Introduction
Man and pain have coexisted since man's creation - it is one
of the most basic human experiences. Pain is a protective signal
acquired spontaneously early in childhood. Literature gives us
many references on pain from which to choose. St. Augustine
(A.D. 345-430) in his Confessions related, "Thou didst then
torment me with pain in my teeth; which when it had come to such
height, that I could not speak..." Francis Bacon (15611626), in
the Advancement of Learning, stated that it was the duty of a
physician "...not only to restore health, but to mitigate pain
and dolors..." In Shakespeare's (1564-1616) Much Ado About
Nothing, Leonato says: "For there was never yet philosopher,
that could endure the toothache patiently." Milton (1608-74)
stated in Paradise Lost, "But pain is perfect miserie, the worst
of evils..." In Don Quixote, Cervantes (1547-1616) observed,
"When the head aches, all the members partake of the pains."
Thomas Jefferson (1743-1826), who suffered from migraine
headaches, once declared, "The art of life is the avoiding of
pain." Emerson (1803-82) stated in his Natural History of
Intellect, "He has seen but half the universe who never has been
shown the house of Pain." Hans Christian Anderson (1805-75), who
suffered from toothache throughout his life, on one occasion
complained, "... the pain played a Miserere on my nervepipes."
Such is the house of pain |
.7, 11,12,16, 18,20
Pain: A Definition
Since ancient days, pain has been defined in many ways by
various individuals. Aristotle (384-322 B.C.) considered pain an
emotion, like joy. Thomas More (1478-1535) referred to pain as
"the direct opposite of pleasure." Descartes (1596-1650)
perceived it as a sensation, like hot or cold. Dunglison (1846)
defined pain as "a disagreeable sensation, which scarcely admits
of definition" (a very good definition). Harris (1849) simply
called pain "dolor." Dorland (1946) refers to pain as "distress
or suffering." Mathison (1958) called pain "an emotion as vague
as love, and as hard to define." Basbaum (1988) stated that pain
is: "...a complexperception, the nature of which depends not
only on the intensity of the stimulus but on the situation in
which it is experienced and, most importantly, on the affective
or emotional state of the individual. Pain is to somatic
stimulation as beauty is to a visual stimulus. It is a very
subjective experience." Finally, Webster (1991), among many
definitions, calls pain "acute mental or emotional distress or
suffering." Whichever definition we choose, it still hurts -
that is the bottom line.8, 9, 15, 20, 22, 23, 25 |
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Primitive Man: Witch Doctors
Every civilization and culture has left behind a reference to
pain, such as incantations, prayers, exorcisms, religious rites,
etc. Artifacts, such as talismans, parchment rolls, scrolls,
clay tablets, etc. from the days of Babylon to the twentieth
century, all bear evidence of man's constant battle with pain,
the antithesis of evil spirits. From early skeletal remains,
anthropologists have demonstrated evidence of diseases and
injuries (abscessed teeth and unhealed fractures) which
undoubtedly caused pain to the individual. Small, round holes
drilled into the skulls are evidence of trepanation, an
operation performed by the witch doctors to let out the evil
spirits, the cause of the pain. Prehistoric man probably
resorted to physical therapeutic methods to manage pain, e.g.
cold water of streams, heat of the sun or later fire, pressure
on nerves, counterirritants, etc. He also employed psychotherapy
by using charms, tattoos, spells, etc. tokeep out evil spirits.25,
32
In early cultures, it was the woman who acted as the
priestess, sorceress-healer, or mother-goddess. Later, as the
male role became dominant, the medicine man took over. Pain,
formerly seen as the sting of an evil spirit, now was
interpreted as a punishment inflicted by an offended god.
