An Exploratory Analysis of Pain Localization via Explainable Computational Modeling

Pain is a complex and pervasive phenomenon affecting a large percentage of the population, and accurate assessment is essential for effective clinical management and intervention. Computational pain recognition systems enable continuous monitoring, support clinical decision-making, and help mitigate pain-related distress and functional decline. This study introduces a unified tokenization framework for heterogeneous 3D modalities in pain recognition that provides a single processing pipeline across behavioral and brain-activity 3D data, without requiring separate architectures for each modality or handcrafted inductive biases. The framework preserves spatial, temporal, and time--frequency structure while mapping diverse inputs into a shared token space. Extensive experiments show that the proposed approach effectively processes facial videos and fNIRS data in both raw-signal and spectrogram-based representations. On the AI4Pain benchmark dataset, the proposed framework achieves state-of-the-art performance while maintaining high computational efficiency and enabling real-time assessment on both GPU and CPU hardware.

Automatic pain assessment from facial video remains challenging due to the spatial heterogeneity of pain-related facial cues. This study proposes ReFace, a spatial reorganization pipeline that divides facial input into four spatial quadrants before tokenization, rather than processing the entire face as a single region. Evaluated on the AI4Pain dataset, the proposed approach achieves $56.00\%$ accuracy on the test set using video only, achieving the highest reported accuracy under the fixed AI4Pain benchmark protocol among the compared methods. Notably, the four-quadrant configuration processes the same total pixel budget as the full-face input, yet achieves higher accuracy, suggesting that spatial reorganization can improve performance under the proposed tokenization design. A single quadrant region, processing just one quarter of those pixels, remains competitive at a fraction of the computational cost.

Tremor is a common movement disorder associated with conditions like Parkinson's disease and Essential tremor, traditionally diagnosed through expert clinician assessment. Current automated detection methods rely on frequency-domain features informed by clinical expertise. In this work, we present an explainable, two-stage hierarchical framework for tremor detection in the time domain that learns tremor patterns directly from 3D kinematic marker time-series data across entire tremor-provoking trials. Our framework combined a deep convolutional and long short-term memory network to learn tremor representations from short, discrete, non-overlapping time segments of kinematic time series data from trials, which are then processed by a vision transformer that models their long-term temporal dynamics of time segment features for trial (session) level classification. Evaluated across nine body parts, the framework achieved F1-scores of 0.594 - 0.947 depending on body parts (average: 0.765), falling short of the frequency-domain state-of-the-art performance (0.909) while requiring minimal preprocessing. Attention weights and gradient-based class activation maps (Grad-CAM) identified time-domain features of tremor across body parts. This proof of concept demonstrated the feasibility of data-driven time-domain modeling for tremor detection across anatomically diverse body parts, while reducing reliance on expert-engineered spectral features and providing posthoc interpretability of temporal and anatomical patterns of tremor.