You’re the voice: the evolution of the PainChek app

News Release
April 2018| Australia – You’re the voice: the evolution of the PainChek app

How can someone tell you they’re experiencing pain or discomfort that isn’t overtly visible, if they can’t communicate through speech? Professor Jeff Hughes from Curtin’s School of Pharmacy and Biomedical Sciences has created an app that gives a voice to people who are living with conditions that impact upon their ability to verbally communicate with others.

Elderly woman sitting down holding a phone with man sitting behind her.

One of these conditions is dementia, a neurodegenerative condition that affects the brain’s cognitive ability. It’s currently the second leading cause of death in Australia, and with the number of people living with dementia set to reach more than 536,000 by 2025, the demand for tools that help treat and manage the condition is sure to increase.

Professor Hughes’ brainchild was the world’s first smartphone app for pain assessment and monitoring, developed under the banner of Curtin start-up company ePAT (electronic Pain Assessment and Technologies Ltd) from 2014. The start-up was acquired by PainChek Ltd in 2016, and the app is now being further developed and marketed by the company as ‘PainChek’.

The app provides an accurate and reliable means for healthcare professionals and family members providing care at home to assess pain, and ultimately help to improve quality of life for those they care for.

“A significant issue among people with advanced dementia is that they no longer have the communication skills to express the level of pain they are suffering,” Hughes explains.

“The seriousness of their pain can often go unrecognised. But PainChek, a smart-device app, which utilises automation and artificial intelligence, allows for the detection and quantification of pain, based in part on a patient’s facial expressions.

PainChek uses facial recognition and a 42-point pain scale to help healthcare professionals and family members decipher the level of pain being experienced by their patient or family member, allowing them to respond accordingly. A level between zero to six represents no pain, seven to 11 mild pain, 12 to 15 moderate pain and anything above 15 means severe pain.

The tailored pain scale was developed by Hughes and his team through a tireless review of existing literature and tools, including the well-known Abbey Pain Scale, an observational pain assessment tool used nationally in the assessment of pain in people with dementia.

PainChek automates pain assessment, allowing for the continual evaluation of pain, and providing the user with access to a personalised pain chart of their patient or family member, which has been mapped over an extended timeframe. The chart is designed to be used in conjunction with other information recorded on the app, which correlates with or affects pain levels, such as medication types and dosages, activity levels and behaviour. All recorded data is backed up when the device is connected to the internet.

Since its inception in 2013, Hughes and his team have been working hard to assess and monitor the performance of the app. They’ve conducted validation studies with a range of Perth-based aged care providers, including Mercy Care, Juniper, Bethanie and Brightwater, comparing each generation of the app with the Abbey Pain Scale. Data from these trials was used to support the registration of the app as a Class 1 medical device in Australia (Therapeutics Goods Administration registration) and Europe (CE Mark) by PainChek Ltd.

Trials in aged care facilities were successful, validating the functionality and purpose of PainChek. One of the residents living with dementia was previously cared for at home by her husband. He says the app has been an invaluable tool for assessing his wife’s constant lower back pain.

“When we tested the app on my wife, we got a score of four out of 10. It was so quick and accurate. She’s in pain constantly with her lower back, and has trouble sitting down. The pain scale changes daily, and it makes me feel really comfortable that I can administer the necessary pain killers at any given time.”

In addition, the research has led to the development of a partnership with Dementia Support Australia, which comprises the two entities Dementia Behaviour Management Advisory Service and Severe Behaviour Response Teams.

“Dementia Support Australia sends consultants out to assist in the care of people living with dementia who have significant behavioural problems,” Professor Hughes says.

“What they had found from their own observations was that somewhere between 35 to 60 per cent of the people had undetected or undertreated pain, and they wanted the means to improve the assessment and documenting of that pain, and better demonstrate the effectiveness of their service.

“PainChek Ltd are effectively doing an implementation trial with them, starting here in Western Australia and then in South Australia. As part of the trial, we provide training and, after each roll out, we also offer clinical and technical support. In 2018, we’ll roll out the app to all 150 of their consultants Australia-wide.”

The development of the app hasn’t stopped there, with PainChek Ltd working on adaptations that can cater for other groups unable to communicate verbally: infants and pre-verbal children.