Therefore, the medicine man was eventually replaced by the
priest, a servant of the gods. Human sacrifices were made to
placate the gods. It was thought human pain bought favor from
the deities. Shrines were built where the priests could offer
prayers to the offended deities. The Babylonians and Assyrians
had their zigurats, the Egyptians their pyramids, the Greeks
their temples, and the Aztecs their teocallis. Votives (clay
replicas of body parts) were often left in the temple to secure
relief for the diseased or painful part. After a sacrifice was
made, it was believed the gods would grant relief to the
sufferer.10, 25, 32
Ancient Sages: The Gods Speak
The ancient Greek and Roman writers often referred to pain.
Homer (9th-8th century B.C.) speaks of pain in a detached manner
in the Iliad as if he personally had no knowledge of it or
experienced it. Pain simply did not exist for his heroes. Even
death was dissociated from the agonies of dying. Aesculapius,
the Greek god of medicine, was referred to as a "gentle
craftsman who drove pain from the limbs that he healed."
Plato(428-348 B.C.) compared pain to pleasure in that when a
person was suffering from acute pain, "...there is nothing
pleasanter than to get rid of their pain." Aristotle (384322
B.C.) stated, "Pain upsets and destroys the nature of the person
who feels it." His concept of pain as a passion of the soul felt
in the heart prevailed for almost twenty-three centuries.
Lucretius (90-53 B.C.) said that "...atoms cannot ache with any
pain or grief" and "...pain exists when violence attacks." Galen
(A.D.129199) recognized "referred pain" (pain felt in areas
other than the affected part). He described five different forms
of sympathetic pain in his treatises.4, 7, 19, 25, 30, 34 |
Herbal Medicine: Nature Speaks
Although we are unable to date the origin of pain, we are
able to identify some of the methods that man used to fight it.
One of the oldest was herbal medicine. Such plants as the
henbane, hemp, poppy, and mandragora were found to be effective
analgesic remedies. The hemp was burned to induce sleep and thus
relieve pain. One of the earliest records for analgesia is on a
Babylonian clay tablet from 2250 B.C., which describes a remedy
for the relief of a toothache. Powdered henbane seeds mixed with
gum mastic were inserted into the cavity of a carious, aching
tooth. The Egyptian Ebers Papyrus mentions opium as a
painkiller. The Hindu Charaka and Susruta, written about 1000
B.C., mention the use of wine and hemp fumes to produce
"insensibility to pain." In Homer's Odyssey, Helen put a drug
(probably hashish) into wine and made a drink which "quenches
pain and strife and brings forgetfulness of every ill."
Aesculapius, the Greek god, supposedly used an herbal potion of
nepenthe to relieve pain. Socrates (470-399 B.C.) imbibed
hemlock during his last hours to relieve his pain. Hippocrates
(460-379 B.C.) discusses belladonna, opium, mandragora, and
jusquiam. Pliny (A.D. 23-79) described a mysterious "Stone of
Memphis," which makes one "quite benumbed and insensible to
pain." Galen (A.D. 129-199) wrote on the use of the mandrake
root as a painkiller.20, 32
For pain control, Egyptian and Assyrian physicians often
performed surgical operations after compressing the carotid
artery to produce unconsciousness from anoxia of the brain. The
Chinese used mandrake wine to produce analgesia for their
torture victims. In 1170, Roger of Salerno (Ruggiero Frugardi),
who wrote Chirurgia magistri Rogeri, the first book on Western
surgery, mentions the monks using sponges soaked in opium and
held over the patient's nose for surgical procedures. A century
later, Theodoric de Lucca (1205-96), referring to this method,
said, "The patient may be cut and will feel nothing as if he
were dead."14, 20
For centuries, alcohol was used as a painkiller and oil of
cloves as a toothache remedy. In Mexico, the agave plant was
utilized as a crude anesthetic. In the Amazon, the natives used
the root of the caapi vine to deaden pain. The Australian
Bushmen still employ the duboisia tree leaves as a painkiller.
