‘Pain’ in SNOMED CT: Is There an Anesthetic?

  • Werner CeustersEmail author
  • Jonathan P. Bona


For sure, an unpleasant odor of feet may be categorized as an unpleasant odor. Though foot fetishists (De Block and Adriaens 2013), podiatrists and manufacturers of washing machines might disagree (Question Everything 2015), most people would contend such odor to be classified as an offensive odor. No clinician would have qualms in classifying an unpleasant odor of feet as an odor of feet nor as a foot finding. Perhaps some, in particular the ontology-savvy ones who are therefore able to detect ambiguities in natural language phrases, might doubt a foot odor to be a limb finding or a body odor. But who would argue it to be a finding of sense of smell, i.e. a neurological finding, or a duplicate, and therefore, inactive concept? This question smells of The Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT) (Donnelly 2006) all over, does it not? Indeed, the former is what its authors argued to be the case until 2003 when they discovered that there are actually two different sorts of smelly feet: “duplicate concept” ones and “offensive body odor” ones. What this discovery means for patients about whom SNOMED CT-based smelly feet assertions were made in their electronic healthcare records (EHR) is rather unclear. Some might, upon chart inspection, be surprised to find their smelly feet to have changed from a neurological finding to an offensive body odor. Others might find their smelly feet to have become inactive concepts and perhaps therefore conclude they are documented as being successfully treated. But in both cases their feet themselves are as stinky as before.



This work was supported in part by Clinical and Translational Science Award NIH 1 UL1 TR001412-01 from the National Institutes of Health, by grant R21LM009824 from the National Library of Medicine (NLM), and by grant 1R01DE021917-01A1 from the National Institute of Dental and Craniofacial Research (NIDCR). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the NIDCR, the NLM or the National Institutes of Health.