“Twenty per cent of children have chronic pain, with common causes being headaches and gastrointestinal or musculoskeletal conditions. And that pain can produce a whole range of issues, such as behavioural problems, poor interaction with others and avoiding school. Most people think that little kids don’t feel pain the way adults do, but we’re learning this isn’t the case,” Hughes reveals.

The intended impact of the children’s app is three-fold. One, to provide parents with surety about whether they’re taking the appropriate action. Two, to assist healthcare professionals in deciding what level of pain a child might be in and which medication to administer if applicable, and three, to encourage the investigation of the root cause of the pain to then seek the appropriate treatment.

Much like the adult app, the children’s app contains a number of items to help assess pain, however, the facial recognition element is far more in-depth due to the fact that children typically use more pain-associated facial expressions than adults. As a result, Hughes’ team has been capturing videos of children who are in pain, primarily during the immunisation process, with each video contributing to a database of coded images. With a preliminary algorithm already built, PainChek Ltd plans to have the first prototype available for trialling in 2018.

More information about the  app can be found on the PainChek website.

Commonly prescribed medications linked to rise in harmful side effects in dementia

News Release
July 2018 | United Kingdom – Commonly prescribed medications linked to rise in harmful side effects in dementia

Medications which are commonly prescribed to people with dementia have been linked to an increase in harmful side-effects, research involving the University of Exeter has concluded.

antibiotic blur cocktail glass cocktail tablets
Photo by Pixabay on Pexels.com

The research, presented at the Alzheimer’s Association International Conference (AAIC) examined the impact of opioid-based painkillers or a class of sleep medication known as Z drugs (zolpidem, zopiclone and zaleplon). They are prescribed to an estimated 200,000 with dementia living in care homes across the UK in total.

In the opioid painkiller research, a team from the University of Exeter, King’s College London and the University of Bergen highlight a tripling in harmful side effects related to the use buprenorphine in people with dementia, compared to those on a placebo. Researchers also identified a mechanism that may be causing the problem.

In a randomized controlled trial of 162 Norwegian care home residents, the team found a significant rise in side effect such as personality changes, confusion and sedation, which can seriously impact people’s lives in dementia. The trial team, led by the University of Bergen, studied 162 people from 47 Norwegian care homes who had advanced dementia and significant depression. In those who were assigned buprenorphine as part of their treatment pathway, harmful side-effects more than tripled. The researchers also found that those taking buprenorphine were significantly less active during the day.

In the Z-drugs research, the team compared data for 2,952 people with dementia who were newly prescribed the medication with data for 1,651 who were not – in order to evaluate the benefits and harms of the medicines. They found that people who take Z-drugs are more likely to fracture a bone than those who do not. Bone fractures are related in turn to an increased risk of death in people with dementia.

Researchers are now calling for studies to examine alternative non-drug approaches to treating pain and insomnia, and appropriate dosing of painkillers such as buprenorphine for people with dementia. Clive Ballard, Professor of Age-Related Diseases at the University of Exeter Medical School, said: “Research into antipsychotics highlighted that they increased harmful side effects and death rates in people with dementia. This compelling evidence base helped persuade everyone involved in the field to take action, from policy makers to clinicians, reducing prescribing by 50 per cent. We now urgently need a similar concerted approach to opioid-based painkillers and Z-drugs, to protect frail elderly people with dementia from fractures and increased risk of death.”

Importantly, research led by Professor Ballard’s team and also presented at the conference also gives insight into the mechanism of why people with dementia are more susceptible to opioid-based painkillers, suggesting they over-produce the body’s natural opioids.

The study treating arthritis in Alzheimer’s mice found increased sensitivity to the opioid-based painkiller morphine in mice with Alzheimer’s disease compared to those without. Those with Alzheimer’s disease responded to a much lower dose to ease pain, and experienced more adverse effects when the dose was increased to a normal level. Looking into this further the study found that the Alzheimer’s mice produced more of the body’s natural endogenous opioids such as endorphins. The study, presented as a poster at AAIC, also concludes that dosing of opioid-based painkillers urgently needs to be reviewed in people with dementia to enable safe and effective treatment of pain, and prevent unnecessary harm and deaths.

Posters presented at conference have not yet been through the journal peer review process.

