A Brief Look at the Journey of Pain
The beauty of the above question lies in the fact that its answer unifies people of every religion, race, ethnicity, nationality and social status of the world.
The unity further extends to involve animals of every size, color and habitat. Pain, by definition, is a distressing sensation felt due to an adversity. Going by this definition, the above-mentioned unification can further extend into the plant kingdom and the micro-biological world as well. Hence pain is a strong union between all creatures that testify life. And just like any other field of knowledge acquired by humans, the concept of pain has also undergone an evolution from pre-historic times till the modern age. From understanding its true nature to defining its characteristics, from delving into its causes to discovering ways to alleviate it, mankind’s journey in the orbit of pain has been truly vivacious.
The word “pain” has been derived from Poine, the Greek goddess of revenge who, according to Greek mythology, was sent to punish anyone who angered the gods. Hence the spiritual roots of the concept of pain can be clearly seen from the origin of the word itself. The early Greek philosophers such as Aristotle saw pain as an emotion rather than a sensation, a torment felt when evil spirits entered the body through injury. In some cultures, the use of gongs and similar sound producing devices was undertaken to ensure that the evil souls were frightened off giving relief to the sufferer. Trepanation, a process of drilling holes into the skull to release the demons, was carried out by ancient tribes in South America, the proof of which can be seen in the Incan archeological sites where several skulls with holes have been found.
Hippocrates, an ancient Greek physician known to many as the “father of Western medicine”, believed that pain was the result of an imbalance of body fluids. He used willow barks to relieve the pain of child-bearing women. Willow barks contain a type of salicylic acid, which is the major component of aspirin, the most widely used analgesic in the world today.
The early Egyptian civilization employed a more dramatic course while battling pain. Physicians of the Egyptian civilization hunted live eels from the Nile and applied them to the wounds of the suffering patients. They implied that the electric currents generated by the eels helped in offering relief to the patients. Interestingly in today’s world, transcutaneous electrical nerve stimulation (TENS) is a method that employs the same principle and is used to treat back pain in many patients across the world.
Prior to the development of modern anesthesia, surgeons and dentists used rather strange methods to render a patient unconscious before starting their procedures. These methods included keeping a bowl on the patient’s head and hammering it till he was unconscious, holding the face of a child patient over the stove and opening the gas, and applying carotid compression until the objective was achieved. That was the time when the fastest surgeon was considered to be the best.
In the year 1664, a French philosopher, mathematician and writer by the name of Rene Descartes proposed that the perception of pain was centered in the brain (and not the heart, as was believed by many), and the damage responsible for the pain was carried by nerve fibers. This theory gave humans a fresh outlook towards pain; from one solely based on spirituality to one that had its roots planted in physiology.
Descartes and Avicenna, through their respective works, laid the foundations of the specificity theory. Emerging in the nineteenth century, the specificity theory described pain as “a specific sensation, with its own sensory apparatus independent of touch and other senses”. In 1858, Moritz Schiff demonstrated that touch and pain sensations traveled to the brain along separate spinal cord pathways, hence adding weight to the specificity theory.
In opposition to the specificity theory, the intensive theory of pain described pain not as a unique sensory modality, but an emotional state produced by stronger than normal stimuli such as intense light, pressure or temperature. Till the last decade of the nineteenth century, most physicians backed the specificity theory whereas the majority of psychologists supported the intensive theory. However, after a series of experiments conducted by English neurobiologist Henry Head demonstrating the validity of the specificity theory, both groups (i.e. the physicians and psychologists) united and accepted the specificity theory of pain.
In 1955, Sinclair and Weddell’s pattern theory of pain suggested that all skin fiber endings (with the exception of those innervating hair cells) are identical, and that pain is produced by intense stimulation of these fibers. Ten years later, Melzack and Wall introduced the gate theory of pain, which stated that thin (pain) and large diameter (touch, pressure, vibration) nerve fibers carry information from the site of injury to two locations in the dorsal horn of the spinal cord; transmission cells that carry the pain signal up to the brain, and inhibitory neurons that impede transmission cell activity.
A decade later, the International Association for the Study of Pain, after considering all the developments in the field thus far, reached a consensus definition of pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The modern scientific world elaborates pain not only as a physical sensation, but a vast and complex phenomenon that has several psychological, social and environmental implications. The pain felt by a similar stimulus applied on two separate subjects might be entirely different. Stimuli that would normally be perceived as highly painful by a particular person might become seemingly painless just by the change of his/her environment. Research also shows that visualization of the insulting stimulus can have an analgesic effect on the subject.
The true understanding of pain has been a hazy affair for mankind spread over thousands of years of research and experimentation. Slowly and gradually, our vision of pain is getting clearer as we continue our journey into the 21st century. Our knowledge of pain may have now become greatly enhanced, but our sense of perception still remains primitive. Our analgesic procedures may have become greatly refined, but our ability to absolutely eliminate pain from our lives is nearly negligible. And hence even after thousands of years of existence, the pest called pain still never fails to amaze us.
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