Early 19th century – Specificity theory – This
was advanced by Johannes Muller and later Maximilian von Fry who saw pain as an
interdependent sensation with its own sensory apparatus.
1801-1858 – Johannes Muller - advances in microscopy helped
Muller’s work. He concluded that there
were specific energies within the nerve fiber and that the paths of nerve fibers
were rigorously ordered.
1803 - Friedrich Sertürner of Paderborn, Germany discovers the
active ingredient of opium by dissolving it in acid then neutralizing it with
ammonia. The result: alkaloids - Principium somniferum or morphine.
1897 – Aspirin is discovered! Although salicyclic acid has
been around for hundreds of years, it wasn’t until 1987 that it was converted
into acetylsalicylic acid and named aspirin.
1852 -1932 – Maximillian von Fray – elaborated on the work
of Muller. Von Frey’s work had different
implications that led to a more restricted concept of pain. He was trying to
identify particular points on the skin, which responded specifically to one of
the four cutaneous sensations: touch, heat, cold, and pain. He invented what he
called an aesthesiometer, where the stimulus consisted of hair.
1858-1935 – Alfred Goldscheider – his work greatly
contributed to the understanding of pain.
A lot of his research at the time focused on looking for specific pain
points and associations. This focus of
research did not produce positive results which ended up leading him to propose
a different theory based on three types of research findings: 1) the increase
of pain upon repeated applications of a stimulus was out of proportion with the
intensity of the stimulus. 2) He found that when pressure was applied to the
skin with the head of a pin, the subject initially felt pressure, followed
shortly by the sensation of pain. 3) He found that there were areas devoid of
pressure points, which turned into pain points.
1861-1948 – Henry Head – Head determined that the major
function of the thalamus was the terminus for all afferent sensory pathways,
which were then redistributed in two directions: 1) first to the cortex and the
body of grew matter in the thalamus. 2) second, that this grey matter
represented the center for certain sensations and complemented the sensory
cortex.
1857-1952 – Charles Sherrington – a Cambridge
neurophysiologist whose best-known work was the Integrative Action of the
Nervous System. In it, he transposes the theory of evolution to the level
of the neuron and the synapse. He coinced the term “synapse” for the space
separating two neurons.
1889-1977 – Edgar Douglas Adrian – published The Basis of Sensation in 1928 and
shared the Nobel Prive in 1932 with Charles Sherrington for work on the
function of neurons.
1931 – First known use of radiofrequency ablation when
Krischner treated trigeminal neuralgia with thermocoagulation of the gassaerian
ganglion.
1947 – Methadone is introduced in the U.S. It became popular in the 1960’s as a
treatment for opioid addiction. In a
study conducted from 1999 to 2009 it represented less than 5% of all opioids
prescribed but was responsible for 1/3 of the opiod-related deaths during that
time. Methadone should only be prescribed by clinicians who are very familiar
with the drug.
1955 – acetaminophen is introduced
Late 1950’s – The first commercial RF machine became
available.
1967 – Spinal cord stimulation is introduced by C. Norman
Shealy for cancer pain. It is now used
to help alleviate other pain as well.
1974 – Ibuprofen now sold in U.S. Although ibuprofen was first
sold in the U.K. in 1964 it wasn’t until 1974 that it made it’s way to the U.S.
1986 – World Health Organization(WHO) pain ladder
This is a widely accepted approach to medication management.
Step 1 – Mild pain. Non-opioid analgesics including NSAIDS
and aspirin. If the pain persists or
worsens, the physician should prescribe analgesics from Step 2.
Step 2 – Mild to moderate pain. Treatment is “weak” opioids
including schedule II opioids such as codeine, with or without a non-opioid or
adjuvant therapy.
Step 3 – Moderate to severe pain. Treatment is “strong” opioids.
Sources:
http://www.practicalpainmanagement.com/treatments/history-pain-brief-overview-19th-20th-centuries
http://www.opioids.com/timeline/
http://www.practicalpainmanagement.com/treatments/pharmacological/history-pain-treatment-pain?page=0,4
http://www.medscape.com/viewarticle/718292_2
