Page 15 Guide to Pain Management in Low-Resource Settings

Chapter 1

History, Defi nitions, and Contemporary Viewpoints

Wilfried Witte and Christoph Stein

Th e experience of pain is fundamental and has been proved by Job’s humility toward God. Humility is still
part of the cultural development of all societies. In the an ideal in Christian thought today. In the New Testa-
history of pain, “supernatural” powers played an equally ment, Jesus Christ fi nishes his life on earth as a mar-
important role as natural factors. To view pain as the re- tyr hanging and dying at the cross. His suff ering marks
sult of a “communication” between mankind and divine the way to God. To bear suff ering in life is necessary to
powers has been a fundamental assumption in many be absolved from sin. Th e message of pain is to show
societies. Th e more societies are separated from West- mankind the insuffi ciency of life on earth and the bril-
ern medicine or modern medicine, the more prevalent liance of being in heaven. Th us, whatever science may
is this view of pain. On the other hand, a purely medi- say about pain, an approach based only on a physiologi-
cal theory based on natural phenomena independent of cal concept does not take into account the religious or
divine powers developed very early on. It happened to a spiritual meaning of pain.
greater extent in ancient China, while in ancient India Th e most important and radically mechanis-
medicine was heavily infl uenced by Hinduism and Bud- tic scientifi c theory of pain in early modern age derives
dhism. Pain was perceived in the heart—an assumption from the French philosopher René Descartes (1596–
familiar to ancient Egyptians. Th e medical practitioners 1650). In his concept, the former assumption that pain
in pharaonic times believed that the composition of was represented in the heart was relinquished. Th e
body fl uids determined health and disease, and magic brain took the place of the heart. In spite of (or because
was indiscriminable from medicine. of) its one-sidedness, Descartes’ theory opened the gate
Ancient Greek medicine borrowed heavily for neuroscience to explain the mechanisms of pain.
from its Asian and Egyptian predecessors. Th e intro- Th e question of how pain should be treated has
duction of ancient medical knowledge into medieval led to diff erent answers over time. If supernatural pow-
Europe was mainly mediated through Arabic medicine, ers had to be pleased to get rid of pain, certain magi-
which also added its own contributions. Latin was the cal rituals had to be performed. If scientifi cally invented
language of scholars in medieval Europe, and ideology remedies were not used or not available, ingredients
was guided by Judeo-Christian beliefs. Despite mul- from plants or animals had to be used to ease the pain.
tiple adaptations, medical theory remained committed Especially, the knowledge that opium poppies have anal-
to ancient models for centuries. Pain had an important gesic eff ects was widespread in ancient societies such as
role. Th e Bible illustrates the need to withstand catas- Egypt. For a long time, opium was used in various prep-
trophes and pain in the story of Job. Strength of faith is arations, but its chemical constituents were not known.
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 3
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or
recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.