There are 50 million people living with dementia and 400 million pre-verbal children, at any given point in time.

Despite being at the opposite stages of life, both groups actually have something in common – they have difficulty in reliably communicating their pain.

And that’s exactly the problem that the Australian based medtech company, PainChek (ASX:PCK), is trying address.

PainChek developed the world’s first app that uses artificial intelligence and smartphone technology to assess pain level in people, effectively giving a voice to those who can’t verbalise or articulate it.

The smartphone camera records the person’s face in just three seconds, and by using its IP-protected AI technology, is able recognise micro expressions and facial muscle movements which are indicative of pain.

Leading PainChek is CEO Philip Daffas, who has more than 30 years of experience in medical diagnostics and devices, having worked in companies like Roche and Cochlear in three different continents.

Speaking exclusively with Stockhead, Daffas says that there are nine features in every person’s face, such as grimacing, that activate different muscle movements when we feel pain.

These muscle movements are picked up by PainChek’s technology, and automatically documented for the caregiver.

“For the adult patient, it’s a six step process, where we look at such things as their face, voice, body movements, behaviours, and pain history,” explained Daffas.

The caregiver would then use PainChek’s guided framework of 42 test points, which are more observational assessments, to give a total pain picture and calculate the overall pain score for the patient.

“We’ve taken out the subjective elements such as the manual facial assessment, and intelligibly automated that whole process into an app.”

“We’re now left with an objective process that does the most complex part of the pain assessment process,” said Daffas.

The aged care sector

The technology has proven itself in the market, especially in the aged care sector.

Since a team of scientists at Curtin University started developing the technology in 2012, the PainChek platform has grown substantially, and is now being used in more than 880 aged care facilities in four continents, serving more than 80,000 beds.

And that’s just scratching the surface, because the adult market is potentially a huge one for PainChek.

A global study estimated that up to 80% of residents living in nursing homes experience chronic pain, with half of all the residents living with dementia or cognitive impairment and often unable to reliably verbalise their pain.

But what about the other half who are able to self-report their pain?

The company realised this potential and decided to upgrade the PainChek app to include a new feature called the Numerical Rating Scale (NRS), designed to document self-reported pain level on those who are able to verbalise it.

The new app version, which is called PainChek Universal, encapsulates everything into one digital environment, and can be used in both home care, hospitals and aged care residences.

This now potentially opens up the PainChek app to assess pain for practically anybody, anywhere.

“The feedback we received from our aged-care clients was that they love PainChek, but they’d love to use it to assess pain for everybody,” said Daffas.

“So we brought in the numeric rating scale, which is a simple 1 to 10 analysis, where the nurse will ask the resident about their level of pain, and they’ll document it into the numeric rating scale in one go,” he added.

But is the PainChek system accurate, and are there any validated data to support this?

“Abosolutely. Our data are clinically tested, and we are peer reviewed and published in major publications such as pain and dementia journals. That’s actually one of the key reasons why we have such a good penetration,” explained Daffas.

In 2018, a peer review published in Journal of Pain Research confirmed PainChek’s clinical accuracy of 95 per cent, which demonstrated its value to clinicians and carers.

Training is also a big part of the PainChek offering, with the company now having trained more than 3,200 aged care clinicians that were mostly conducted through virtual workshops during last year’s lockdown period.

The training has also translated across to family members, particularly those who are transitioning their loved ones from hospitals or the aged care environment into a home care environment.

Government funding

In 2019, the Australian government allocated up to $5 million for aged care homes in the country to adopt PainChek, as part of a two-year trial.

It was an initiative to promote innovation in the aged care sector, which practically gave a grant for up to 100,000 PainChek annual licences for all Australian residential aged-care facilities. The cost of using PainChek is around $50 a bed annually.

That subsidy has run its course, and the final day for aged care facilities to sign up is on the 31 May 2021.

Replacing that is the additional $10 a day per bed to be provided to every aged-care resident, announced in the recent Budget.

In general, the aged sector was a big winner in the Budget, receiving almost $18 billion in funding over the next five years, in line with the royal commission’s recommendations.

“As people transition out of the government grants and onto our normal contract over the next year, they’ve now got far more capacity to pay for the $50 per annum cost on PainChek than they had previously,” Daffas argued.

And there’s more in the Budget package that bodes well for PainChek.

The Treasury also announced tens of thousands of additional home care packages, as more and more people with dementia, for example, are looking to stay at home longer.

Potentially huge infant market

PainChek has recently expanded its business significantly by entering into the infant market.

Just last week, it announced that its PainChek Infant Face-Only app has received regulatory clearances, which will now allow it to market the product in Australia, Europe, UK, Canada, Singapore and New Zealand.

The infant app also scans the child’s face in three seconds, to decipher if the child is hungry, tired, or in real pain.

“With children, there are no behaviours or history of pain that you have to think about. Children don’t hide expressions, and their face is a mirror of what they’re expressing,” Daffas explained.

The Infant app is cleared for use with children aged between 1 month to 12 months, but the company is already undergoing research to expand it to those between 12 months to 2 years old.

“We’ve already got the adult product from 18 years upwards. So with the current infant offering, I would say we’ve covered 70% or 80% of the global population,” said Daffas.

Daffas also believes the potential for the infant market is huge, with 400 million pre-verbal babies and 100 million children born every year to first time parents.

He says that more and more first-time parents are being educated to do first line care for their babies, and the PainChek Infant app could potentially be used as a standard tool that are used in the homes.

The company is also exploring the disability market, and is currently on a six-month trial with disability service provider Nulsen Group in WA, as part of the National Disability Insurance Scheme (NDIS).

Global ambitions

PainChek is currently being marketed in Australia, NZ, Europe, Canada, and Singapore, but the company has ambitions to expand the offering globally.

Daffas points to the fact that the company is not far off from covering its core costs just from the Australian market, which is only 2 per cent of the global market.

This means that there is a huge runway for the app to scale internationally, which includes the obvious huge markets like China and the US, where talks with the FDA have already begun.

Daffas says that Australia is the perfect place to establish an emerging product, as the healthcare market here is mature, and an ideal initial market to validate the business model before moving into larger markets.

“I worked for Cochlear for many years with the strategy of initially building their product and usability in Australia. But the real opportunity was always overseas in Europe or US. And that’s exactly the strategy that we’re following here with PainChek,” he explained.

Given the business is totally digital, from a global perspective, the company could in theory scale to every market from Australia if it wanted to.

Asked if PainChek actually wants to be in every market, Daffas was very optimistic.

“This is a very cost effective and sustainable business model. Our goal is to be a global business, and to be in every country in the world,” he emphasised.