Pain’s Silent Signals

It’s been more than 30 years since Martin Schiavenato ’07PhD tried to comfort a newborn girl in the neonatal intensive care unit (NICU) in Tallahassee, Florida. She was born with a genetic disorder where the epithelial tissue that protects all internal and external surfaces of the body is missing. Her skin sloughed off. The simplest touch caused pain, but she had no way to communicate the extent of it.

“The memory is seared into my mind,” Schiavenato says.

A trained nurse, he vividly remembers taking 12-hour overnight shifts with the little girl. He couldn’t swaddle her. He couldn’t give her a pacifier. He couldn’t even change her diaper without causing pain.

“Everything you want to do for an infant, instinctually and therapeutically, you couldn’t do,” says Schiavenato, who is now an associate professor at Gonzaga University. “We were left to give her morphine, which can cause permanent damage when the brain is still developing. I kept telling myself, ‘We should have a way to assess pain for patients who can’t verbalize it.’ No matter how short that little girl’s life would be, I wanted to make it count. That’s how my long journey began.”

The journey led him on a route rarely followed, from bedsides in the NICU to UCF where he joined the university’s first-ever cohort of doctoral nursing students aiming to be among the less than 1% of nurses in the U.S. who have Ph.D.s. Schiavenato chose a track in innovative technologies. He took courses in engineering and collaborated with computer science students, driven by the desire to create something tangible rather than theoretical — a path made possible by UCF’s interdisciplinary work in health and human performance. For his dissertation, he researched signals that might indicate the severity of pain among patients who are unable to report it for themselves.

People with dementia, for example. Or babies.

“A patient’s inability to verbalize how much pain they’re in will directly affect our ability to treat it with precision. I knew that I needed to develop a device somehow.” — Martin Schiavenato ’07PhD

Schiavenato’s tireless work reached its most recent milestone when Aster DM Healthcare chose him as one of 10 finalists from among a pool of 78,000 entries for the prestigious 2024 Aster Guardians Global Nursing Award. If he needed a boost of inspiration, he drew it from the award ceremony in India. There, Schiavenato met a man from rural Papua New Guinea who spends two days crossing rivers and mountains to reach patients. He spoke with people from regions in Africa where the infant mortality rate is among the highest in the world.

Turns out, the inspiration was mutual.

“The honorees understood what I’m doing and why,” Schiavenato says. “There’s always something tugging at my heart — always.”

Schiavenato received similar encouragement from mentors and colleagues during his time at UCF. He’d spend days and nights at Winnie Palmer Hospital observing newborns reacting to heel sticks, a blood testing method. That’s where he began to note a consistency in facial expressions, especially in the lower jaw. The natural grimace became Schiavenato’s first building block. Next, he gathered evidence of infants in distress raising one hand to the forehead and splaying the fingers. Over time, he investigated heart-rate variability among newborns and added his findings to create a composite pain score.

“These three signals — facial expression, finger splaying and heart rate variability — tell us each baby’s story of pain,” Schiavenato says.

To convert the signals into a useful tool, he ventured into artificial intelligence. With enough data fed into an algorithm, a pain score could be monitored 24/7. After working with engineers at UCF, the University of Rochester and Washington State University, Schiavenato finally patented a prototype device that some refer to as “the orb” because of the shape of the earliest versions.

It’s taken three decades of literal blood, sweat and tears to get to this point.

“And now comes the hard part,” Schiavenato says.

He needs teams to conduct hundreds of clinical trials across the country. He needs hospitals and nurses to participate. He needs babies in NICUs and cooperation from their families. Schiavenato has the heart and good intentions, but taking the next steps will require finances. Investors want to know how much money they stand to make — and how soon.

As a doctoral graduate with knowledge of economic development, he understands the importance of the return on investment. But as a medical practitioner, he understands the problem of unspoken pain. He’s seen it with his own eyes. He can never forget it.

“There’s always this question in my mind: ‘Who will help the voiceless experiencing pain?’ I simply want to do something for them. To me, that’s the currency that counts.” — Martin Schiavenato ’07PhD

Schiavenato is now 56 and lives in the Northwest for the quiet commutes and to raise chickens in the forested mountains. Out here, it’s easy to think. Sometimes he thinks about getting a few goats. He always thinks of that baby girl. And now he can also think about his bond with the Aster Guardians finalists.

“I draw a lot of personal comfort from knowing there are people around the world doing the same thing,” he says. “We’re trying out best to help others because we care.”