Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany.
School of Public Health, University of Haifa, Haifa, Israel.
Pain. 2024 Jul 1;165(7):1434-1449. doi: 10.1097/j.pain.0000000000003195. Epub 2024 Mar 5.
Understanding, 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.
理解、衡量和减轻与疼痛相关的痛苦是临床护理和疼痛研究的关键挑战。然而，对于与疼痛相关的痛苦的概念具体包括哪些内容，目前还没有共识，而且在实证研究中也没有精确地实现。在这里，我们（1）系统地回顾了现有文献中与疼痛相关的痛苦的概念化，（2）制定了一个定义和一个概念框架，（3）使用机器学习来交叉验证结果。我们通过对 Web of Science、PubMed、PsychINFO 和 PhilPapers 中同行评议文章的系统搜索，确定了 111 篇关于与疼痛相关的痛苦体验的概念性贡献的文章。我们开发了一种新的提取和综合研究信息的程序，该程序基于定性分析与基于大型语言模型和主题建模的人工智能方法的交叉验证。我们从文献中得出了一个定义，该定义代表了当前的理论观点，并将与疼痛相关的痛苦描述为一种严重的负面、复杂和动态的体验，是对个人作为自我和身份的完整性的感知威胁的反应。我们还提供了一个与疼痛相关的痛苦的概念框架，区分了 8 个维度：社会、身体、个人、精神、存在、文化、认知和情感。我们的数据表明，与疼痛相关的痛苦是一种多维现象，它与疼痛本身密切相关，但又有所不同。本分析为进一步的理论和实证发展提供了路线图。
