In a manner expressive of great pain, grief, or distress.

Of sickness or other physical suffering: Severely, dangerously, seriously.

With reference to a punishment, reproof, etc.: so as to be keenly felt. Obsolete.

In an agonizing manner; to an agonizing degree; exceedingly painfully.

To an excruciating degree; in an extremely painful manner. Often hyperbolically in humorous use.