The term "most pitiful" can be replaced with several synonyms. Some of them are miserable, wretched, sorrowful, pathetic, and heartrending. These synonyms can be used to describe someone who is going through a tough time or is experiencing a great deal of suffering. These words convey a sense of empathy and compassion towards the person being described. Using alternative words to describe the situation can help in expressing emotions and thoughts more effectively. However, it's important to note that the context and tone of the sentence can change the connotation of these synonyms, making it necessary to use them appropriately.