputs from physiological sensors. This study uses BioVid Heat Pain Dataset. We extracted features from Electrodermal Activity (EDA), Electrocardiogram (ECG), Electromyogram (EMG) signals collected from study participants subjected to heat pain. We built different machine learning models, including Linear Regression, Support Vector Regression (SVR), Neural Networks and Extreme Gradient Boosting for continuous value pain intensity estimation. Then we identified the physiological sensor, feature set and machine learning model that give the best predictive performance. We found that EDA is the most information-rich sensor for continuous pain intensity prediction. A set of only 3 features from EDA signals using SVR model gave an average performance of 0.93 mean absolute error (MAE) and 1.16 root means square error (RMSE) for the subject-independent model and of 0.92 MAE and 1.13 RMSE for subject-dependent. The MAE achieved with signal-feature-model combination is less than 1 unit on 0 to 4 continues pain scale, which is smaller than the MAE achieved by the methods reported in the literature. These results demonstrate that it is possible to estimate pain intensity of a patient using a computationally inexpensive machine learning model with 3 statistical features from EDA signal which can be collected from a wrist biosensor. This method paves a way to developing a wearable pain measurement device.