Ceusters Developing “Vocabulary of Pain” to Improve Patient Care

With a $794,000 grant from the National Institutes of Health, Werner Ceusters, MD, professor of psychiatry, is developing an ontology—a uniform, agreed-upon system of meaning—to describe pain and related disability, mental health and quality of life issues.

“Pain research is very difficult because nothing allows the physician to see the patient's pain directly,” says Ceusters, the grant’s principal investigator. “The patient has to describe what he or she is feeling.”

That is a serious shortcoming because each patient’s subjective experience of pain is different. Descriptions of pain lack the precision and specificity taken for granted with other disorders, whose biomarkers or physiological indicators reveal what health care providers need to assess their severity.

“If we want to more effectively help people suffering from chronic pain, we need to study a population that is consistent, with patients who have features in common,” says Ceusters, who directs the Ontology Research Group of UB’s New York State Center of Excellence in Bioinformatics and Life Sciences.

“The problem with pain is, it’s very hard to build up a group with the same sort of pain. People don't have the same vocabulary or linguistic capabilities or even the same cultural backgrounds.

“It’s something pain researchers have struggled with for decades. We need to develop a vocabulary of pain.”

That’s where ontology comes in. It provides methods of distinguishing among categories and describing data in uniform and formal ways, which can produce much more precise definitions of pain.

With the NIH grant, Ceusters and colleagues will study data from thousands of patients in the U.S., the United Kingdom, Sweden, Israel and Germany who suffer from oral and facial pain, including temporomandibular disorder (TMD).

From the data, researchers will learn more about the complexity of pain disorders, specifically the assessment of pain disorders and how they impact patients’ mental health and quality of life.

The goal of the research is to build a software program that can represent pain in clear terms, with a symptom checklist that can be universally understood by both people and computers.

Ceusters is working with Richard Ohrbach, DDS, PhD, associate professor of oral diagnostic sciences in the UB School of Dental Medicine, and other researchers to develop the ontology.

The NIH grant builds on past work that Ceusters conducted with an Oishei Foundation grant to improve the classification, diagnosis and treatment of psychiatric conditions.

 “We have to define the terminology of pain,” says Ceusters, who has degrees in knowledge engineering and information science as well as in neuropsychiatry.

 “This can only be solved by the kind of ontology we are doing here at the University at Buffalo.”

While the philosophical approach to ontology has its roots in ancient Greece, a computational approach emerged in the late 20th century, when computer scientists interested in artificial intelligence began exploring how to create software programs that can reason the way humans do.

UB excels in both approaches, Ceusters says.

“We have a very strong foundation in the philosophical approach to ontology with Barry Smith, who is a pioneer in contemporary ontology—especially as it relates to biomedical applications—and we also have a very strong presence in computational approaches, especially to biomedical ontology.

“These computational approaches allow us to devise systems of communication in which there is a consistent meaning for terms used in different language systems and conceptual frameworks.”