ontology of pain

Ontology of Pain

Barry SmithNational Center for Ontological Research

University at Buffalo

BFO

A simple top-level ontology to support information integration in scientific research

2

Basic Formal Ontology

Continuant Occurrent(Process, Event)

IndependentContinuant

(thing, substance)

DependentContinuant

http://ifomis.uni-saarland.de/bfo/3

Continuant


DependentContinuant

..... .....

Non-realizableDependentContinuant(quality)

Realizable DependentContinuant(function, role, disposition)

4

Specifically dependent continuants

Examples:

the height (quality) of this patient

the disposition of this patient to experience diarrhea

5

Continuant


DependentContinuant

..... .....

Non-realizableDependentContinuant

(quality)

Realizable DependentContinuant(function, disposition)

6

depends_on

Continuant Occurrent

process


thing

DependentContinuant

quality

.... ..... .......temperature dependson bearer

7

universals, types, kinds

Continuant Occurrent

process, eventIndependentContinuant

DependentContinuant

.... ..... .......9particulars, instances

the particular case of redness (of this particular fly’s left eye)

the universal red

instantiates

this instance of eye (in this particular fly)

the universal eye

instantiates

depends_on

10

this particular case of redness

red

instantiates

this eye (in this particular fly)

eye

instantiates

depends on

color anatomical structure

is_a is_a

11

this particular eye (in this particular fly)

the universal eye

12

instantiates at t1

this particular eye (in this particular fly)

the universal eye

13

instantiates at t1

instantiates at t2

instantiates at t3

portion of water

this portion of H20

15

portion of ice

portion of liquid water

portion of gas

instantiates at t1

instantiates at t2

instantiates at t3

Phase transitions

human

John

16

embryo fetus adultneonate infant child

instantiates at t1

instantiates at t2

instantiates at t3

instantiates at t4

instantiates at t5

instantiates at t6

in nature, no sharp boundaries here

temperature

John’s temperature

17

37ºC 37.1ºC 37.5ºC37.2ºC 37.3ºC 37.4ºC

instantiates at t1

instantiates at t2

instantiates at t3

instantiates at t4

instantiates at t5

instantiates at t6



Dependent Continuants

DependentContinuant

Quality, Pattern

Realizable Dependent Continuant

if the bearer ceases to exist, then its quality, function, role ceases to exist

the color of my skin

the function of my heart to pump blood

my weight18

Realizable dependent continuants

Disposition: fragility, virulence, susceptibility, genetic disposition to disease X

Function: to pump (of the heart), to unlock (of the key)

19

OGMS

Ontology for General Medical Science,

http://code.google.com/p/ogms/

22

Big Picture

23

Disorder

an independent continuant

fiat object part of

the whole organism

(boundaries hard to specify)

24

Where does Mount Everest begin and end?Cf. Barry Smith and David M. Mark, “Do Mountains Exist?”, Environment and Planning B, 30, 2003.

25

Disorder

A fiat object part of an organism which serves as the bearer of a disposition of a certain sort

This fiat object may have no determinate boundaries

(compare: Downtown Santa Barbara)

26

A disease is a disposition having as its bearer a physical disorder in the organism and realized in pathological processes.

etiological process

produces

disorder

bears

disposition

realized_in

pathological process

produces

abnormal bodily features

recognized_as

signs & symptomsinterpretive process

produces

diagnosis

used_in27

Influenza - infectious Etiological process - infection of

airway epithelial cells with influenza virus produces

Disorder - viable cells with influenza virus bears

Disposition (disease) - flu realized_in

Pathological process - acute inflammation produces

Abnormal bodily features recognized_as

Symptoms - weakness, dizziness Signs - fever

Symptoms & Signs used_in

Interpretive process produces

Hypothesis - rule out influenza suggests

Laboratory tests produces

Test results - elevated serum antibody titers used_in

Interpretive process produces

Result - diagnosis that patient X has a disorder that bears the disease flu

28

independentcontinuant

dependentcontinuant

disposition

diseasedisorder

John’s disordered

heart

John’s coronary heart

disease

occurrent

process

course of disease

course of John’s disease

30

coronary heart disease

John’s coronary heart disease

31

coronary disease at the

stage of asymptomatic

(‘silent’) infarction

coronary disease at the stage of early lesions and

small fibrous plaques

coronary disease at the

stage of stable angina

coronary disease the

stage of surface

disruption of plaque

coronary disease at the stage

of unstable angina

instantiates at t1

instantiates at t2

instantiates at t3

instantiates at t4

instantiates at t5

time

OGMS:pathological processdef. – A process in an organism that is clinically

abnormal.*

i) is not part of the life plan for an organism of the relevant type (unlike aging, pregnancy or menopause),

ii) is causally linked to an elevated risk either of pain or other feelings of illness, or of death or dysfunction, and

iii) is such that the elevated risk exceeds a certain threshold level.

