Pain past, present and future: the unhappy paradox of scientific advances and therapeutic standstill

Abstract

Apart from those rare individuals with an inability to feel pain, and those who are indifferent to it—and they suffer in different ways—all of us will experience pain. How fortunate, then, we are to be living now: it is almost beyond one's comprehension to envisage what tortures were experienced by those at the sharp end of the sword or the surgeon's knife, or during childbirth, when there was so little to offer in the way of pain relief. At the end of life, too, what suffering was endured—and all too often still is—by those in the terminal and often painful stages of their existence, before the need for alleviating pain became accepted as something of unsurpassed importance. The story of ‘The fight against pain’, the subtitle of Dormandy's book, is the story, or more accurately the very many stories, of attempts to grapple with pain and its prevention, abolition and management. In the stories are reflected too the virtues and imperfections of man when making these attempts. The virtues include humanity, fortitude, energy, ingenuity and optimism; the imperfections include ignorance, laziness, greed and arrogance; and these human qualities are amply demonstrated in Dormandy's absorbing account. One might have expected the relief of suffering would always have been an endeavour of mankind, but this is not so. Thus, although in 17th century England the poet John Milton expressed in Paradise Lost that ‘Pain is perfe[c]t misery, the worst Of evils, and, excessive, overturns All patience’, it remained a commonly held view, at least until the 20th century, that ‘the worst Of evils’, the book's title, was often beneficial: an opportunity for fortitude, and an ordeal that God had provided for man to endure. Doctors often acquiesced in this view, and as a result, buttressed by the hazards that pain relief undeniably …