Wednesday, July 27, 2011

Bad News For MDs. Researchers Work on Vocabulary for Chronic Pain

Just released on Science Daily is the news that psychiatrists in Buffalo are working on a project to enable chronic pain sufferers to better describe what they are feeling. The docs are using ontology, the branch of metaphysics that studies the nature of existence or being as such. Metaphysics is sometimes called philosophy, especially in its more abstruse branches. [Definitions are from]

Here is a quote from the Science Daily article:

"The philosophical definition of ontology is the study of things that exist and how they relate to each other," says [Werner] Ceusters, who also is director of the Ontology Research Group of UB's New York State Center of Excellence in Bioinformatics and Life Sciences. "I am a person and you are a person so we share something. Suppose I drop dead. What lies on the floor? Is that still a person? If it is no longer a person, is it still the very same thing that was sitting here as a person but now is a corpse?"

If you can explain that quote to me, I would certainly appreciate it.

Someone must understand it because the group has received an NIH grant of $793,571 to study the subject.

You may have no idea how many chronic pain sufferers there are. I do. For fibromyalgia [also known as chronic widespread pain syndrome] alone, 17% of a population in a published study from England had it. In my blog on the paper, I pointed out that at the rate people were developing the syndrome, 50% will have it by the year 2033.

Honestly, I do not see standardizing a vocabulary for pain based on ontology leading to anything good.


Gurdur said...

Can you please detail WHY you don't see it as good?

Skeptical Scalpel said...

1. If the vocabulary that is eventually produced is as confusing as the "dead person" quote, it will make matters worse.

2. How can you standardize terminology of something that is intangible and perceived differently in just about every person?

3. The simple attempt to categorize the intensity of pain on a scale of 1 to 10 does not work. Ask any nurse.

4. It is very difficult to sort out the drug seekers from those who are truly in pain. Give the drug seekers a vocabulary and see what happens.

Patricia said...

I see a problem in equating people with genuine pain with 'drug seekers'. This can be as subjective a process as trying to find an universal argot able to aptly describe the pain one feels.

Why not separate the two groups from each other as they are almost completely dissimilar except for one superficial behavior (getting drugs that alleviate pain). The damage done to those who legitimately have pain, especially chronic pain by associating them with drug seekers is incalculable. Something a physician is probably tempted to ignore.

Skeptical Scalpel said...

@Patricia-Thanks for your comment. I wish it was easy to separate the drug seekers from the people who really have pain. That is indeed the problem. MDs are in a "Catch-22" situation. We are criticized if we don't alleviate suffering in the true pain sufferers and lose our licenses if we give addicts narcotic prescriptions.

Werner Ceusters said...

I can explain my quote. I was giving an example of how we analyze matters using the principles of ontological realism (OR). OR assumes that individual entities - that is entities that carry identity like you and me, your car and my car, etc. - are instances of generic entities called 'types', examples being PERSON, CAR, etc. I write the names of the types in capitals to clearly indicate that I am not referring to individual entities. Thus you are an instance of PERSON; my car and your car are both instances of CAR. Persons and cars, as so many other entities, undergo changes. Think of the types CHILD and ADULT. Because matters change over time, it does not make sense for entities like persons to simply say 'x is an instance of X': you must say: 'x is an instance of X at time t'. For example: 'Werner Ceusters instance of CHILD in 1960' and 'Werner Ceusters instance of ADULT in 2016'. But note that both in 1960 and in 2016, Werner Ceusters is (was) an instance of PERSON. So you see that individual entities like persons can change their instantiation of distinct types. Now some changes are such that an individual entity continues to exist while it undergoes a type-shift. A shift from CHILD to ADULT is an example: I continued to exist as ADULT with the same identity I had as CHILD. Other changes are such that the individual entity ceases to exist, but that out of it one or more new individual entities are created. For example, an individual bacterium #1 of type STAFYLOCOC splits into two other individual bacteria (#2 and #3), both of type STAFYLOCOC. But when #2 and #3 exist, #1 does not exist anymore. With my quote, I raised the question what sort of change is brought about by an individual person dying. Imagine that entity #6 is an instance of ADULT at time t and dies at time t+1? What would be the correct statement at t+2? Some would argue that #6 is instance of CORPSE at time t+2. Others would argue that at time t+2, there is no #6 anymore, but that at time t+1 a new individual entity #7 is created which derived from #6, and #7 is instance of CORPSE at time t+2. If you - and with 'you' I mean Skeptical Scalpel - believe that the first option is the correct one, then you believe that you will be buried or burned, or whatever. If you believe that option 2 is correct, then you believe that nothing of that sort will happen to you because what would be in the coffin or in the incinerator would simply not be you.

Skeptical Scalpel said...

Werner, Thank you for attempting to explain your quote to me. I would be lying if I told you that it is clearer now. I still don't quite get it. I'm old and I have always tended to think more in the concrete than the abstract. I would not have made it as an ontologist.

I am curious about the outcome of your project. Have you indeed developed a new vocabulary for pain? I note in PubMed that you have written some papers about oro-facial pain, but I could only read the abstracts.

I would like to point out that my comment of August 9, 2011 was prescient. Here it is. "MDs are in a "Catch-22" situation. We are criticized if we don't alleviate suffering in the true pain sufferers and lose our licenses if we give addicts narcotic prescriptions." This is even more true (if that is possible) today.

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