{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:38:22Z","timestamp":1777498702979,"version":"3.51.4"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,28]]},"DOI":"10.7759\/cureus.107883","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:10:21Z","timestamp":1777389021000},"source":"Crossref","is-referenced-by-count":0,"title":["Real-Time Estimation of Numerical Rating Scale (NRS) Scores Using Machine Learning-Based Facial Expression Analysis: A Proof-of-Concept Study"],"prefix":"10.7759","author":[{"given":"Kentaro","family":"Uejima","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsutomu","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miki","family":"Matsui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sakae","family":"Fukushima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshifumi","family":"Nishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","reference":[{"key":"ref1","article-title":"World Health Organization. WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents","author":"WHO","year":"2018","unstructured":"WHO. WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. World Health Organization, Geneva; 2018. https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/809a021b-e75c-4f9c-b002-6fb13bf1a0f5\/content."},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.52.2508","article-title":"A personalized approach to assessing and managing pain in patients with cancer","volume":"32","author":"Hui D","year":"2014","unstructured":"Hui D, Bruera E. A personalized approach to assessing and managing pain in patients with cancer. J Clin Oncol. 2014, 32:1640-6. 10.1200\/JCO.2013.52.2508","journal-title":"J Clin Oncol"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.3322\/caac.20112","article-title":"The management of cancer pain","volume":"61","author":"Paice JA","year":"2011","unstructured":"Paice JA, Ferrell B. The management of cancer pain. CA Cancer J Clin. 2011, 61:157-82. 10.3322\/caac.20112","journal-title":"CA Cancer J Clin"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1136\/ard.37.4.378","article-title":"Studies with pain rating scales","volume":"37","author":"Downie WW","year":"1978","unstructured":"Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978, 37:378-81. 10.1136\/ard.37.4.378","journal-title":"Ann Rheum Dis"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2010.08.016","article-title":"Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review","volume":"41","author":"Hjermstad MJ","year":"2011","unstructured":"Hjermstad MJ, Fayers PM, Haugen DF, et al.. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011, 41:1073-93. 10.1016\/j.jpainsymman.2010.08.016","journal-title":"J Pain Symptom Manage"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2011.10.002","article-title":"Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations","volume":"12","author":"Herr K","year":"2011","unstructured":"Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Manag Nurs. 2011, 12:230-50. 10.1016\/j.pmn.2011.10.002","journal-title":"Pain Manag Nurs"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1155\/2006\/197616","article-title":"Children's self-reports of pain intensity: scale selection, limitations and interpretation","volume":"11","author":"von Baeyer CL","year":"2006","unstructured":"von Baeyer CL. Children's self-reports of pain intensity: scale selection, limitations and interpretation. Pain Res Manag. 2006, 11:157-62. 10.1155\/2006\/197616","journal-title":"Pain Res Manag"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1037\/t27734-000","article-title":"Facial Action Coding System","author":"Ekman P","year":"1978","unstructured":"Ekman P, Friesen WV. Facial Action Coding System. Consulting Psychologists Press, Palo Alto; 1978. 10.1037\/t27734-000"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2008.04.010","article-title":"The structure, reliability and validity of pain expression: evidence from patients with shoulder pain","volume":"139","author":"Prkachin KM","year":"2008","unstructured":"Prkachin KM, Solomon PE. The structure, reliability and validity of pain expression: evidence from patients with shoulder pain. Pain. 2008, 139:267-74. 10.1016\/j.pain.2008.04.010","journal-title":"Pain"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001424","article-title":"Facial muscle movements encoding pain-a systematic review","volume":"160","author":"Kunz M","year":"2019","unstructured":"Kunz M, Meixner D, Lautenbacher S. Facial muscle movements encoding pain-a systematic review. Pain. 2019, 160:535-49. 10.1097\/j.pain.0000000000001424","journal-title":"Pain"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(01)00314-1","article-title":"The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement","volume":"93","author":"Hicks CL","year":"2001","unstructured":"Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement. Pain. 2001, 93:173-83. 