# Efficient Pain Recognition via Respiration Signals: A Single Cross-Attention Transformer Multi-Window Fusion Pipeline

arXiv: https://arxiv.org/abs/2507.21886 · HTML: https://mlsanity.com/paper/2507.21886/

## Key facts

- Cited by 11 papers in the map (data through 14 Oct 2026).
- Builds on 7 of its 65 references that are in the map.
- First posted on arXiv 29 Jul 2025.

## Builds on (most cited first, 7 of 7)

- [Transformer Encoder with Multiscale Deep Learning for Pain Classification Using Physiological Signals](https://mlsanity.com/paper/2303.06845/) (2023)
- [Twins-PainViT: Towards a Modality-Agnostic Vision Transformer Framework for Multimodal Automatic Pain Assessment using Facial Videos and fNIRS](https://mlsanity.com/paper/2407.19809/) (2024)
- [Synthetic Thermal and RGB Videos for Automatic Pain Assessment utilizing a Vision-MLP Architecture](https://mlsanity.com/paper/2407.19811/) (2024)
- [A Full Transformer-based Framework for Automatic Pain Estimation using Videos](https://mlsanity.com/paper/2412.15095/) (2024)
- [PainFormer: a Vision Foundation Model for Automatic Pain Assessment](https://mlsanity.com/paper/2505.01571/) (2025)
- [Faces of Experimental Pain: Transferability of Deep Learned Heat Pain Features to Electrical Pain](https://mlsanity.com/paper/2406.11808/) (2024)
- [Transformer with Leveraged Masked Autoencoder for video-based Pain Assessment](https://mlsanity.com/paper/2409.05088/) (2024)

## Built on by (most cited first, 11 of 11)

- [A Lightweight Transformer for Pain Recognition from Brain Activity](https://mlsanity.com/paper/2604.16491/) (2026)
- [A Unified Tokenization Framework for Pain Recognition using Heterogeneous 3D Modalities](https://mlsanity.com/paper/2607.19716/) (2026)
- [ReFace: Reorganizing Facial Spatiotemporal Representations for Improved Pain Assessment](https://mlsanity.com/paper/2607.19722/) (2026)
- [Towards a Unified Modality-Agnostic Multimodal Framework for Cognitive Workload Assessment](https://mlsanity.com/paper/2609.20199/) (2026)
- [Efficient Emotion-Aware Iconic Gesture Prediction for Robot Co-Speech](https://mlsanity.com/paper/2604.11417/) (2026)
- [Beyond the Raw Waveform: Fusing Visual Representations of EDA for Stress Detection](https://mlsanity.com/paper/2609.22095/) (2026)
- [A Multi-Scale Temporal Framework with Dynamic Fusion for EEG-Based Emotion Recognition](https://mlsanity.com/paper/2608.09088/) (2026)
- [One-Block Transformer (1BT) for EEG-Based Cognitive Workload Assessment](https://mlsanity.com/paper/2605.00856/) (2026)
- [FUSE: Frame-Unified Stress Estimation from Facial Video](https://mlsanity.com/paper/2608.10442/) (2026)
- [MUPA2E: Multimodal Unified Perception with Asymmetric Attention for Emotion Assessment](https://mlsanity.com/paper/2608.15999/) (2026)
- [UNWIND: Any-Length Facial Video for Stress Detection without Temporal Windowing](https://mlsanity.com/paper/2609.29553/) (2026)

## Abstract (arXiv)

Pain is a complex condition that affects a large portion of the population. Accurate and consistent evaluation is essential for individuals experiencing pain and supports the development of effective and advanced management strategies. Automatic pain assessment systems provide continuous monitoring, aid clinical decision-making, and aim to reduce distress while preventing functional decline. This study has been submitted to the Second Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4PAIN). The proposed method introduces a pipeline that employs respiration as the input signal and integrates a highly efficient cross-attention transformer with a multi-windowing strategy. Extensive experiments demonstrate that respiration serves as a valuable physiological modality for pain assessment. Furthermore, results show that compact and efficient models, when properly optimized, can deliver strong performance, often surpassing larger counterparts. The proposed multi-window strategy effectively captures short-term and long-term features, along with global characteristics, enhancing the model's representational capacity.