In the early years, human beings attributed pain to demons and therefore attempted to ward them off with charms, amulets and incantations. As a result, shrines or pyramids were built to appease the gods while the priests distributed charms and made sacrificial offerings as treatment of pain. Throughout the ages, the fear of suffering unrelieved pain has been a great concern. Even on Babylonian day tables, Egyptian papyri and artefacts of ancient Persia and Troy, pain relief was depicted. Nearly 4,600 years ago, the Chinese first described two opposite forces in the body and called them yin and yang. According to them, imbalance between these two forces leads to pain. They reported the use of opium as treatment of pain, as early as 1550 вс.
Today 'pain medicine' is a broad subspeciality, with development of special improvised techniques for relief from pain. Special systems to deliver injections over several days, weeks, months or years can be placed within the body for prolonged relief from pain. They can be placed on the skin to deliver drugs through the intact skin (called transdermal systems), or can be implanted within the spinal column (called intra-spinal systems). The drugs commonly used are derivatives of opium which form in the body naturally and are called 'opioids'. Some drugs can be implanted inside the spine for direct continuous stimulation of the spinal cord itself. The most important development in pain management is the development of multidisciplinary approach which includes not only physicians specialising in pain management, but also nurses, physiotherapists, pharmacists and psychologists. In this book, there is crucial information about all aspects such as pathophysiology of pain, its mechanism and its management. It also acts as a simple guide for the treatment of some common causes and types of pain.
In the early years, pain was considered a form of punishment meted out by supreme spiritual beings, for sin and evil activity on part of man. As a result, man began to at-tribute pain to demons and tried all kinds of means to ward off evils with charms, amulets and incantations. Shrines were built to appease the gods, while the priests resorted to giving talisman and making sacrificial offerings as treatment for pain.
Pain and Religion
In the view of Christians, the fall of Adam and Eve in the Garden of Eden, produced for man (and woman) a large life of suffering full of pain. Pain is viewed as a negative experience. In the book of Genesis, God told Eve that following her fall from grace, she would experience pain during childbirth: "In pain you shall bring forth children, yet your desire shall be for your husband and he shall rule over you." This led the early Christians to accept 'pain' as nor-mal result of Eve's action. So any attempt to reduce pain during labour or childbirth was not approved by the early Christians. It was only after 1847, when Queen Victoria was given 'chloroform' by James Simpson for delivery of her eighth child, named Prince Leopold, did the Christians accept the fact that it is not controversial to have painless childbirth as part of labour. Another example of Christian belief is that in the first century AD, many people belonging to the Catholic church were assaulted and suffered ruthless persecution, including death, because of their belief in Jesus as 'Messiah' (deliverer). Later, these people became known as martyrs as their suffering was due to their love for Christ who had suffered for them and was crucified. In other words, this became an early example of the importance of psychotherapy as one of the modes of pain management. Even today, many cancer patients with strong Christian beliefs, consider their pain and suffering as part of their journey towards eternal salvation. This has led to many scientific studies advocating intercessory prayer as an effective modality for cancer pain management.
Pain and Ancient Cultures
Pain usually results from an injury or dysfunction of an in-ternal system. Traditionally it was thought that once the of-fending injurious agent was removed, the pain could either subside or else the victim died. And if pain was due to a disease, the treatment was usually based on superstitious traditions. Tribals thought that pain came as a result of 'intrusion' in the body by an outside source. Intruders were thought to be evil spirits sent by gods as a form of punishment. The spirits were supposed to enter the human body through different routes. So the approach to therapy was based on blocking the particular pathway selected by the spirit by medicine and shamans (witchcraft).
The Egyptians thought that the 'left nostril' was the main culprit through which the disease entered. Papyri of Ebers (an ancient Egyptian manuscript) and Berlin sup-ported this thought, which stated that treatment of head-ache included expulsion of spirit by sneezing, sweating, vomiting, or urination. The early Egyptians treated pain by placing an electric fish over the wounds to control pain. Pain relief, which was produced by electrical stimulation, was very similar to transcutaneous electrical nerve stimulation (TENS), which is used nowadays to treat pain.
The Papyrus of Ebers even contained plenty of pharmacological information and described lots of techniques. The use of opium for the treatment of pain in children was also mentioned. Unfortunately even today, pain treatment for children is far from optimal, for which there are two reasons. There is an assumption that children are less sensitive to pain. Secondly, it is assumed that in newborn babies, the central nervous system is not completely developed. As a result, they are denied pain relief because they cannot complain about it as articulately and effectively as the adults.
Nearly 4,600 years ago, the Chinese described two opposite forces in the body as yin and yang and any imbalance between these two forces was supposed to lead to pain. Later on, they identified multiple points on the body, from where pain was thought to originate. Various attempts were made to drain these 'pain points' by inserting needles. It was this process which later on gave birth to 'acupuncture'-a pratice that is more than 2,000 years old.
The early Indians believed that pain was experienced in the heart and blood vessels, and not in the brain, and tried to treat it by drugs, chantings and witchcraft.
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