Mankind has undoubtedly experienced pain since the beginning of time. From prehistroric bones to artifacts of ancient civilizations, evidence of pain and attempts at its relief has been found throughout history.
Early man attributed pain to demons, evil humors, and dead spirits. Accordingly, treatment of pain entailed discouraging their entrance into the body, blocking their entry, or once inside, drawing, transferring, or removing them from the body. Later, pain was felt to be a punishment from the gods.
The word “pain” comes from the Latin poena, for punishment.
Finding the source of pain is an ongoing mystery that still challenges us today. Even by 18th century, there still were two schools of thought on the location of pain perception: heart versus brain.
Ancient Egyptians had no knowledge of a nervous system. The heart was the most exalted organ, and in it rested the center of pain.
Hindus believed the heart was the seat of all pain.
Mesopotamians regarded pain as a punishment from the gods demanding sacrifice and prayer.
In ancient China, pain involved an imbalance between the Yin and the Yang. Acupuncture practice today still strives to adjust the balance of these energies in one’s Chi.Hippocrates (c. 460 to 370 B.C.) felt pain was a manifestation of conditions disturbing the natural balance of the body.
Democritus (460 to 362 B.C.) and Plato (427 to 347 B.C.) attributed pain to the intrusion of particles into the soul.
Aristotle believed that the brain controlled the temperature of the heart, and that vital heat in the heart determined pain.
Herophilus (315 to 280 B.C.) and later Erasistratus ((310 to 250 B.C.) in Alexandria believed that brain is seat of pain. Their original work has not survived.
Galden (A.D. 130 to 200) postulated that the brain was the center of sensation and pain.
William Harvey, who discovered the circulation of blood in 1628, still believed that the heart was the seat of pain.His contemporary, Descartes, postulated that the brain was the center of sensation. This concept of the pain pathway with delicate threads was published in 1664, and resurfaced over 300 years later in Melzack and Wall’s famous 1965 article in Science.
Opium and its derivatives find quite a reference in history. Morphine, a modern analgesic was discovered by Friedrich Wilhelm Adam Sertuerner in 1804.
Procaine was discovered in 1904 by Alfred Einhorn in response to the need for a less toxic agent than cocaine.One of the recent advances in pain treatment has been the discovery of COX-2 (cyclooxygenase-2) inhibitators.
Felix Hoffman, wishing to improve upon sodium salicylateis, resurrected an old formula for acetylsalicylic acid, better known as aspirin.
The first multidisciplinary pain clinic may have been at the temple of Aesculapius, the Greek god of medicine. Patients in pain came to sleep at the temple. During the night, Aescullapius, priests, and physicians effected a cure through magic potions (nepenthe), bandages, medical and physical procedures, as well as mystical and transcendental energies.
Based on the success of an informal collaboration with an orthopedist, a neurosurgeon, and a psychiatrist, Bonica, a young anesthesiologist, established a multidisciplinary pain clinic at Tacoma General Hospital in 1947. At the same time, William K. Livingston started his “Pain Project” at the University of Oregon. Bonica later brought his pain clinic to the University of Washington in 1960.
Today, we are living longer as a result of continual advances in medicine, surgery, and anesthesia. On the other hand, increasing life expectancies put us at increased risk for the development of chronic pain secondary to trauma, cancer, and old age itself.
It is possible to treat 90 percent of postsurgical, posttrauma, and cancer pain but in reality less than 50 percent get relief worldwide.
In spite of all the advances, less than 10 percent of chronic, noncancer pain is relieved.
Severe chronic pain is a massive medical, economic, and societal problem. We must continue to work to alleviate pain for the benefit of mankind.
Dr. Singh,
I applaud your efforts. I am a Board Certified Neurologist, who has treated chronic pain patients in the past, having successfully passed certification exams with the American Academy of Pain Management and the American Board of Pain Medicine. Unfortunately, despite those efforts, a former vindictive partner of mine filed a complaint with my state Medical Board, asserting that I was a “problem prescriber” of pain medicines for patients for whom all other therapies had failed. After a lengthy investigation, and BEFORE due process, my license was summarily suspended. Despite proving in court that I was not a problem physician, the Board sanctioned me with a probation that has made me unemployable and impossible to practice alone. I have earned no income for > 2 yrs and I am now starting duties as a Red Cross Volunteer Physician and a local pro bono clinic.
Both chronic pain patients, and, the doctors who treat them are targets. I might point out that I have NEVER had to fear the DEA, federal or state, for obviously I have committed no crime. I have only had to fear my State Medical Board. It is more LETHAL than the DEA’s. I have asked my state medical society, and physician rehab program to do research on the outcomes of their actions, and quantify the numbers of divorces, bankruptcies, and suicides suffered by sanctioned physicians.
Dr Arun Pal Singh Reply:
November 27th, 2010 at 11:03 am
@Dr Harper,
Thanks for your appreciation and I am sorry to hear about all the stuff you are going through.
My best wishes are with you.