A Brief History of Pain


May 8, 2005 — -- The Greek goddess of revenge, Poine, was sent to punish the mortal fools who had angered the gods. Poine also gave us our word "pain," a fact not lost on people who suffer from bodily torment so brutal it feels like divine vengeance.

Many ancient cultures believed pain and disease were punishment for human folly. They tried to appease angry gods with rituals like votive offerings and scapegoats, sacrificial animals that carried the sins of people out into the wilderness.

"Magic and ritual were very common in ancient cultures," said Dr. Doris K. Cope, director of the Pain Medicine Division at the University of Pittsburgh Medical Center.

"Primitive man understood pain when it was visible, like a cut or scrape, but didn't understand it as well when it was internal," she said.

In some cultures, rattles, gongs and other devices were believed to frighten painful devils out of a person's body. Amerindian healers sucked on pain pipes held against a person's skin to "pull" out pain or illness.

Many ancient doctors apparently figured their patients needed a hole in the head. Hundreds of skulls with small holes that have partially healed over have been found worldwide, but especially in Incan archaeological sites in South America.

"A lot of cultures would cut holes to let the pain out," Cope said. Even Hippocrates, the ancient Greek physician considered the father of Western medicine, wrote about the practice, called trepanation.

Hippocrates also heard about the pain-relieving benefits of willow bark and leaves from earlier cultures, and he prescribed chewing willow leaves to women in childbirth.

His prescription was not without merit -- willow trees, members of the plant genus Salix, contain a form of salicylic acid, the active ingredient in aspirin.

Other medical practices from the ancient world have been updated for use by modern physicians.

"The Egyptians used to take electric eels out of the Nile and lay them over the wounds of patients," said Dr. Carol A. Warfield, professor of anesthesiology at Harvard Medical School.

Though using electric eels to ease pain sounds crude, even dangerous, a similar technique is used today to relieve pain. Transcutaneous electrical nerve stimulation, or TENS, is a popular treatment for lower back pain and arthritis aches.

"We do it in a much more controlled fashion," said Warfield.

In the medieval era, pain relief came mainly from a wide variety of herbs, used liberally.

"The Middle Ages was big on polypharmacy," said Marcia Meldrum, co-director of the John C. Liebeskind History of Pain collection at the UCLA Biomedical Library. "The more drugs, the better."

One especially popular concoction was known as theriac. "Theriac was considered to be a truly effective compound," said Meldrum. "It was usually prepared in a honey base with about 64 different compounds in it.

"Most European cultures would have used some kind of herbs along with some kind of incantation," Meldrum said. Because some of those herbs contain opiates, the patient could enter a trancelike state.

"That could have a profound effect on pain," said Meldrum.

In addition to plant-based remedies, minerals were also used in the medieval pharmacopoeia, she said. Among the most popular ingredients were bits of gold, ivory and, from a time when magical creatures were believed to roam wild, pieces of purported unicorn horn.

Even as recently as the early 1900s, "some physicians used gold salts injected into limbs to treat arthritis," Meldrum said.

The American contribution to the history of pain relief is as colorful as a patchwork quilt.

Quilts from Appalachia incorporated images of medicinal plants in "medicine squares," said Cope. The quilts were then used by those suffering from pain or other ailments.

In the 1800s and early 1900s, as magnets and electricity became widely available, medical quacks were quick to exploit these exciting and mysterious forces for their purported healing properties.

"Both electricity and magnetism have been used for as long as people have been able to produce them," said Meldrum.

In addition to belts and trusses containing magnets, a range of balms and liniments said to contain magnetic properties were available to gullible sufferers.

Other commercial remedies contained varying quantities of opiates, alcohol or cocaine -- which probably made them effective at relieving pain temporarily, said Meldrum.

"Coca-Cola was originally sold as a cure for everything," said Warfield. "It contained cocaine. Remember, stuff wasn't regulated in those days."

Another popular approach to pain relief called for the preparation of a wet plaster made from hot mustard. The plaster was applied directly to the skin, or on a cloth that was then laid on the skin.

The heat from the mustard plaster worked on the principle of "counterstimulation," the idea that one kind of pain or sensation could cancel out another, more severe pain.

"There are scientific reasons we know about now that has shown why they worked," said Warfield.

"The first new significant treatment for pain occurred in 1846 with the use of anesthesia for surgery," said Meldrum.

Prior to that, doctors and dentists used some bizarre techniques before operating.

An old Italian technique involved putting a wooden bowl over a patient's head, then hammering on the bowl until the patient passed out, according to Warfield.

"They used to hold kids over a gas stove so [the kids] would breathe gas until they lost consciousness," Warfield said.

"They would also choke people with carotid compression until they passed out," said Warfield. "In those days, the best surgeons were the fastest surgeons."

It took a British royal to popularize the concept of relieving the pain of childbirth, previously thought to be an unavoidable or necessary part of motherhood.

"Queen Victoria was really the first one to have anesthesia for childbirth -- she had chloroform," said Warfield. "She made it fashionable."

In spite of a dazzling array of modern treatments for pain, some experts wonder if ancient and primitive cultures still have much to teach us about pain and human health.

"People now like to think of science and pain treatment as being very objective," said Cope.

"Now we're very rigid and almost literal," she said. "We just want a quick fix. The suffering and the emotional context -- that defines what the patient is actually experiencing."

The next frontier for pain relief, then, may lie in the past.

"Ancient people saw pain more accurately -- pain not only as a physical condition but as an emotional and a spiritual condition," she said. "They would work with the entire patient."

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