External Validation of EEG-Based Machine Learning Models for Continuous Pain Prediction.

Authors

Tyler Mari, Jessica Henderson, Syed Hasan Ali, Danielle Hewitt, Christopher Brown, Andrej Stancak, Nicholas Fallon

Published in

The journal of pain. Pages 106416. Aug 14, 2026. Epub Aug 14, 2026.

Abstract

Machine learning (ML) has been used to predict subjective pain intensity from electroencephalographic (EEG) data. However, few ML models for pain assessment have been externally validated, particularly for continuous pain prediction. We externally validated ML regression models using multi-stage validation to predict pain intensity from single-trial oscillatory EEG features. Ninety-one participants were recruited across three samples. Sample one (n = 40) was used for model development, sample two (n = 51) for cross-subject external validation, and sample three (n = 25), comprising additional recording sessions from sample one participants, for within-subject temporal external validation. Pneumatic pressure stimuli were delivered at 10 graded intensity levels. Single-trial EEG time-frequency features were used to train a Random Forest (RF) model and a long short-term memory (LSTM) network to predict pain intensity. Both models outperformed a random prediction model, with the RF achieving mean absolute errors (MAE) of 19.59, 21.29, and 18.90 for internal validation, cross-subject external validation, and within-subject external validation, respectively. However, neither model outperformed a baseline dummy model predicting the mean training-set rating. We also trained a RF classifier to distinguish low and high pain trials, achieving internal and external validation accuracies up to 64% and 58%, respectively. Overall, our results indicate that predicting continuous pain ratings from oscillatory EEG changes using ML remains highly challenging. Classification models demonstrated above-chance performance across validation samples but remained below clinically meaningful thresholds. Further methodological improvements, particularly the integration of composite measures, are required before ML can achieve clinical utility in pain assessment.

PMID:
42600964
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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