* ≠ statistically abnormal

32

OGMS:disease

def. – A disposition (i) to undergo pathological processes that (ii) exists in an organism because of one or more disorders in that organism.

33

Big Picture

42

Ontology for Mental Health

Werner CeustersUniversity at Buffalo

43

Ontology for Mental Health V0.0001Legend

representation

process

continuant

disjunction

MHO BFO/OGMS

45

some obvious links left out to aid readability

Ontology for Mental Health V0.0001Legend

representation

process

continuant

disjunction

MHO BFO/OGMS

46

MENTAL PROCESS (L1,U)=def. BODILY PROCESS which brings into being, sustains or modifies a COGNITIVE REPRESENTATION or a BEHAVIOR INDUCING STATE

47

MENTAL FUNCTIONING RELATED ANATOMICAL STRUCTURE (L1,U)

• =def. ANATOMICAL STRUCTURE in which there inheres the DISPOSITION to be the agent of a MENTAL PROCESS

49

Mental Functioning Related Anatomical Structure

an independent continuant

fiat object part of

brain + central and

peripheral nervous

system

50

• MENTAL DISORDER =def. DISORDER in one or more MENTAL FUNCTIONING RELATED ANATOMICAL STRUCTURES

• PATHOLOGICAL MENTAL PROCESS =def. PATHOLOGICAL PROCESS which is the manifestation of a MENTAL DISORDER

• MENTAL DISEASE =def. a DISEASE which is a DISPOSITION to undergo PATHOLOGICAL MENTAL PROCESSES

51

Big Picture

53

Big Picture

54

Clinical Evaluation Terms

Sign =def. – A bodily feature of a patient that is observed in a physical examination and is deemed by the clinician to be of clinical significance. (Objectively observable features)

Symptom =def. – An experienced bodily feature of a patient that is observed by and observable only by the patient and is of the type that can be hypothesized by a patient to be a realization of a disease. (A restricted family of phenomena including: nausea, anger, drowsiness, itchiness, anguish, and pain, which are of their nature experienced in the first person)

Symptoms are subjective. But this does not mean that there is no objective fact of the matter whether a given symptom exists

55

Symptoms Signs Physical Basis Examples

Canonical PainPCT: Pain with concordant tissue damage

Pain Manifestation of tissue damageSignals sent to nociceptive system

Activation of emotion- generating brain centers, which can produce increased heart rate, blood pressure, galvanic skin response.

Peripheral tissue damage Intact nociceptive system

Primary sunburnPain from strained musclePain from fracturePulpitis

Variant PainPNT: pain without concordant tissue damage

Pain Manifestation of some disorder in the patientSignals sent to nociceptive system Patient reports of pain are either exaggerated or muted relative to disorderActivation of emotion generating brain centers

Physical disorder of amplitude control mechanisms associated with the nociceptive systemIntact nociceptive system

Myofascial pain disorderTension-type headacheChronic back pain

NN: neuro-pathic nociception

Pain Neurological test confirming nerve damage

Disorder in the nociceptive system

Trigeminal neuralgiaPost-herpetic neuralgiaDiabetic neuropathyCentral pain

PRP: Pain-Related Phenomena Without PainPBWP: pain behavior without pain

? Report of painSick role behaviors accompanied by normal clinical examinationGrossly exaggerated pain behaviors Identified external incentives

Mental states such as anxiety, rather than peripheral tissue locus Disordered emotional or cognitive systems misinterpreting sensory signals

Factitious painMalingeringAnxiety-induced pain report

TWP: tissue-damage without pain

No pain Manifestation of tissue damage normally of the sort to cause pain

Suppression of pain system by one or other mechanism

Stress associated with sudden emergenciesPhysiological damping of the pain process caused by endorphins Placebo-induced opioid analgesiaGenetic insensitivity to pain

Pain Ontology (PN)

Closing remarks about borderline cases

• The methodology of canonical ontology

Where does Mount Everest begin and end?Cf. Barry Smith and David M. Mark, “Do Mountains Exist?”, Environment and Planning B, 30, 2003.

60

ontology of pain

Documents