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Introduction:
The Universal Disorder You know it at once. It may be the fiery sensation of
a burn moments after your finger touches the stove. Or it's a dull ache above
your brow after a day of stress and tension. Or you may recognize it as a sharp
pierce in your back after you lift something heavy.
It is pain. In its most benign form, it warns us that something isn't quite
right, that we should take medicine or see a doctor. At its worst, however,
pain robs us of our productivity, our well-being, and, for many of us suffering
from extended illness, our very lives. Pain is a complex perception that differs
enormously among individual patients, even those who appear to have identical
injuries or illnesses.
In 1931, the French medical missionary Dr. Albert Schweitzer wrote, "Pain is
a more terrible lord of mankind than even death itself." Today, pain has become
the universal disorder, a serious and costly public health issue, and a challenge
for family, friends, and health care providers who must give support to the
individual suffering from the physical as well as the emotional consequences
of pain.
A Brief History of Pain
Ancient civilizations recorded on stone tablets accounts of pain and the treatments
used: pressure, heat, water, and sun. Early humans related pain to evil, magic,
and demons. Relief of pain was the responsibility of sorcerers, shamans, priests,
and priestesses, who used herbs, rites, and ceremonies as their treatments.
The Greeks and Romans were the first to advance a theory of sensation, the
idea that the brain and nervous system have a role in producing the perception
of pain. But it was not until the Middle Ages and well into the Renaissance-the
1400s and 1500s-that evidence began to accumulate in support of these theories.
Leonardo da Vinci and his contemporaries came to believe that the brain was
the central organ responsible for sensation. Da Vinci also developed the idea
that the spinal cord transmits sensations to the brain.
In the 17th and 18th centuries, the study of the body-and the senses-continued
to be a source of wonder for the world's philosophers. In 1664, the French philosopher
René Descartes described what to this day is still called a "pain pathway."
Descartes illustrated how particles of fire, in contact with the foot, travel
to the brain and he compared pain sensation to the ringing of a bell.
In the 19th century, pain came to dwell under a new domain-science-paving
the way for advances in pain therapy. Physician-scientists discovered that opium,
morphine, codeine, and cocaine could be used to treat pain. These drugs led
to the development of aspirin, to this day the most commonly used pain reliever.
Before long, anesthesia-both general and regional-was refined and applied during
surgery.
"It has no future but itself," wrote the 19th century American poet Emily Dickinson,
speaking about pain. As the 21st century unfolds, however, advances in pain
research are creating a less grim future than that portrayed in Dickinson’s
verse, a future that includes a better understanding of pain, along with greatly
improved treatments to keep it in check.
The Two Faces of Pain: Acute and Chronic
What is pain? The International Association for the Study of Pain defines it
as: An unpleasant sensory and emotional experience associated with actual
or potential tissue damage or described in terms of such damage. It is useful
to distinguish between two basic types of pain, acute and chronic, and they
differ greatly.
Acute pain, for the most part, results from disease, inflammation,
or injury to tissues. This type of pain generally comes on suddenly, for example,
after trauma or surgery, and may be accompanied by anxiety or emotional distress.
The cause of acute pain can usually be diagnosed and treated, and the pain
is self-limiting, that is, it is confined to a given period of time and severity.
In some rare instances, it can become chronic.
Chronic pain is widely believed to represent disease itself. It can
be made much worse by environmental and psychological factors. Chronic pain
persists over a longer period of time than acute pain and is resistant to
most medical treatments. It can—and often does—cause severe problems for patients.
Prepared by: Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD
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