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The datafication of pain: trials and tribulations in measuring phantom limb pain

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Abstract

This article takes the phenomenon of phantom limb pain (PLP), and a therapeutic technology designed to treat it, as springboards to critically consider a transformation: from deeply subjective experiences into quantitative data. Drawing upon ethnographic fieldwork on neuroprosthetic development, I examine an international clinical trial coordinated in Sweden using neuromuscular activation, machine learning, and virtual reality to treat PLP. I excavate the trial’s underlying fundaments and tools, tracing how they define, produce and record changes in an individual’s pain along the course of treatment, a process I call the ‘datafication of pain.’ Moving beyond the representational problematic of pain as simultaneously subjective experience and object of medical intervention, I ask: What gets left out, in this process of datafication? And what gets created in the void it leaves? I argue that the experimental paradigm of datafication elides certain key dimensions of pain itself, particularly its relational dimensions, and surfaces new pain-experiences in-situ. The stakes of this elision and surfacing not only impact the data produced, but also the ethics of actual lived, embodied experiences of pain itself. In leaking out of the experimental apparatus, the excess of pain becomes an artifact of the experimental process, as opposed to merely its object. This article examines the relational dimensions—of both the experimental process and phantom limb pain at large—elided by the data-gathering apparatus itself.

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Notes

  1. “Patient” is the emic term used to describe participants in the clinical trial, and thus the identifier I use here. Alternative terms include “trial participant” and “device user,” but these are not used as frequently.

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Acknowledgments

This research was supported by grants from the National Science Foundation (NSF) (#1850672) and the American Scandinavian Foundation. I am grateful to the patients, clinicians and scientists who participated in this study; to João Biehl, Carolyn Rouse, Elizabeth Davis, Klaus Hoeyer, and Henriette Langstrup for their generative, engaging, and insightful comments throughout this research and writing process; as well as to the editors at Biosocieties and the helpful suggestions of three anonymous reviewers.

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Correspondence to Alexandra Middleton.

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The author does not have any competing interests in the research detailed in the manuscript.

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The study on which the research is based has been subject to appropriate ethical review by Princeton University’s Institutional Review Board (IRB) (0000008317 Emerging Prosthetic Technologies and Brain-Machine-Body Relations) and the regional ethical approval in Västra Götalands region, Sweden (1098-17). All names used (with the exception of Dr. Max Ortiz Catalan’s) are pseudonyms to protect the anonymity of the interlocutors.

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Middleton, A. The datafication of pain: trials and tribulations in measuring phantom limb pain. BioSocieties 17, 123–144 (2022). https://doi.org/10.1057/s41292-020-00203-7

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