Hi Cynthia, Wladimir and Cian,
Great post!
Another study used a similar methodology with chronic pain patients [20], estimating the disutility of mild, moderate and severe chronic pain as, respectively, 0.04, 0.14, and 0.26 in a paper test, and as 0.16, 0.26, and 0.27 when interviewed face to face.
The severe pain of this study is less intense than disabling pain, right? You say disabling pain âprevents all forms of enjoyment or positive welfareâ, which suggests its disutility would have to be at least 1, i.e. that being unconscious would be better.
The second study investigated postoperative pain and cancer pain [22]. Here, the relationship among seven categories of pain (2: just noticeable, 3: weak, 4: mild, 5: moderate, 6: strong, 7: severe, 8: excruciating) was best described by a power function of the form y=0.99*x^2.99 for patients with postoperative pain and a power function of the form y=1.1*x^2.14 for patients with chronic cancer pain, where x corresponds to the pain category (1 to 8) and y the perception of intensity/âdistress. This translates into a perception of intensity for the seven categories of respectively 1, 8, 25, 62, 122, 210, 333 and 496 (postoperative pain) and 1, 5, 12, 21, 34, 51, 71 and 94 (cancer pain).
Nitpicks:
The last sentence should read â8 categoriesâ instead of âseven categoriesâ, since you list 8 numbers, and say âx corresponds to the pain category (1 to 8)â?
The 3rd number for postoperative pain should be 26 (= 0.99*3^2.99) instead of 25?
From Figure 8 of Wallenstein et. al (1980), the power law for cancer pain is ây=1.19*x^2.14â, not ây=1.1*x^2.14âł (there is a missing 9). So the intensities are 1, 5, 12, 23, 37, 55, 77 and 102 (the 1st 3 numbers are the same as yours).
But if the most intense pain, as evaluated in these studies, corresponded to the âDisablingâ category, the equivalence between Annoying and Disabling pain would be best represented by a ratio of approximately 1 to 94-496.
From Figure 6 of Wallenstein et. al (1980), the least intense pain is categorised as âNoneâ (x = 1), which sounds less intense than annoying pain[1]? I would say this is best described as âWeakâ (x = 3). If so, and the most intense pain (âExcruciatingâ, x = 8) corresponded to disabling pain (as you suggest above), this would be 8.16 (= (8/â3)^2.14; cancer pain) to 18.8 (= (8/â3)^2.99; postoperative pain) times as bad as annoying pain. For Wallenstein et. al (1980)âs power law fit to data on cancer and postoperative pain (y = 1.39*x^2.261), disabling pain would be 9.19 (= (8/â3)^2.261) times as bad as annoying pain.
One potentially promising strategy would thus involve conducting extensive surveys where participants from diverse backgrounds, who experienced the events evaluated, make comparisons between painful (affective) experiences of varying intensities and durations.
Have you considered running/âsupporting surveys involving your definitions of pain (annoying pain, hurtful pain, disabling pain, and excruciating pain) and pleasure (satisfaction, joy, euphoria, and bliss)? Maybe collaborating with Faunalytics or Rethink Priorities. I guess Open Philanthropy would be interested in funding it, as knowing how to compare different experiences is crucial to compare interventions.
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For readersâ reference, annoying pain is defined as follows:
Experiences of pain perceived as aversive, but not intense enough to disrupt the animalâs routine in a way that alters adaptive functioning or affects the behaviors that animals are motivated to perform. Similarly, Annoying pain should not deter individuals from enjoying pleasant experiences with no short-term function (e.g., play) and positive social interactions. Sufferers can ignore this sensation most of the time. Performance of cognitive tasks demanding attention are either not affected or only mildly affected. Physiological departures from expected baseline values are not expected to be present. Vocalizations and other overt expressions of pain should not be observed.
I was previously assuming disabling pain to be 100 times as intense as fully healthy life, i.e. 10 % (= 10â100) as intense as I am assuming now. I updated after going through the studies discussed here, especially Wallenstein et. al (1980). According to this, it looks like disabling pain is 8.16 to 18.8 times as bad as annoying pain, whereas I was supposing disabling pain to be 1 k times as bad as annoying pain. Now I am assuming disabling pain is 100 times (= 10^2) as bad as annoying pain, which is still more intense than the suggested by the study, but not so much so.
My updated past cost-effectiveness of HSI is 431 DALY/â$, which is 99.5 % (= 431â433) of my previous value of 433 DALY/â$. There is basically no change because the cost-effectiveness is approximately proportional to the intensity of excruciating pain, which I have not updated.