Introduction The Need for Historical Perspective on Pain

The importance of recognizing, assessing, understanding, and treating pain is central to the role of any caregiver. When a patient presents to the physician, he rarely comes labeled with a given diagnosis; rather, he more often has a chief "complaint" that he suffers in some manner. To the patient, the symptom, not the pathology or disease, is the affliction. As such, it is imperative that we respect and understand that pain and suffering are the often primary reasons that patients seek medical care for.

The necessary nature of pain treatment has long been categorized among other basic human rights, and in 1999 the Joint Commission on Accreditation of Healthcare Organizations formalized pain standards to ensure to all patients their right to appropriate assessment and management of their pain, describing pain as the "fifth vital sign (Lanser 2001)." Intrinsic to our capacity to treat pain is possession of perspective of the many cultural beliefs, philosophical ideologies, and scientific discoveries that have influenced and evolved into the modern Western conceptualization of pain.

Why would we stress the importance of the history of pain medicine? History helps us understand our own place in the universe as healers. We need to appreciate our past in order to gain a sense of connectivity and perspective that is inherent in establishing our identity as a professional. Hundreds of years hence, our theoretical constructs and clinical practices may be considered quaint and outmoded, but the essence of professionalism and the critical, scientific study of medicine will remain unchanged through the ages. Like the times before us, our current era is an exciting one for the study and treatment of pain. With rapidly evolving capacity to elucidate ever more microscopic scientific detail of the anatomy and physiology of pain, developing technologies yield a vast scientific understanding and lexicon of pain. As developments in laboratory and clinical science continue to increase our capacity to further reduce pain to its biological components, simultaneously we must possess the knowledge and vocabulary to discuss pain with our patients in this time of great renewed public interest in many of the "old" medical arts. With a majority of our patients now choosing to partake of complementary and alternative medicine approaches (Barnes 2002), there is a renewed and growing public interest in a more holistic medical model which requires us to recognize that

Historical Management

N. Vadivelu et al. (eds.), Essentials of Pain Management,

DOI 10.1007/978-0-387-87579-8_1, © Springer Science+Business Media, LLC 2011

"everything old is new again." Likewise, having an intercultural and historical appreciation and perspective on pain is an asset to any clinician.

Defining "pain" in a succinct manner is a great challenge. What is pain? It has been described as an emotional state, a physical experience, a spiritual sacrament, and a complex set of interconnected subcellular signals. This chapter will discuss this plurality of concepts. From the mind-body dilemma, through the larger context of how our intellectual constructs shape our understanding, we will consider some of the historical and evolving treatment approaches of this complex phenomenon we call pain. The chapter will close with a discussion of how the medical subspecialty of pain management is evolving within the broader context of medical specialization and thoughts for future development (Benedelow and Williams 1995).

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