Watch carers talk about their experience of the WHELD training. To find out more about our world-leading dementia research, follow #ExeterDementia and @Clive_Ballard on Twitter, or visit the Exeter Dementia website.

Where do Asian immigrants go when we have dementia?

My husband and I have been talking about kids for a long time now, and I’m certainly not getting any younger. As the days tick by and my facebook is filled with walls of baby photos in my activity feed, I wonder about having my own. On top of that I wonder what the future will hold for my children? I am Singaporean, my husband is Australian, our racial and cultural differences are vast. We look like chalk and cheese and our cultures are chalk and cheese. I am born and raised in Singapore and proud of it.

Looking back at my youth when I was growing up, the house was filled with an orchestra of languages. Instead of the wind, brass, drums and percussions, we had English songs from Abba, Michael Jackson, Kenny Rogers, playing on the radio. I remembered my mum even attended a Debbie Gibson concert. That was really cool! I remembered the souvenir she brought back, it was a fan in the shape of a blue hand, sounds odd now but when I was a kid, that was possibly super cool.

There would be English in the background, my great grandmother speaking in the Teochew dialect, my mum in Mandarin and my dad would speak in either English or Teochew. Sometimes I hear him speaking Malay to the man who comes to collect the payments for our daily newspaper. Singapore was an amazing melting pot of cultures and languages, and I embraced every crumb of the colourful heritage that I can call my own. There was never a dull moment growing up in Singapore, my childhood was certainly a happy one.

Image from abusymom.wordpress.com

My child will have an Asian migrant parent depending on where we will reside when we retire, and I often wonder what will happen to my children when I have dementia. Will they be able to speak my language if I regress to Mandarin or Teochew? Will I lose the ability to communicate because there will be no one who can understand me? I remember caring for a lady who spoke Russian and I would carry a notebook with me with some basic words like “dobroye utro” or good morning, “Da” for yes and “Net” for no, and about 20 other phrases for different times of the day and meals.  I wondered if her children could speak the language?

Sometimes I watch the western videos on nursing homes or visit residential aged care homes and I think, I’m never going to be comfortable in a place like this. It’s beautiful, no doubt about it, but there’s nothing familiar in the four walls. Even the people look foreign, no one speaks my language, the food is all wrong and if I were to live in a residential aged care facility, it would be like living in a foreign television show. I would think I was on the Truman show or something. I have only seen one Asian nursing home in Australia, the home is lovely, with Asian staff and sumptuous simple Chinese meals, with menus beautifully printed in Mandarin, but the environment itself looks like community hospital on the inside with nursing reception counters and a very modern western feel.

There are 10.6 million Asian immigrants in the United States of America in 2009, in the United Kingdom almost 10% of immigrants are from South Asia and in Australia a million immigrants were from Asia according to the statistics in 2011.

I wonder if I am the only person with these worries and thoughts? I wonder what happens to Asian immigrants who work long and hard to bring their children to the west, only to live out the end of their lives in confusing and disorientating environments? What can we do for them, and how can we make their lives better? Will there be more places that can cater for Asian migrants? Where can we go to feel at home when we have dementia?

I have no answers and only questions, hopefully, time will tell.

References:

Australian Bureau of Statistics 2004, ‘Where do the Overseas-born population live?’ in Australian Social Trends, cat. no. 4102.0, viewed: 18 May 2012, <http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/4102.0>.

Department of Immigration and Citizenship, Booklet 6, General Skilled Migration, viewed: 24 April 2012, <www.immi.gov.au>.

Australian Bureau of Statistics 2010, Migration, Australia, 2009-10, cat. no. 3412.0, viewed: 18 May 2012, <http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3412.0Main+Features12009-10>.

Salt, J. “International Migration and the United Kingdom, 2010.” Report of the United Kingdom SOPEMI correspondent to the OECD, Migration Research Unit, University College London, 2011.

U.S. Department of Homeland Security, Office of Immigration Statistics. 2010 Yearbook of Immigration Statistics.

I’ve attached a video that I found very moving about the trials and tribulations experienced by migrant parents to help people understand the difficulties of resettling and raising children in a foreign land. I also found a funny video about the same group of kids and parents imitating each other and that’s actually really funny.


Children Of Asian Immigrants Reveal Sacrifices Their Parents Made

Asian Moms And Their Kids Imitate Each Other