Defining suffering in pain: a systematic review on pain-related suffering using natural language processing

• Published in: Pain (Amsterdam) Vol. 165; no. 7; pp. 1434 - 1449
• Main Authors: Noe-Steinmüller, Niklas, Scherbakov, Dmitry, Zhuravlyova, Alexandra, Wager, Tor D., Goldstein, Pavel, Tesarz, Jonas
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Wolters Kluwer 01.07.2024
• Subjects: Humans; Machine Learning; Natural Language Processing; Pain - diagnosis; Pain - psychology; Stress, Psychological - psychology; Systematic Review and Meta-Analysis; Topic modeling; Pain; ChatGPT; Machine learning; Definition; LDA; Natural language processing; Suffering; GPT-3
• ISSN: 0304-3959; 1872-6623; 1872-6623
• DOI: 10.1097/j.pain.0000000000003195

Supplemental Digital Content is Available in the Text. AbstractUnderstanding, measuring, and mitigating pain-related suffering is a key challenge for both clinical care and pain research. However, there is no consensus on what exactly the concept of pain-related suffering includes, and it is often not precisely operationalized in empirical studies. Here, we (1) systematically review the conceptualization of pain-related suffering in the existing literature, (2) develop a definition and a conceptual framework, and (3) use machine learning to cross-validate the results. We identified 111 articles in a systematic search of Web of Science, PubMed, PsychINFO, and PhilPapers for peer-reviewed articles containing conceptual contributions about the experience of pain-related suffering. We developed a new procedure for extracting and synthesizing study information based on the cross-validation of qualitative analysis with an artificial intelligence-based approach grounded in large language models and topic modeling. We derived a definition from the literature that is representative of current theoretical views and describes pain-related suffering as a severely negative, complex, and dynamic experience in response to a perceived threat to an individual's integrity as a self and identity as a person. We also offer a conceptual framework of pain-related suffering distinguishing 8 dimensions: social, physical, personal, spiritual, existential, cultural, cognitive, and affective. Our data show that pain-related suffering is a multidimensional phenomenon that is closely related to but distinct from pain itself. The present analysis provides a roadmap for further theoretical and empirical development.