Pain and pain management have always been a part of humanity. Pain is a primal constituent of the experience of being alive. And the feeling of pain as a result of disease has been crucial to shape how we understand the universe both in and outside our bodies.
Figuring out the causes of pain, the source of the sensation and the remedies to alleviate its burden on the body and the soul has been a constant journey — one going from divine punishment and religious beliefs to the depths of human anatomy and scientific proof.
Let’s take a look at how we have dealt with chronic pain throughout history. The quest will take us to review important pain theories, dig up ancient pharmacopeia, Highlight exciting scientific discoveries, and see where we are today.
Chronic Pain Management in Ancient Times
Across ancient civilizations and primitive cultures, chronic pain meant evil spirits, malevolent demons and enraged gods taking over and punishing the body. Alleviating pain was a superhuman endeavor. Shamans, healers, priests, sorcerers, and medicine men were in charge of it. And it took place during ritual practices involving sacrifices, chants, prayers, plants, and magic.
Rattles, gongs, and other noise-making devices frightened evil spirits out of the body. Native-Americans tried to suck pain out of a pipe against a person’s skin. And in the Andes, the Incas cut holes in the head to alleviate pain. The process, which used coca leaf as an analgesic, was known as trepanation.
Sure, you had other options too: rubbing the affected area, applying cold water, draining fluids and, mostly, herbal potions were the norm. Many cultures have known for millennia about natural analgesic remedies derived from plants. And among them, the four most important ones were:
Mandrake (Mandragora officinarum)
The root of mandrake was “probably the most widely used analgesic of antiquity. The Babylonians used it more than 4000 years ago for pain relief”. And its fruits rested on Tutankhamen’s tomb in Ancient Egypt. In addition to its analgesic properties, its soporific effect to induces sleep. But its excessive intake could be fatal.
Opium poppy (Papaver somniferum)
The Sumerians in Mesopotamia cultivated the poppy plant around 3400 BC. The Sumerian clay tablet one of the oldest lists of medical prescriptions, mentions opium among 250 various plants. It use was medicinal. But known as Hul Gil, meaning the joy plant, its use as recreational narcotic is also documented.
Opium was also well known in ancient Egypt. The Eber papyrus, “which contained medical prescriptions and charms” referring up to 700 plant species and drugs for therapy, also recommended preparations including opium. Even the goddess Isis prescribed it for King Ra to ease his severe headaches.
Hemp (Cannabis sativa)
Even though Egyptians and Assyrians knew about the benefits of hemp, the epicenter for its use as a medicine has to be sought for in China. The Pen-Tsao-ching, considered one of the earliest pharmacopeia of herbal medicine, mentions cannabis as being “useful in the treatment of over 100 ailments, including rheumatic pain, gout, and malaria”.
In India, the plant was considered one of the five sacred plants of Hinduism. It was a daily companion in devotional services. And its extensive religious use opened the door to explore its medicinal applications. Among them, cannabis was used “as an analgesic, anticonvulsant, anesthetic, antibiotic and anti-inflammatory.” All qualities were valuable to treat diseases like epilepsy, rabies, and anxiety.
Henbane (Hyoscyamus niger)
It was one of the most important plants in the early history of anesthesia. Henbane was also referenced in Babylonian clay tablets as a remedy for dental pain. Its high toxicity and potent hallucinogenic effects made it a dangerous medication. But despite its deadly consequences, it was frequently used as a sedative and anesthetic.
Hippocrates and a new approach for pain management
In Ancient Greece, physicians, philosophers, and writers alike were concerned about the matter of pain and its mechanisms. But the works of Hippocrates, the most prominent figure among Greek physicians, and considered the father of medicine, were perhaps the most significant turning point in our approach and understanding of pain in ancient times.
Beliefs of pain and disease being caused by divine punishment and offended deities still prove popular. But Hippocrates took the first steps towards moving away from superstition and supernatural phenomena. His approach? He focused his work on observation and the search for physical causes of pain.
As part of it, he developed the theory of the four humors–– blood, phlegm, yellow bile, and black bile––.