In India, the natives eat the fruit of the java plum tree to
control pain. The East Indian pangiun tree is used as a narcotic
by the natives. In North America, the natives used the bark of
the Dogwood (C. canadensis) to relieve pain; Hops (Humulus
Lupulus) blossoms for earache or toothache; Speckled Alder (Alnus
incana) twigs for headache and backache; Burdock (Arctium minus)
leaves for rheumatic pains. In the Orient, the Chinese developed
a pain-alleviating technique called moxibustion, whereby a small
cone of combustible plant material (usually wormwood) was laid
on a prescribed point (as in acupuncture) and set afire. The
pain of the blister acted as a counterirritant and the patient
soon forgot the original ailment's pam.14, 20 ,35 |
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Christianity: Wages of Sin
The advent of Christianity ushered in the concept that
pain could be relieved by the laying on of hands and through
prayer to Jesus Christ and his Father. The Roman Church made
good use of healing through psychotherapeutic methods in its
conversion of the faithful. Pain was considered a
disciplinary measure for sinners, "good for the soul," and
not to be the object of scientific scrutiny. It was
perceived as a divine punishment and a continuous act of
penance or contrition. Therefore, pain could be rationalized
as a preview of what it meant to be damned. One group,
called the "Flagellants," went about self-flogging
themselves as penance for sin. Bodily pain was also linked
to Christ's suffering on the cross or as one of the effects
of original sin. Christ on the cross had set the example.
Morris (1991) called pain in the period, "a kind of internal
crucifix."25,32,37
The Dark Ages: Arabian Medicine
As the Dark Ages (A.D. 476-1000) settled over Europe, the
center of medicine moved to Arabia, where Avicenna (A.D.
980-1037), "the Prince of Physicians," became the dominant
physician. His textbook, Canon of Medicine, was used in
Europe for six centuries. He described fifteen types of pain
and recommended both therapeutic and psychotherapeutic
measures for relief of pain. He was probably the first to
regard pain as a separate and distinctive sense. In Europe,
the ancient analgesics were forgotten; sickness was the
reward of sin. Only one's faith could lessen suffering.
4, 20 ,32
The Middle Ages: "Black Death"
Europe in the thirteenth century saw the arrival of the
Bubonic plague or "Black Death." The victims lived only
three or four days after contracting the disease and died a
horrible death. An estimated 25 million people perished. The
Church called for "resignation and prayer." Another disease,
syphilis (the French called it the Neapolitan sickness,
while the Italians called it the French sickness), was first
described in 1495 following the battle of Fornovo, "...the
sufferers were driven to distraction by the pains they
experienced". Ambroise Pare (1510-90) stated that the pains
were so severe that. "the sufferers say they feel as if they
have been beaten with sticks." Basically, the Middle Ages
contributed very little to pain control.20, 31 |
The Inquisition: The "Holy Office"
Any reference to pain during the Middle Ages has to
include the Inquisition or "Holy Office." The very word
Inquisition conjures up thoughts of pain and suffering. It
began in the twelfth century when Pope Innocent III
(1161-1216) ordered the members of the Church to prosecute
heretics. Previously, heretics were punished by the
confiscation of their property; now they were tortured and
burned to death. It was believed that the unrepentant
heretics would be given a taste of perpetual hellfire and at
the last minute they would repent and save their souls.
Torture was also used as a legal means of getting a
confession out of a criminal in the absence of two
eyewitnesses or a written confession. The rack, thumbscrew,
and iron maiden, etc. caused intense pain to the victim,
but, it was thought, permitted the truth to emerge. The
Inquisition's last victim met his death in 1826, and the
practice was finally abolished in 1835.25, 29
The Renaissance: A Stalemate
Although the Renaissance fostered remarkable advancements
in science, especially in physics and chemistry, medicine
failed to follow. During the Renaissance, basically no new
drugs for pain relief were added to the pharmacopoeia. The
same drugs developed by the Egyptians, Chinese, Greeks, and
Romans two thousand years earlier were still being used.
