A timeline of pain

Early 19^th 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.encyclopedia.com/topic/ibuprofen.asp

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