And he described their effects on the human body and its emotions. For him, pain was produced by the excess or deficiency in one of those fluids. And his mission, along with the rest of Hippocratic physicians, was to re-balance that equilibrium and return it back to health.
To do it, he proposed a holistic approach. In it, he combined the use of animal, plant, and mineral based medicines with baths, diets, and exercise. Four centuries later, around the year 65 BC, Dioscorides, a Greek physician and pharmacologist, wrote De Materia Medica. The work, a go-to manual for 1500 years, listed 600 natural substances. And among them, said to alleviate different pains, were poppy, mandrake, and henbane.
Renaissance and the anatomy of pain
The Middles Ages were stagnant when it comes to chronic pain treatment. For the most part, theories by Hippocrates and Galen remained valid, and herb remedies thrived on monastery gardens. Physicians-monks, experts on the preparation of drugs, grew a myriad of plants. And they used them for healing purposes following Greek and Arab medical guidelines.
Research was limited due to the ban on the dissection of human bodies, and supernatural ideas were once again prevalent. Illness and pain were attributed to sins, demons, witchcraft, and astrology. But the variety of natural remedies instead of ritual practices was remarkable.
Now, on the other hand, the Renaissance was a fertile time for chronic pain management development. Exploration inside the human body sparked significant advancements in anatomy and physiology. And the scientific method gave way to a more accurate understanding of the causes of pain.
Laudanum, an opium-based tincture, was famous across Europe as an effective painkiller. Paracelsus, a Swiss physician, and alchemist credited to introduce the drug called it “the immortality stone.” And he carried it with him all the time.
Chronic Pain Management in Modern Times
The four centuries from 1600 to 1900 marked the emergence of a predominant opium approach to alleviate chronic pain. In the 17th century, “many Europeans doctors gave their patients opium to relieve pain.” But it was in the 19th century when the most significant turning point came with the discovery of morphine.
Obtained by the German pharmacist Friedrich Sertürner, morphine popularity grew fast. But so did the concerns and fears about abuse and addiction when prescribed by doctors.
From then on, medical researchers and pharmaceutical companies have developed opioid analgesic alternatives. These efforts gave way to a broad spectrum of known opioid substances. Hydrocodone, tramadol, oxycodone, codeine, fentanyl, and methadone supported pain treatment, combined with anti-inflammatory agents like ibuprofen, acetaminophen, and aspirin.
Today, in the wake of the opioid crisis, there is a growing trend towards non-opioid analgesic strategies. Non-opioid pharmacotherapy includes anti-inflammatories, antidepressants, and anticonvulsants. But is the multidisciplinary approach for treating pain that it’s making big waves.
This approach is based on lifestyle changes and low-tech alternatives. They look more like what a doctor would suggest in classical times. And maybe not what you would expect in these days led by the pharmaceutical industry. Actually, the key areas go back in time and seem to circle around to the basics of chronic pain treatment:
Physical therapy. The techniques used are timeless. Think about stretching exercises, hot or cold applications, and massage. And add transcutaneous electrical nerve stimulation (TENS). It sounds sophisticated. But the truth is that the principle existed in Ancient Egypt, where they gave electric shocks to the sufferers using eels and torpedo fish.
Complementary and alternative medicine. The rebirth of these techniques has been increasingly attracting patients. On the one hand, you have promising advancements on the new plant-based natural remedies such as hemp CBD oil. And on the other you have millennial practices making a big comeback.
Look Back and Look Forward when finding the right treatment
We are talking about acupuncture, yoga, and meditation. Used in traditional Chinese Medicine, acupuncture it’s been a part of pain treatment for over 2000 years. And it has been proven helpful in the treatment of conditions like osteoarthritis, chronic pelvic pain, fibromyalgia, and chronic lower back pain.
Finally, the important thing to know today is that you have options. But don’t rely on the idea that the latest scientific and technological advancement is the way to go. Sometimes you want to look back in time. Who knows. Maybe history is where you can find the remedy you have been looking for all your life.