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referred pain definition #9

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wdduncan opened this issue Mar 19, 2024 · 8 comments
Open

referred pain definition #9

wdduncan opened this issue Mar 19, 2024 · 8 comments

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@wdduncan
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The spreadsheet comments were getting a bit long. So, I created a ticket.

@Finn1928 has proposed the following definition for referred pain:

A feeling of pain (MFOEM) that is perceived at some site or material anatomical entity (UBERON) x, where there is also some noxious stimulus y that is located at bodily site or material anatomical entity z, and y is the cause of the feeling of pain, and x is not connected with z.

This is great start! However, I think we need to modify it a little to make it more accessible to non-full-time-ontologists.

Consider how the symptom ontology (SYMP) defines referred pain:

A pain that is characterized by pain which is subjectively localized in one region although it is due to irritation in another region.

We can't import this class directly b/c SYMP defines pain as a symptom ... which is wrong. Plus, from a formal perspective, it uses the 'characterized by' locution, which is better suited for things like qualities (and other SDCs). However, I think it may provide some inspiration, and we can reference it as a skos:match.

Here is my attempt to build on Finn's definition and incorporate SYMP's more natural language definition:

A feeling of pain that is perceived to occur in an anatomical entity but is result of some noxious stimulus that affects a different anatomical entity.

notes:

  • feeling of pain is already defined as subjective. So, using SYMP's "subjectively localized" expression is redundant.
  • In Uberon, anatomical entity includes both material and immaterial entities. But, I am unsure if would cover things like a random patch of skin. I think the answer is "yes", but we can discuss more.
  • I changed "perceived at" to "perceived to occur in". Maybe the definition can be modified to use "perceived at" w/o making it too obtuse.
  • We should address how to best define noxious stimulus in another github ticket.

Also, here is the definition of referred pain from the Cleveland clinic:

Referred pain is when you have an injury in one area of your body but feel pain somewhere else.

I think this makes a good gloss. (BTW, we need to decide if we want the gloss to occur after the definition or in a separate annotation such as dcterms:description.)

cc @addiehl @JisooSeo @gopi-kris
@Finn1928
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If we can say 'anatomical entity' to cover both body parts and missing body part sites, that would help cut down the clunkiness a lot (and we'd be able to do the same with other definitions that use 'perceived at'). However, I'm not sure whether the space for a missing hand counts as an immaterial anatomical entity. The definition for immaterial anatomical entity doesn't help much for deciding if it counts.

Under 'immaterial anatomical entity', there's 'anatomical space', which might be what we want, but there's parts of the definition that don't match the missing hand space very well. "Non-material anatomical entity of three dimensions, that is generated by morphogenetic or other physiologic processes; is surrounded by one or more anatomical structures; contains one or more organism substances or anatomical structures." I'm not sure this space is generated through these processes, it's not 'surrounded' by anatomical structures, and it doesn't contain organism substances or anatomical structures.

If the sites we're concerned about don't match anything UBERON currently has, could we create our own subclass under immaterial anatomical entity that would count those sites?

@wdduncan
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An immaterial anatomical entity is not a missing body part. They are things like ear canals and heart chamber cavities. I.e., They are "meant" (in some sense) to be (or not be) there.

Representing missing body parts is an interesting issue. In the oral health and disease ontology we represented a missing tooth as a missing tooth finding. The reasoning being that a missing tooth is not a tooth. However, we can have a finding about person's dentition that it is missing a certain tooth. E.g. Here is the axiom for missing tooth 1 finding:

'is about' some 
    ('Secondary dentition'
     and ('has part' only (not ('Right upper third secondary molar tooth'))))

I.e., The finding (an information content entity) is about an adult (i.e., secondary) dentition that lack the tooth.

This will not work phantom limb pain. The pain isn't perceived to occur in a clinical finding. Although, you can have clinical findings about feelings of pain that are perceived to occur in areas (i.e., sites) where there is no anatomical entity.

@Finn1928
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If immaterial anatomical entity can't include sites for missing body parts, then I think this definition will have to say the pain can either be perceived at an anatomical entity or site and that the noxious stimulus effects some other anatomical entity or site. This would be needed to allow for referred phantom pain sensations.

@wdduncan
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wdduncan commented Mar 22, 2024 via email

@Finn1928
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I think referred pain can involve phantom limbs. There's lots of papers that talk about referred phantom sensations, including phantom pain: link These papers are talking about scenarios where, for instance, someone who lost a hand feels sensation where their hand was due to stimulation of the upper arm. Any painful cases of this would be both phantom pain and referred pain.

@wdduncan
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wdduncan commented Mar 22, 2024 via email

@Finn1928
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I don't think I'm understanding your position. Based on the google scholar search, the domain experts are treating some cases of referred pain as phantom pain. I think it's important for the definition to reflect this. And it seems like low hanging fruit to me to accommodate this by allowing referred pain to be about sites, especially since we're already allowing 'perceived at' to be about sites. I really don't want to be too pushy about this, but I'm not understanding why we shouldn't represent it this way.

@wdduncan
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wdduncan commented Mar 22, 2024 via email

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@wdduncan @Finn1928