10.1016\/S0304-3959(01)00314-1","journal-title":"Pain"},{"key":"ref12","article-title":"The facial expression of pain","author":"Craig KD","year":"2011","unstructured":"Craig KD, Prkachin KM, Grunau RE. The facial expression of pain. Handbook of Pain Assessment. Turk DC, Melzack R (ed): The Guilford Press, New York; 2011. 117-33."},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e3182290d90","article-title":"A comparative investigation of observational pain assessment tools for older adults with dementia","volume":"28","author":"Lints-Martindale AC","year":"2012","unstructured":"Lints-Martindale AC, Hadjistavropoulos T, Lix LM, Thorpe L. A comparative investigation of observational pain assessment tools for older adults with dementia. Clin J Pain. 2012, 28:226-37. 10.1097\/AJP.0b013e3182290d90","journal-title":"Clin J Pain"},{"key":"ref14","article-title":"The FLACC: a behavioral scale for scoring postoperative pain in young children","volume":"23","author":"Merkel SI","year":"1997","unstructured":"Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997, 23:293-7.","journal-title":"Pediatr Nurs"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1097\/01.JAM.0000043422.31640.F7","article-title":"Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale","volume":"4","author":"Warden V","year":"2003","unstructured":"Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003, 4:9-15. 10.1097\/01.JAM.0000043422.31640.F7","journal-title":"J Am Med Dir Assoc"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1109\/TCYB.2017.2662199","article-title":"Deep pain: exploiting long short-term memory networks for facial expression classification","volume":"52","author":"Rodriguez P","year":"2022","unstructured":"Rodriguez P, Cucurull G, Gonzalez J, Gonfaus JM, Nasrollahi K, Moeslund TB, Roca FX. Deep pain: exploiting long short-term memory networks for facial expression classification. IEEE Trans Cybern. 2022, 52:3314-24. 10.1109\/TCYB.2017.2662199","journal-title":"IEEE Trans Cybern"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1109\/TAFFC.2019.2946774","article-title":"Automatic recognition methods supporting pain assessment: a survey","volume":"13","author":"Werner P","year":"2022","unstructured":"Werner P, Lopez-Martinez D, Walter S, Al-Hamadi A, Gruss S, Picard RW. Automatic recognition methods supporting pain assessment: a survey. IEEE Trans Affect Comput. 2022, 13:530-52. 10.1109\/TAFFC.2019.2946774","journal-title":"IEEE Trans Affect Comput"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.artmed.2020.101954","article-title":"Ensemble neural network approach detecting pain intensity from facial expressions","volume":"109","author":"Bargshady G","year":"2020","unstructured":"Bargshady G, Zhou X, Deo RC, Soar J, Whittaker F, Wang H. Ensemble neural network approach detecting pain intensity from facial expressions. Artif Intell Med. 2020, 109:101954. 10.1016\/j.artmed.2020.101954","journal-title":"Artif Intell Med"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2023.107365","article-title":"Automatic assessment of pain based on deep learning methods: a systematic review","volume":"231","author":"Gkikas S","year":"2023","unstructured":"Gkikas S, Tsiknakis M. Automatic assessment of pain based on deep learning methods: a systematic review. Comput Methods Programs Biomed. 2023, 231:107365. 10.1016\/j.cmpb.2023.107365","journal-title":"Comput Methods Programs Biomed"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001939","article-title":"The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises","volume":"161","author":"Raja SN","year":"2020","unstructured":"Raja SN, Carr DB, Cohen M, et al.. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020, 161:1976-82. 10.1097\/j.pain.0000000000001939","journal-title":"Pain"}],"container-title":["Cureus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cureus.com\/articles\/476208-real-time-estimation-of-numerical-rating-scale-nrs-scores-using-machine-learning-based-facial-expression-analysis-a-proof-of-concept-study","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:10:22Z","timestamp":1777389022000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cureus.com\/articles\/476208-real-time-estimation-of-numerical-rating-scale-nrs-scores-using-machine-learning-based-facial-expression-analysis-a-proof-of-concept-study"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":20,"URL":"https:\/\/doi.org\/10.7759\/cureus.107883","relation":{},"ISSN":["2168-8184"],"issn-type":[{"value":"2168-8184","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}