Like Plato, Leonardo da Vinci (1452-1519) compared pain to
pleasure. His drawing, entitled "Allegory of Pleasure and
Pain," represents pleasure and pain as twins, growing out of
the same trunk. He explained, "... for there is never the
one without the other... [T]hey have one and the same
foundation, for the foundation of pleasure is labor with
pain, and the foundations of pain are vain and lascivious
pleasures." Rene Descartes (1596-1650) considered the brain
the seat of pain sensation rather than the Aristotelian
concept that pain was felt in the heart. In his book,
L'Homme, published posthumously, he described the conduction
of pain via nerves to the brain. He was also the first to
separate the body from the soul and reduce "the body to a
mechanical apparatus." This concept led to the modern view
that pain was not inevitable and the result of original sin,
but rather "a sign of a reparable derangement of a
mechanism. "32, 25, 4, 7
Hypnosis: Animal Magnetism
Ancient priests, particularly in the Orient, were
familiar with hypnotism. Travelers from the East reported a
strange phenomenon in India called "yar-phoonk" where
natives went into a "stony trance" and were impervious to
pain. Sailors reported that witch doctors could put savages
into deep comas. Most physicians scoffed at these
allegations as absurdities. However, in 1779, Franz Anton
Mesmer (1734-1815) of Vienna published his book on hypnotism
or "animal magnetism" as he called it. He felt that he had
discovered how to transmit "cosmic energy" and capitalized
on it to become in most reputable physicians' eyes, a
charlatan. He was ridiculed and forced into retirement in
Switzerland. As a result, this valuable tool for producing
psychic anesthesia lay dormant for the next 150 years.20,
26 |
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Flagellation: Prelude to Sade
Flagellation, a sexual perversion involving whipping and
flogging as a painful method of arousing an erotic response,
dates back to the Roman Empire. Seneca (4 B.C.-65 A.D.), the
Roman philosopher, regarded it as a cure for the quartan
ague (malaria). Lucian (A.D. 120-180), the Greek satirist
and rhetorician, in one of his Dialogues described
flagellation as a means of sexual excitation by two
courtesans, Ampelis and Chrysis. Galen said that slave
traders used it to make their chattel more plump and
appealing. In the seventeenth century, a monograph, De
Flagrorum Usu in Re Venerea, began with a couplet:
Lo! Cruel stripes the sweets of love insure,
And painful pleasures pleasing pains procure.37
Flagellation was also practiced in the Orient for
eroticism. However, it remained for Sade and SacherMasoch to
perfect the image for this type of pain.37
Sadism and Masochism: The Pleasure Twins
Count Donatien Alphonse Francois de Sade (17401814), in
his novels written in prison, celebrated cruelty in the name
of sexual pleasure. His lifetime coincided with an era in
France that not only produced a series of medical
discoveries and advancements (particularly in surgery and
pharmacy), which Sade utilized in his own personal pursuit
of perversion and debauchery, but which also featured
torture and public executions as entertainment. Therefore,
when one judges Sade's works, the cruelties of his time must
be considered. An eyewitness described the 1757 execution of
Robert Francois Damiens (1715-57), who had made an attempt
to assassinate Louis XV (1710-74), in this manner: "...Damiens
was put on the rack; with glowing hot forceps his breasts,
arms, legs and calves were torn out and into the wounds were
poured molten lead, boiling oil, burning pitch mixed with
red hot wax and sulphur." Later when his limbs were pulled
off from his torso, "The people clapped their hands in
applause!" Sade's writings represented pain in a
pornographic context, e.g. incest, rape, and murder. Sade
showed that desire, "freed 118 from its normal social
restrictions, finds its deepest satisfaction in cruelty and
pain." During the nineteenth century, the term sadism became
the definition for "sexual perversion in which gratification
is obtained through the infliction of pain on others." After
Sade, pain would never have quite the same meaning.3,
21, 25 |
Chevalier Leopold von
Sacher-Masoch (1836-95) was an Austrian novelist, whose
preoccupation, like Sade's, was on the sexual pleasures of
pain. However, in his case the role was reversed; dominating
females inspired his fantasies for a slave-master
relationship, which he not only wrote about, but also
personally acted out. Pain was the price for his pleasure
and sexual gratification. Before his death in an asylum, the
word masochism was the accepted term for "the psychosexual
disorder in which a person derives pleasure through having
his sexual partner inflict physical or emotional pain." For
masochists, suffering and pain "represent a bid for
affection." It brings with it "a feeling of being loved."