  1. Arp, Robert, Barry Smith, and Andrew D. Spear. 2015. “Building ontologies with basic formal ontology.” In Cambridge, Massachusetts: The MIT Press. ebrary
  2. Ceusters, W. 2010. “Applying Evolutionary Terminology Auditing to SNOMED CT.” AMIA Annu Symp Proc 2010:96–100.Google Scholar
  3. Ceusters, W. 2011. “SNOMED CT revisions and coded data repositories: when to upgrade?” AMIA Annu Symp Proc 2011:197–206.Google Scholar
  4. Ceusters, W. 2014. “Pain assessment terminology in the NCBO BioPortal: evaluation and recommendations.” In Proceedings of the International Conference on Biomedical Ontology 2014, 1–6. Houston, TX.Google Scholar
  5. De Block, A., and P. R. Adriaens. 2013. “Pathologizing sexual deviance: a history.” J Sex Res 50 (3–4):276–98. doi:10.1080/00224499.2012.738259.Google Scholar
  6. Dentler, Kathrin, Ronald Cornet, Annette ten Teije, and Nicolette de Keizer. 2011. “Comparison of reasoners for large ontologies in the OWL 2 EL profile.” Semantic Web 2 (2):71–87.Google Scholar
  7. Donnelly, K. 2006. “SNOMED CT: The Advanced Terminology and Coding System for eHealth.” In Studies in Health Technology and Informatics—Medical and Care Compunetics 3. Vol 121, edited by Bos L, Roa L, Yogesan K, O’Connell B, Marsh A and Blobel B, 279–290. Amsterdam: IOS Press.Google Scholar
  8. Fung, K. W., W. T. Hole, S. J. Nelson, S. Srinivasan, T. Powell, and L. Roth. 2005. “Integrating SNOMED CT into the UMLS: an exploration of different views of synonymy and quality of editing.” J Am Med Inform Assoc 12 (4):486–94. doi:10.1197/jamia.M1767.Google Scholar
  9. Geller, J., C. Ochs, Y. Perl, and J. Xu. 2012. “New abstraction networks and a new visualization tool in support of auditing the SNOMED CT content.” AMIA Annu Symp Proc 2012:237–46.Google Scholar
  10. IHTSDO. 2015. International Health Terminology Standards Development Organization - SNOMED CT® Technical Implementation Guide - January 2015 International Release (US English).Google Scholar
  11. Lee, Dennis, Ronald Cornet, and Francis Lau. 2011. “Implications of SNOMED CT versioning.” International Journal of Medical Informatics 80 (6):442–453. doi:10.1016/j.ijmedinf.2011.02.006.Google Scholar
  12. Major, P., B. J. Kostrewski, and J. Anderson. 1978. “Analysis of the semantic structures of medical reference languages: part 2. Analysis of the semantic power of MeSH, ICD and SNOMED.” Med Inform (Lond) 3 (4):269–81.Google Scholar
  13. Mortensen, Jonathan M., Mark A. Musen, and Natalya F. Noy. 2014. “An empirically derived taxonomy of errors in SNOMED CT.” AMIA Annual Symposium Proceedings 2014:899–906.Google Scholar
  14. Ochs, C., J. Geller, Y. Perl, Y. Chen, J. Xu, H. Min, J. T. Case, and Z. Wei. 2015. “Scalable quality assurance for large SNOMED CT hierarchies using subject-based subtaxonomies.” J Am Med Inform Assoc 22 (3):507–18. doi:10.1136/amiajnl-2014-003151.Google Scholar
  15. Question Everything. 2015. Is it normal to like smelly feet?
  16. Scheuermann, R. H., W. Ceusters, and B. Smith. 2009. “Toward an ontological treatment of disease and diagnosis.” Summit on Translat Bioinforma 2009:116–20.Google Scholar
  17. Smith B, Ceusters W, Goldberg LJ, and Ohrbach R. 2011. “Towards an Ontology of Pain.” In Proceedings of the Conference on Logic and Ontology, edited by Mitsu Okada, 23–32. Tokyo: Keio University Press.Google Scholar
  18. Smith, B., M. Ashburner, C. Rosse, J. Bard, W. Bug, W. Ceusters, L. J. Goldberg, K. Eilbeck, A. Ireland, C. J. Mungall, O. B. I. Consortium, N. Leontis, P. Rocca-Serra, A. Ruttenberg, S. A. Sansone, R. H. Scheuermann, N. Shah, P. L. Whetzel, and S. Lewis. 2007. “The OBO Foundry: coordinated evolution of ontologies to support biomedical data integration.” Nat Biotechnol 25 (11):1251–5. doi: 10.1038/nbt1346.Google Scholar
  19. Smith, B., W. Ceusters, B. Klagges, J. Kohler, A. Kumar, J. Lomax, C. Mungall, F. Neuhaus, A. L. Rector, and C. Rosse. 2005. “Relations in biomedical ontologies.” Genome Biology 6 (5). doi: Artn R46 Doi 10.1186/Gb-2005-6-5-R46.Google Scholar
  20. Smith, Barry. 2004. “Beyond concepts: ontology as reality representation.” In Proceedings of the third international conference on formal ontology in information systems (FOIS 2004), 73–84. Amsterdam: IOS Press.Google Scholar
  21. Smith, Barry, and Werner Ceusters. 2015. Aboutness: Towards Foundations for the Information Artifact Ontology. International Conference on Biomedical Ontology, Lisbon, Portugal, July 27–30.Google Scholar
  22. Sommers, S. C. 1967. “Systematized nomenclature of pathology.” Pathol Microbiol (Basel) 30 (5):826–7.Google Scholar
  23. Spackman, Kent A. 2005. “Rates of Change in a Large Clinical Terminology: Three Years Experience with SNOMED Clinical Terms.” AMIA Annual Symposium Proceedings 2005:714–718.Google Scholar
  24. Tao, Shiqiang, Licong Cui, Wei Zhu, Mengmeng Sun, Olivier Bodenreider, and Guo-Qiang Zhang. 2015. “Mining Relation Reversals in the Evolution of SNOMED CT Using MapReduce.” AMIA Summits on Translational Science Proceedings 2015:46–50.Google Scholar
  25. Wang, A. Y., J. W. Barrett, T. Bentley, D. Markwell, C. Price, K. A. Spackman, and M. Q. Stearns. 2001. “Mapping between SNOMED RT and Clinical terms version 3: a key component of the SNOMED CT development process.” Proc AMIA Symp:741–5.Google Scholar

Copyright information

© The Author(s) 2016

Authors and Affiliations

  1. 1.University at Buffalo, State University of New YorkBuffaloUSA
  2. 2.State University of New York Buffalo BuffaloUSA

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