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

ABSTRACT

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.

Exploring the efficacy of music in palliative care: A scoping review

OBJECTIVE

There is an increasing recognition of the significance of music as a complementary therapy in palliative care. Limited studies exist on how music is used as a coping mechanism by palliative care patients. Therefore, the purpose of this scoping review was to explore the efficacy of music interventions for palliative care.

METHOD

We conducted a literature search between June and November 2019 in the Cumulative Index of Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), and PubMed, which includes MEDLINE. The search identified eight articles which met the inclusion and exclusion criteria.

RESULTS

Using thematic analysis, six themes were synthesied to show how music contributes to palliative care. The six themes include Pain management; Relaxation; Happiness and hope; Anxiety and depression management; Enhanced spirituality; and Improved quality of life. These themes reflect the psychological and emotional benefits palliative care patients derive from music therapies.

SIGNIFICANCE OF RESULTS

Music therapy can be an effective psychosocial approach when managing palliative symptoms through its therapeutic effects on physical, psychological, emotional, and spiritual well-being.

Music therapy for palliative care: A realist review

OBJECTIVE

Music therapy has experienced a rising demand as an adjunct therapy for symptom management among palliative care patients. We conducted a realist review of the literature to develop a greater understanding of how music therapy might benefit palliative care patients and the contextual mechanisms that promote or inhibit its successful implementation.

METHOD

We searched electronic databases (CINAHL, Embase, Medline, and PsychINFO) for literature containing information on music therapy for palliative care. In keeping with the realist approach, we examined all relevant literature to develop theories that could explain how music therapy works.

RESULTS

A total of 51 articles were included in the review. Music therapy was found to have a therapeutic effect on the physical, psychological, emotional, and spiritual suffering of palliative care patients. We also identified program mechanisms that help explain music therapy's therapeutic effects, along with facilitating contexts for implementation.

SIGNIFICANCE OF RESULTS

Music therapy may be an effective nonpharmacological approach to managing distressing symptoms in palliative care patients. The findings also suggest that group music therapy may be a cost-efficient and effective way to support staff caring for palliative care patients. We encourage others to continue developing the evidence base in order to expand our understanding of how music therapy works, with the aim of informing and improving the provision of music therapy for palliative care patients.

Pain as Symptom, Pain as Sign

This article proposes a theoretical contribution to critical health psychology. Charles Sanders Peirce’s semiotics provide health psychology and related fields with an analytic that centers interest at the intersection where the co-constitution of reified categories occurs. I begin with the terms symptom and sign as used in medical contexts. Symptoms and signs can be reinterpreted, drawing on the Heideggerian notion of ‘attunement’, and upon Peirce’s semiotics. Next, I present Peirce’s concept of sign, with its triadic structure of object-representamen-interpretant. An understanding of pain as a sign in this sense is developed on this basis. The value of Peircian semiotics for a critical health psychology is illustrated with some examples drawn from a qualitative study. Pain is not only something of concern and the bearer of meanings, but a way of interpreting one’s situation. This semiotics of pain furthers the project, common to phenomenological and discursive approaches in health psychology and related fields, of studying the upsurge of meaning in speech and in other acts that co-constitute it.

Beyond expressive writing: evolving models of developmental creative writing

Pennebaker's expressive writing paradigm has helped to introduce the benefits of writing to health care. However, research in expressive writing has been largely dominated by an experimental and quantitative approach that does not take into account critical methodologies and approaches in health psychology, the increasingly complex ways in which creative writing is now being used in health care settings or recent research in the broader field of creative writing and personal development, health and well-being (developmental creative writing). This article contrasts expressive writing theories and methodologies with those evolving in the relatively new field of developmental creative writing. It investigates a number of theoretical and methodological problems with the expressive writing model and argues for a more critical approach to future research.

Pain narratives and narrative practitioners: a way of working ’in-relation’ with children experiencing pain

Children's narratives about their pain are often drowned out by the more pervasive, scientific, dominant, academic and professional discourses. The ideas I propose in this paper are drawn from narrative inquiry and from the narrative medicine movement to illustrate how a narrative approach can positively influence nursing (and other) practice. Sharing children's narratives of pain allows to be 'in-relation' with children and their experiences of pain, requiring practitioners to be less distanced and passive. In order to start and to understand their pain we need to be prepared to be hurt by it. Attending to children's stories helps them to articulate their experiences and gives them voice and agency. A narrative approach to practice can help us to be more the sort of professionals we wanted to be, i.e. more generous, more affective, more remembered and more effective. By helping to 'fix' children's broken stories we can help them move towards stories of healing.