Some individuals even derive sexual pleasure from painful
surgical procedures.16, 21, 25
Opium: Pleasant Dreams
Finally, in 1806, after centuries of use of opium as a
painkiller, Friederich Wilhelm Sertuerner (1784-1841), an
apothecary's assistant in Westphalia, isolated the alkaloid
of opium. He called it "morphium" after the Greek god of
dreams, Morpheus. Later it was changed to morphia or
morphine. In general, its use as painkiller would have to
wait for the invention of the hypodermic syringe and hollow
needle in the 18501. It would remain the principal pain drug
well into the twentieth century. Meanwhile, mankind was
still waiting for relief from the horrors of the surgeon's
knife and the pain of childbirth.32, 2
General Anesthesia: Man's Gift to Man
The contemporary era in pain control began in 1772, when
Joseph Priestley (1733-1804) discovered nitrous oxide and
later Sir Humphry Davy (1778-1829) noted its analgesic
properties; nitrous oxide "...appears capable of destroying
physical pain..." However, although by 1803 a few physicians
had experimented with its use for treating various pulmonary
diseases, nitrous oxide remained dormant in the medical
pharmacopoeia. When the intoxicating effects of nitrous
oxide were discovered by the public, students and showmen
began using it for frolics and sideshows. Samuel Colt
(181462) of revolver fame originally raised the money for
his gun manufacturing business by touring the country and
giving nitrous oxide exhibitions as entertainment.32,
20, 1, 17
Although the anesthetic properties of diethyl ether had
been noticed by Michael Faraday (1791-1867) in 1818, its use
remained dormant. In 1842, Crawford W. Long (1815-78), a
Georgia physician, impressed by the "ether frolics," used
ether as an inhalant for surgical procedures; however, he
did not report it until 1849. In 1844, Horace Wells
(1815-48), a Hartford, Connecticut dentist, discovered that
nitrous oxide could be used to produce freedom from pain
during surgical procedures. However, when he demonstrated
his technique to Dr. John Collins Warren (1778-1856) and his
medical students at the Massachusetts General Hospital in
Boston, the patient (a medical student) cried out and Wells
was humiliated, a "humbug" affair. Despondent, he returned
home and later sailed for France to pursue the merits of his
claim.1, 7, 36 |
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T.G. Morton (181968), a former apprentice of Wells,
administered ether as an anesthetic to a patient who had a
tumor of the neck. It was removed painlessly by the
aforementioned Dr. Warren, who this time remarked to those
present, "Gentlemen, this is no humbug." Oliver Wendell
Holmes (1809-94) coined the term, "anesthesia" for this
state of total absence of sensibility. Morton was hailed as
the discover of surgical anesthesia. In the ensuing
controversy for the title of discoverer of anesthesia, Wells
committed suicide and Morton died penniless. In 1870, the
American Medical Association bestowed the honor to Dr.
