{
  "schemaVersion": "1.0",
  "workId": "BRC-2026-W106",
  "asOf": "2026-08-15",
  "question": "How should discordance between felt heat or cold and measured temperature be explained and studied, and is that discordance linked to invalidation and social isolation?",
  "priorSot": [
    {
      "workId": "BRC-2026-W001",
      "role": "prior construct and measurement framework",
      "boundary": "Did not directly synthesize nonlinear thermal transformation or the social pathway from invalidation to isolation."
    }
  ],
  "retrievalArtifacts": [
    {
      "kind": "official-pubmed-xml",
      "records": 19,
      "sha256": "b0fc0b45c34d3b5e7c1c9a89dd9ba5ed8786ec7667ef1871129d901aea41de00",
      "publiclyRedistributed": false
    },
    {
      "kind": "open-fulltext-bioc",
      "pmcid": "PMC10635420",
      "topic": "thermal interoception",
      "sha256": "c6d2a6614a06176ec1c89e0eb68405c8541821a37dea1744229a5a4b02b29abf",
      "publiclyRedistributed": false
    },
    {
      "kind": "open-fulltext-bioc",
      "pmcid": "PMC8396808",
      "topic": "thermal grill illusion",
      "sha256": "63953e73ec243e7fa51e8e32f517966132cefea8e74bd9182836a0ca07a9a3eb",
      "publiclyRedistributed": false
    },
    {
      "kind": "open-fulltext-bioc",
      "pmcid": "PMC2866775",
      "topic": "subjective-objective hot-flush discordance",
      "sha256": "e7ffc05c9678f9983aa4a6dfeee904c3c51e22ab0cf56147c9acfa7e662ba133",
      "publiclyRedistributed": false
    }
  ],
  "evidenceLayers": [
    {
      "layer": "physical-state",
      "observables": ["core temperature", "surface temperature", "bilateral asymmetry", "rate of change", "perfusion", "sweating"],
      "boundary": "No single observable is a complete measure of felt heat or cold."
    },
    {
      "layer": "spontaneous-perception",
      "observables": ["heat", "cold", "burning", "chilling", "location", "depth", "intensity", "interference"],
      "boundary": "A genuine report is not a calibrated estimate of surface temperature or a stand-alone diagnosis."
    },
    {
      "layer": "evoked-sensory-function",
      "observables": ["cold detection threshold", "warm detection threshold", "cold pain threshold", "heat pain threshold", "allodynia", "paradoxical direction"],
      "boundary": "QST is psychophysical and complementary; it requires standardized methods and appropriate reference data."
    },
    {
      "layer": "meaning-and-social-response",
      "observables": ["felt credibility", "discounting", "self-doubt", "concealment", "participation", "social isolation"],
      "boundary": "Evidence is indirect for thermal discordance and must not be presented as established causation."
    }
  ],
  "discordancePatterns": [
    "perception and physiological signal concordant",
    "perception without a matching device signal",
    "device signal without awareness",
    "direction or intensity transformation"
  ],
  "keyStudies": [
    { "pmid": "37529855", "supports": "Wide individual variation in thermal interoceptive accuracy among healthy participants.", "limits": "31 healthy participants; does not establish pathology." },
    { "pmid": "37578447", "supports": "Paradoxical heat during cooling occurs disproportionately in somatosensory lesions.", "limits": "Does not diagnose an individual or explain all spontaneous thermal symptoms." },
    { "pmid": "37332303", "supports": "Precooling can increase paradoxical heat responses in healthy people.", "limits": "Experimental evoked phenomenon, not spontaneous chronic symptoms." },
    { "pmid": "34441893", "supports": "Spatially interlaced innocuous warm and cool stimuli can evoke burning or pain.", "limits": "Laboratory illusion; mechanism and patient transfer remain bounded." },
    { "pmid": "18194841", "supports": "Mild cooling and heating can evoke nociceptive qualities at small skin spots.", "limits": "Healthy experimental sample and labile responses." },
    { "pmid": "20443722", "supports": "Subjective and physiological vasomotor events can diverge in both directions.", "limits": "Small hot-flush sample; skin conductance is a sweating surrogate, not direct temperature." },
    { "pmid": "23742795", "supports": "QST should complement, not replace, clinical and other diagnostic evidence.", "limits": "Consensus scope is neuropathic pain assessment." },
    { "pmid": "31665231", "supports": "Small-fiber neuropathy diagnosis requires converging evidence rather than symptoms alone.", "limits": "Diagnostic criteria do not adjudicate whether a reported sensation is real." },
    { "pmid": "31290347", "supports": "Chronic-pain invalidation includes disbelief, stigma, identity threat, and isolation.", "limits": "Indirect evidence; not a thermal-discordance cohort." },
    { "pmid": "38246108", "supports": "Chronic illness can produce relational and temporal experiences of loneliness.", "limits": "Indirect qualitative evidence; not specific to thermal symptoms." },
    { "pmid": "40972073", "supports": "Medical invalidation can be conceptualized as undermining perception and autonomy.", "limits": "The concept and its measurement remain evolving." },
    { "pmid": "24427173", "supports": "Normalizing symptoms without a constructive explanation can be experienced as dismissive.", "limits": "Small qualitative sample under an older medically-unexplained-symptom frame." }
  ],
  "directEvidenceGap": {
    "found": false,
    "statement": "No located study directly recruited people for felt-measured thermal discordance and tested whether discordance or its clinical interpretation causes social isolation.",
    "consequence": "The pathway from normal measurement through invalidation, concealment, withdrawal, and isolation is a testable model, not a causal conclusion."
  },
  "claimBoundary": {
    "supported": [
      "Thermal perception and surface temperature are distinct measurement targets.",
      "Nonlinear amplification and directional reversal are physiologically possible.",
      "Thermography and QST each have target-specific methodological limits.",
      "Invalidation and isolation occur in adjacent chronic pain and chronic illness literatures."
    ],
    "notEstablished": [
      "A normal thermogram disproves the sensation.",
      "A strong sensation proves elevated surface temperature.",
      "Thermal discordance alone identifies neuropathy, dysautonomia, or a psychiatric condition.",
      "Clinical invalidation causes isolation in this specific population.",
      "Any proposed treatment improves discordance or isolation."
    ]
  },
  "proposedStudy": {
    "stage0": "Maximum-variation qualitative and cognitive interviews with 20–30 participants; develop Korean-language descriptors and communication items.",
    "stage1": "Twenty-one-day event-contingent repeated measurement at onset, peak, and recovery, prioritizing within-person baselines, slopes, lags, disclosure, and immediate social response.",
    "stage2": "Standardized rest-challenge-recovery visit with simultaneous thermography, sensory ratings, QST, and feasible perfusion or sweating surrogates; blinded site comparisons.",
    "stage3": "Prospective validation of the hypothesized communication-invalidation-isolation pathway before any communication intervention trial.",
    "instrumentPolicy": "Do not deploy translated invalidation or isolation scales without Korean content-validity, cognitive-testing, licensing, and psychometric checks.",
    "treatmentTrialBeforePhenotypeValidation": false
  },
  "safetyBoundary": "This work does not replace evaluation of persistent fever, acute unilateral sensory change, weakness, altered consciousness, tissue injury, skin-color change, or severe systemic symptoms."
}