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July-August 2018

Man and Pain: Eternal Partners

By John M. Hyson, Jr., DDS, MS, MA - Morris (1991) divides pain into two categories - physical and mental; he calls it the "Myth of Two Pains."25 He rationalizes that it is difficult to separate the pain of mind and body and that they are interdependent, e.g. one mind and body. However, this paper will limit itself to the history, philosophy, and psychology of physical pain (both acute and chronic) from ancient days to the twentieth century. It will not discuss mental or psychosomatic pain; nor will it include the anatomical, biochemical, pharmacological, and physiological aspects of modern methods of chronic pain control, e.g. psychotherapy, psychoanalysis, biofeedback, etc...


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

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. to keep 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 ziggurats, 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

Christianity: Wage 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

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 & 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

On October 16, 1846, William 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

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

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DR. HYSON is the Director of Curatorial Affairs, Dr. Samuel D. Harris National Museum of Dentistry, 
Associate Professor, Oral Health Care Delivery, Baltimore College of Dental Surgery, Dental School,
University of Maryland, Baltimore, MD.

Article orginally published in the Journal of the History of Dentistry
Vol. 49, No. 3 / November 2001 copyright ©2001, all rights reserved

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