Wells.1, 36 In 1847, James Young Simpson
(1811-70) of Scotland, introduced chloroform as a substitute
for ether in obstetrical practice. Queen Victoria's
acceptance of chloroform in 1853 to relieve the pains of
childbirth was a major factor in spreading the inhalation
agent's popularity. Previously, church leaders were opposed
to the use of anesthesia during childbirth on the grounds
that "women should bring forth children in sorrow." Pain and
fear had been the "inevitable components of labor."16,
33, 36
Local Anesthesia: A Popular Technique
While much attention has been paid to the history of
general anesthesia, the history of local anesthesia has been
either ignored or merely mentioned in passing. Nevin (1943)
calls the discoverers of local anesthesia the "unsung
heroes." Many individuals contributed to its development
including, Charles Gabriel Pravaz (17911853) of France, who
invented the hypodermic syringe in 1851; and Alexander Wood
(1817-84) of Scotland, who invented the hollow hypodermic
needle in 1853. In 1869, Claude Bernard (1813-78), a French
physiologist, injected morphine prior to the administration
of chloroform or ether for general anesthesia. In 1884, the
breakthrough came when Carl Koller (1857-1944), a Viennese
ophthalmologist, discovered the anesthetic properties of
cocaine. William S. Halsted (1852-1922), a Bellevue Hospital
surgeon, blocked the inferior alveolar nerve with a four
percent cocaine solution in November 1884 - the first
mandibular nerve block. However, cocaine was found to be an
addictive and dangerous drug.27
The synthesis of Novocain (procaine) by Alfred Einhorn
(1856-1917) of Germany in 1905 finally provided a local
anesthetic without the dangerous side effects of cocaine. It
was introduced into the United States in 1907, and became
the most popular anesthetic for dental procedures. Finally,
pain was under man's control with a choice of anesthesia,
local or general. Paradoxically, two dentists, Wells and
Morton, introduced inhalation (general) anesthesia used
primarily by physicians while two physicians, Koller and
Halsted, introduced block (local) anesthesia used primarily
by dentists.1, 27 |
In the Heat of Battle: Bite the Bullet
As a carryover from the days when pain was looked upon by
Christians as God's will, medical philosophy continued to
reflect the belief that there was some mysterious
physiological value to pain. During the Crimean War in 1854,
a British surgeon stated: "A good hand on the knife is
stimulating. It is much better to hear a fellow shouting
with all his might than to see him sink quietly into his
grave..." As late as the American Civil War, the majority of
battlefield surgeons refused to use any anesthesia, except a
bottle of liquor, a dose of laudanum, and brawn. Sometimes
the victim bit on a lead bullet to grin and bear the pain.
The physicians considered shock a necessary part of the
operation for successful healing. The reports of painless
operations were not worth the "consideration of a
serious-minded doctor." Surgeons took great pride in the
speed with which they could cut, amputate, sew, and
cauterize. "Surgery depends more on dexterity than on
twaddle." Well-sharpened knives were also a necessity.1,2,
7, 14, 20
Beecher (1946) in his study of battle pain in World War
II, found that the pain experienced was not always
proportional to the tissue damage. Among seriously wounded
men, some reported only slight pain and others reported no
pain at all from their wounds. Some even refused pain
medication. Actually, the wounded soldier felt relieved and
safe in the hospital and became "euphoric." Beecher
concluded that "strong emotion can block pain." Although the
body produces "opiate-like analgesic peptides" under stress
conditions and shock, the emotions can "exaggerate or
diminish the perception of pain."25, 33
Phantom Pain: It Still Hurts
Phantom limb pain occurs in five to ten percent of all
amputees and causes excruciating pain. Patients describe it
as "cramping, shooting, burning, or crushing." The pain is
in body parts that no longer exist. It may be present for a
year or more or even decades. Modern medical opinion points
to interaction among the sympathetic, peripheral, and
central nervous systems.25
Post Lister: Septic Surgery
The nineteenth century also produced new surgical methods
for pain eradication. With the introduction of septic
techniques by Joseph Lister (1827-1912), surgeons began to
look for ways to surgically interrupt the afferent pathways
of the nervous system. Among the first to use Lister's gift
to relieve the pain of trigeminal neuralgia was Sir Victor
