发表机构
Hunter College and the Graduate Center, CUNY（亨特学院与纽约市立大学研究生中心）
机构由 AI 辅助整理，请以论文原文为准。AI 中文总结
本文区分疼痛定位的三种认知失效，构建疼痛报告位置的空间贝叶斯模型，修正诊断效用梯度，提出与现有分类不同的疼痛定位失效综合解释
AI 中文摘要
患者报告的疼痛部位对部分临床表现具有诊断决定性，而对另一些表现几乎无信息价值。主流观点将此视为由解剖复杂性支配的单一诊断效用梯度。该解释混淆了三种认知上截然不同的定位失效，每种失效都有其自身的数学结构、最优工具和公共卫生后果：在解剖多路复用（a）中，多个结构共享一个位置，属于不可识别的逆问题；在去定位放大（b）——临床中即中枢敏化或伤害性疼痛——中，中枢驱动的疼痛行为模式取代了外周发生器，属于生成模型的改变；在牵涉/非典型移位（c）中，位置以系统的、个体依赖的方式偏移，如牵涉痛和非典型表现，属于协变量依赖的偏差。这三种情况在逆问题、信息论、决策论和神经场模型下表现不同，需要不同的补救措施。一个单一原则将它们统一：它们是一个贝叶斯推理问题在不同节点的失效，即一个生成模型中的不同点：似然、模型类别、先验和损失。随时间的观察增加了可恢复的信息。第四个节点，即报告本身，承载了本文的主要形式贡献——一个关于疼痛被报告位置的空间贝叶斯模型，区别于疼痛被感知的位置。进一步重新检验发现，已发表的“高效用”精度区间依赖于被夸大的特异性，因此该梯度是真实的，但比所描绘的更平缓。该解释处于“为何定位失效”轴上，是与伤害性/神经性/伤害敏感性疼痛分类（Kosek等人，2016）不同的综合结论。
英文摘要
Patient-reported pain location is diagnostically decisive for some presentations and nearly uninformative for others. The prevailing account treats this as one gradient of diagnostic utility set by anatomical complexity. That explanation conflates three epistemically distinct failures, each with its own mathematics, its own optimal instrument, and its own public-health consequence. In anatomical multiplexing, many structures share one location: a non-identifiable inverse problem. In delocalized amplification - clinically, central sensitization or nociplastic pain - a centrally driven pain-behaviour pattern replaces the peripheral generator: a change of generative model. In referred and atypical displacement, location is hypothesized to shift in a systematic, person-dependent way: a group-conditional bias whose direct evidence is still open. The three are one Bayesian inference problem failing at different nodes - the likelihood, the model class, and the group-conditional prior - with a fourth node at the report itself. The formal development is in a companion paper; this paper states what each model shows and what follows clinically. Re-examination finds that the published "high-utility" accuracy band leans on overstated specificity (Lipton et al., 2003; Bruyninckx et al., 2008; Devillé et al., 2000), so the gradient is real but flatter than drawn. The well-evidenced finding that better detection alone does not improve outcomes when treatment uptake lags is about the care pathway, not perception - a distinction the three-way split makes visible and a single utility number hides. The paper organizes the failures along a why-location-fails axis, distinct from the nociceptive/neuropathic/nociplastic taxonomy (Kosek et al., 2016), and sets out the study that would test the one prediction still open.
Commentsv2. The mathematical appendix is now a standalone companion paper, "One Inference, Four Nodes: Formal Models of Why Pain Location Fails," submitted separately; this version is the clinical and evidential half. Also: specificity re-examination corrected, registered sample raised to ~1250. 47 pages, 6 figures
