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The face of low back pain: A preliminary method for quantifying pain-related facial expressions

dc.contributor.authorParolini, Franciele
dc.contributor.authorPires, Ricardo
dc.contributor.authorSantos, Sara Dereste dos
dc.contributor.authorGoethel, Márcio F.
dc.contributor.authorBecker, Klaus
dc.contributor.authorVilas-Boas, João Paulo
dc.contributor.authorSantos, Rubim
dc.contributor.authorErvilha, Ulysses F.
dc.contributor.authorRubim Silva Santos, Manuel
dc.contributor.authorCarvalho Santos Parolini, Franciele
dc.date.accessioned2026-03-17T12:04:58Z
dc.date.available2026-03-17T12:04:58Z
dc.date.issued2026-03-16
dc.description.abstractFacial expressions of pain are essential for pain assessment, yet subjective pain reports often vary between sexes. Traditional self-report measures are prone to bias, and objective methods are needed for more reliable pain evaluation. To develop and validate a subjectivity-free automated tool to assess acute low back pain using facial expressions recorded during a functional spinal extension task. Thirty healthy adults, aged 18–40 years. Methods: Participants received intramuscular injections of hypertonic (pain) and isotonic (placebo) saline in the lumbar region during separate sessions. Facial expressions were video-recorded during a submaximal lumbar extension task and analyzed using a custom software based on Haar Cascade and Local Binary Pattern Histogram algorithms, which are techniques that do not require neither training data nor subjective labeling, contrary to what happens in deep learning solutions. The tool successfully detected significant differences in facial expressions between pain, placebo, and pain-free conditions (p < 0.001). Test–retest reliability was good (ICC = 0.85). While both sexes showed similar facial expression patterns during pain, males reported higher pain scores on the numeric rating scale (p < 0.01). Pain significantly reduced steadiness of force in both sexes. The automated tool objectively quantified facial expressions associated with acute low back pain and revealed sex-related differences in subjective pain perception. This multimodal approach integrating expression analysis, physical performance, and self-report may enhance the accuracy of pain assessment in physiotherapy settings.eng
dc.identifier.citationParolini, F., Pires, R., dos Santos, S. D., Goethel, M. F., Becker, K., Vilas-Boas, J. P., Santos, R., & Ervilha, U. F. (2026). The Face of Low Back Pain: A Preliminary Method for Quantifying Pain-Related Facial Expressions. Applied Sciences, 2.5, 16(6), 2830. https://doi.org/10.3390/app16062830
dc.identifier.doi10.3390/app16062830
dc.identifier.eissn2076-3417
dc.identifier.urihttp://hdl.handle.net/10400.22/32147
dc.language.isoeng
dc.peerreviewedyes
dc.publisherMDPI
dc.relationUI/BD/151415/2021
dc.relation.hasversionhttps://www.mdpi.com/2076-3417/16/6/2830
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectFacial expression of pain
dc.subjectAcute low back pain
dc.subjectForce
dc.subjectArtificial intelligence
dc.titleThe face of low back pain: A preliminary method for quantifying pain-related facial expressionspor
dc.typeresearch article
dspace.entity.typePublication
oaire.citation.issue6
oaire.citation.titleApplied Sciences
oaire.citation.volume16
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameRubim Silva Santos
person.familyNameCarvalho Santos Parolini
person.givenNameManuel
person.givenNameFranciele
person.identifier.ciencia-idA018-2B24-C597
person.identifier.ciencia-id7A15-D089-9627
person.identifier.orcid0000-0002-7394-7604
person.identifier.orcid0000-0001-6765-6475
relation.isAuthorOfPublication0a264044-a870-4fca-b976-f7ce003d23a8
relation.isAuthorOfPublication52bcd7e1-57ed-425f-8dcf-00cceb42eb70
relation.isAuthorOfPublication.latestForDiscovery0a264044-a870-4fca-b976-f7ce003d23a8

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