A.H. Horsley (1857-1916) of England. The American surgeons
Robert Abbe (18511928) and Charles H. Frazier (1870-1936)
introduced retrogasserian neurectomy and cordotomy.32 |
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Comedy and Pain: The Poor Dentists
Comedy and pain have one common denomination - the human
body. The "toothache" is probably only exceeded by the
"headache" in comic characterization to depict pain. For
many centuries, dentistry has been the scapegoat for pain
jokes, prints, books, cartoons, and even films. From
Rowlandson's art work to Norris' 1899 novel, McTeague
(Metro-Goldwyn movie Greed), to the 1986 film, The Little
Shop of Horrors, it has been depicted as "a modern comic
metaphor for pain." The recent Home Box Office video film,
The Dentist, in which the dentist character tortures and
murders people including his wife, has been criticized by
the American Dental Association. The ADA complained to HBO
that their film set a new standard for "irresponsible
portrayal of the profession." The sight of the dentist's
drill and instruments is enough to provoke the pain emotion
in some individuals. Despite the fact that the dental
profession has tried to live down this image, it still
persists for those not educated in modern dentistry. One
dentist, Edgar Randolph Parker (1872-1952), even changed his
name legally to "Painless Parker."6, 25, 28, 38
Chronic Pain: Big Business
Szasz (1955) pointed out that pain is a form of
communication between the patient and the doctor whether the
pain is real or unreal. Although its earliest expressions in
childhood are spontaneous and not goal-oriented, later on
pain can establish itself as "a fundamental method of asking
for help." If the physician directs his attention to whether
the pain is real or unreal, he may miss the motive for the
patient's signal. Gamsa (1994) stated that it is now
generally recognized that "psychological factors play an
important role" in chronic pain and that the study of pain
as a medical discipline is a modern concept. Today, although
it does not receive the media attention that cancer, AIDS,
or even tuberculosis receives, chronic pain is the
characteristic malady of our time. It is not a public health
problem, not fatal, has no biological purpose, and works in
secret. By contrast, acute pain does serve a biological
purpose by warning us of potential danger.13, 16, 25
In 1987, U.S. News & World Report predicted that during
the year some 40 million American adults would experience
"chronic, debilitating headaches," 100 million would have
back pain, and 90 million would be bothered with a "hurtful
throbbing in their joints." In the quest for pain relief,
some 30 billion aspirin (discovered in 1899) tablets would
be swallowed during the year. Adding the cost of
over-the-counter and prescription drugs, psychotherapy,
surgery, and "quack remedies peddled to victims of chronic
pain" and the annual health-care tab would come close to $40
billion. In 1985, a survey of workers found that the average
employee lost five workdays per year because of pain
problems; a $55 billion loss in productivity. Pain was big
business even ten years ago.5, 25 |
After World War II, as a result
of the recognition that pain was not just a symptom of
illness but an illness in itself, pain clinics began to
appear in the United States. They were organized by
anesthesiologists, who used nerve-block techniques for pain
control. By 1977, over 300 pain-control facilities were
listed by the American Society of Anesthesiologists. By
1987, there were 1000-1200 in the country. Several societies
have been formed: the International Association for Study of
Pain (IASP) in 1974, which publishes the journal Pain; and
the American Academy of Pain Medicine (AAPM) in 1983, which
publishes the Clinical Journal of Pain.24, 33
Conclusion
Morris (1991) states: "Pain has always served and
continues to serve specific social and ethical purposes.
Indeed, as a species we show an endless ingenuity for
discovering new uses for pain within the recurring
structures of formal or informal rites." Then, too, the
theme of comparing pain to pleasure, beginning with Plato,
constantly seems to resurface. Is there any truth to this
theory? Frankly, I think Dunglison's 1846 definition of pain
as "a disagreeable sensation, which scarcely admits of
definition," is still the most appropriate description of
pain to be found. What more can modern science add? Man and
pain will always be the eternal partners.25, 9 |
Protective Dental Plan
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