A WA invention is shaping up to be a game changer in assessing pain in those who can’t speak up for themselves.

The Australian Government announcement of a $5 million grant to extend the roll-out the WA-developed PainChek app into registered aged care facilities around the country is testament to how a great idea takes years of hard work.

Medical Forum first spoke to Prof Jeff Hughes about five years ago when he was the head of pharmacy at Curtin University. Then he excitedly related research of his PhD student Mustafa Atee who along with himself and co-supervisor Dr Kreshnik Hoti had devised a digital program that would identify and assess pain for non-verbal dementia sufferers.

As the idea germinated and attracted commercial and government attention, the concept grew to become a smart phone app, developed with the use of modified facial recognition and artificial intelligence technology, and trialled in the Regents Garden aged care facility in Scarborough.

Jeff is again brimming with excitement when he considers what this technology can mean for the aged care sector and beyond.

“We listed as a public company in 2016 and, yes, it’s gone from strength to strength. The early days was Mustafa, Kreshnik and me and we were all at Curtin. We involved the Swiss-based Nviso IT company with it facial recognition software, which has allowed us to detect the face and landmark it. We then built an algorithm over the top of that to check pain-related facial expressions.”

PainChek has taken over the three men’s lives – in a good way!

WA leads the way

“I still work at Curtin but I am part of a contract between PainChek Ltd and the university and I function as the Chief Scientific Officer. Mustafa works within the company as a senior research scientist and Kreshnik, who is currently at the Massachusetts Institute of Technology studying AI on a Fulbright scholarship, is a consultant,” Jeff explained.

“There is so much potential for this technology. If we just look at the dementia app, it has been cleared by Australian regulator TGA as a Class 1 medical device and in Europe for the CE mark.”

“We have until now worked only in the aged care space but we are expanding to home care with a trial running in palliative care. There is enormous potential to expand the user space for professionals working in primary care as well as family carers, and then there’s an enormous unmet need within the hospital setting.”

“What we know is that about half of elderly patients who go into hospital for surgery end up having an acute delirium, which impacts on their care. And about a third of elderly patients on medical wards also have those problems.”

From aged care to children’s pain and Jeff said a PainChek children’s app was set to enter the validation stage at an Eastern States hospital, while a prototype for an infant app was in development.

While all these variations are based on the same principle of facial recognition and analysis, there are different sets of facial expressions and non-facial indicators to calibrate, not the least with the simple fact that children’s physiology and facial morphology change constantly.

The scope of the app in the adult and paediatric spheres is enormous and not just in a clinical sense.

Family’s peace of mind

“The Aged Care Minister Ken Wyatt was at the recent launch at Regents Garden in Scarborough and he introduced a woman whose mother is a resident there. Her story is not unique. Although her mother has not been overly troubled with pain, her daughter said the facility’s use of the PainChek app gave her peace of mind.”

“That could be said for every parent, including me, who has been up half the night with a fretful child. Having some indicator of the need for pain relief, or not, would have given me big peace of mind,” Jeff said.

“My wife and I had 12 months of a very unsettled child and I was only reflecting on those days after hearing this woman’s story. Was my son in pain or was there another unmet need that we couldn’t work out? An app such as PainChek will give a lot of security to a lot of people and that’s what we’re hoping to do.”

“Research shows that 20% of children probably experience untreated acute pain. They suffer migraine, they get reflux pain, abdomen pain, joint pain and if not treated they can become chronic. And so for all our best effort not to give children pain medication when it is not required, there will be a percentage of children who are not medicated, or given other treatment, when it is required.”

“We have learnt skills over the time of this journey. We’re not programmers but we know what needs to be done and have collected libraries of children’s images undergoing things such as vaccinations and code then train the algorithm.”

The amount of work needed to clear the dementia pain app through the regulators in Australia, Europe and now in the US for FDA approval, is being replicated by the team working on the children’s app.

The app is in prototype and has undergone in-house testing. The next step, says Jeff, is partnering with a group that provides access to young patients undergoing painful procedures and compare PainChek against a standard pain tool.

Less second-guessing

“The first area to be studied will be Face Leg Activity Crying Consolability (FLACC), which is a widely recognised tool but in the helter skelter of ED the best guess is still clinical judgement. Clinicians would find it very useful to use the same tool for every child so that when it comes to hand over a patient, there is tangible data. It will help enormously to maintain continuity of care,” Jeff said.

The PainChek app does not record or store images of individuals so as to protect privacy.

“The app is trained on multiple images, so it will analyse in real time across a number of images of the patient. For instance it may select images 6, 7, 10 and 25 as having certain pain codes. After an interval, 6, 7 and 25 are present. No image is stored in that process,” he said.

“Within a nursing home setting, a picture on the resident’s profile page is stored as part of quality and safety procedures but privacy is maintained by not recording any real-time images.”

The app has been warmly welcomed at its trial site and Jeff said the second Regents Garden facility has started using PainChek and anecdotes are starting to filter back.

“We heard that a person who was not suspected as having pain issues using the old system, was identified by PainChek as having pain and as a consequence of intervention, that person’s behaviour improved.”

Jeff said that PainChek was also proving to be a bonus when it comes to accreditation auditing for an aged care facility.

“The backend of the app allows analytics of user use so the aged care facility can demonstrate strong evidence that thorough pain assessment has been done.”

Eyes on consumers

“And we have a lot of people inquiring about potential PC use so, slowly and surely, we are engaging with people to expand care. There is great enthusiasm in the hospital setting and for the children’s app, and eyes are also turning to a consumer app.”

And with the growth of more in-home services, the sky is the limit.

“Carers need to be empowered and educated around pain and pain assessment in people with dementia and there is an absolute need to educate about behaviours in people with advancing dementia that may not necessarily be related to dementia. They must always consider if there is an unmet need and that may not be pain, but if it is, it can be dealt with.”

Jeff said that the $5 million from the government will help give 100,000 people in aged care access to PainChek. Currently cost per head depends on how many beds will be covered by a subscription, and price is negotiable.

As economies of scale settle down, Jeff is content with an even bigger prize than a successful business model.

“This idea that started so small will make a big difference to people’s lives. We all have good ideas but not all of them come to fruition. To change one person’s life is great but changing multiple lives is the best feeling.”

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