Pain and Religion

The early concept of pain as a form of punishment from supreme spiritual beings for sin and evil activity is as old as the human race. In the book of Genesis , God told Eve that following her fall from grace she would endure pain during childbirth: “I will greatly multiply your pain in childbearing; in pain you shall bring forth children, yet your desire shall be for your husband and he shall rule over you” (Genesis 3:16). This condemnation led early Christians to accept pain as a normal consequence of Eve’s action and to view this consequence as being directly transferred to them. Thus any attempt to decrease the pain associated with labor and delivery was treated by early Christians with disdain and disapproval. It was not until 1847, when Queen Victoria was administered chloroform by James Simpson for the delivery of her eighth child, Prince Leopold, that contemporary Christians and in particular Protestants accepted the notion that it was not heretical to promote painless childbirth as part of the obstetric process.

From the Old Testament, Job has been praised for his endurance of pain and suffering. Yet Job’s friends wondered whether these tribulations were an indication that he had committed some great sin for which God was punishing him (Job 5:17). Nonetheless, Job was considered a faithful servant by God and was not guilty of any wrongdoing. In fact, he was described as a man who was “blameless and upright” and one who feared God and turned away from evil.

In the 5th century, St. Augustine wrote that “all diseases of Christians are to be ascribed to demons; chiefly do they torment the fresh baptized, yea, even the guiltless newborn infant,” thus implying that not even innocent infants escape the work of demons. Today, major typhoons, hurricanes, fires, earthquakes, volcanoes, tsunamis, floods, and droughts destroy hundreds and at times thousands of innocent, defenseless people. One ponders the rationale of such pain and suffering endured by otherwise good people while seemingly ruthless and evil persons apparently triumph and prosper in an atmosphere of luxury and comfort.

This paradox can be discouraging at times but is usually upheld by firm Christian belief. In the 1st century, many people who belonged to the Catholic Church were rebuked and suffered ruthless persecution, including death, because of their belief in Jesus as the Messiah. Some who were subsequently described as martyrs endured their suffering in the belief that they did it for the love of Christ, and they felt that their suffering identified them with Christ’s suffering on the cross during his crucifixion. This may be the earliest example of the value of psychotherapy as an important modality in managing pain. Thus, many present-day cancer patients with strong Christian beliefs view their pain and suffering as part of their journey toward eternal salvation. This concept has led to several scientifically conducted and government-sponsored studies evaluating intercessory prayer as an effective modality for controlling cancer pain.

To fully appreciate the historical significance of pain, it is important to reflect on the origins of the “pain patient.” The word pain comes from the Latin word poena , which means “punishment.” The word patient is derived from the Latin word patior , meaning “to endure suffering or pain.” Thus, it is not too outrageous to appreciate that in ancient days persons who experienced pain were interpreted to have received punishment in the form of suffering that was either dispensed by the gods or offered up to appease the gods for transgressions.

As spinal and epidural modes of anesthesia have developed and the techniques have been refined so that mortality and morbidity from them are negligible, childbirth and delivery are increasingly considered relatively painless in most developed societies. Unfortunately, in many countries neither the personnel nor the technology for obstetric regional analgesia is available, and resources to provide such personnel and technology are inadequate, thus making childbirth a primitively painful and at times disastrous event. The history of anesthesia is full of instances wherein attempts to relieve pain were initially met with resistance and sometimes violence. In the mid-19th century, Crawford Long from the state of Georgia in the United States attempted to develop and provide anesthesia, but contemporary Christians of that state considered him a heretic for his scholarly activity. As a result, he literally had to flee for his life from Georgia to Texas. Although surgical anesthesia was well developed by the late 19th century, religious controversy over its use required Pope Pius XII to give his approval before anesthesia could be used extensively for surgical procedures. Pope Pius XII wrote, “The patient, desirous of avoiding or relieving pain, may without any disquietude of conscience, use the means discovered by science which in themselves are not immoral.”

Pain and the Ancient Cultures

Disease, pain, and death have always been considered undesirable. The principles on which medicine was founded were based on measures to overcome human suffering from disease. Thus pain was usually thought of as either emanating from an injury or originating from the dysfunction of an internal organ or system. Traditionally, pain after physical injury (e.g., a gunshot wound or spear injury) was not considered problematic since as soon as the offending injurious agent was removed or once the consequences of the offending injury were corrected, the patient either recovered rapidly or, on occasion, died. On the other hand, pain from disease (e.g., the pain of an inflamed gallbladder or ruptured appendix) was regarded with more mystique, and treatment was usually tinged with superstitious tradition. The tribal concept of pain came from the belief that it resulted from an “intrusion” from outside the body. These “intruders” were thought to be evil spirits sent by the gods as a form of punishment. It was in this setting that the role of medicine men and shamans flourished because these were the persons assigned to treat the pain syndromes associated with internal disease. Since it was thought that spirits entered the body by different avenues, the rational approach to therapy was aimed at blocking the particular pathway chosen by the spirit.

In Egypt, the left nostril was considered the specific site where disease entered. This belief was confirmed by the Papyri of Ebers and Berlin, which stated that the treatment of headache involved expulsion of the offending spirit by sneezing, sweating, vomiting, urination, and even trephination. In New Guinea it was believed that evil spirits entered via a spear or an arrow, which then produced spontaneous pain. Thus it was common for the shaman to occasionally purge the evil spirit from a painful offending wound and neutralize it with his special powers or special medicines. Egyptians treated some forms of pain by placing an electric fish from the Nile over the wounds to control the pain. The resulting electrical stimulation that produced relief of pain actually works by a mechanism similar to transcutaneous electrical nerve stimulation (TENS), which is frequently used today to treat pain.

The Papyrus of Ebers, an ancient Egyptian manuscript, contains a wide variety of pharmacologic information and describes many techniques and recipes, some of which still have validity. This papyrus describes the use of opium for the treatment of pain in children. Other concoctions for treating pediatric pain have included wearing amulets filled with a dead man’s tooth (Omnibonus Ferraruis, 1577) as treatment of teething pain. Although early documents specifically address the management of pain in children, it is unfortunate that even today treatment of pediatric pain is far from optimal. This glaring deficiency was highlighted in 1977 by Eland, who demonstrated that in a population of children 4 to 8 years of age, only 50% received analgesics for postoperative pain. The results are even more unsatisfactory for the treatment of chronic pain and cancer pain in children. It is unfortunate that the observations of earlier scholars have been ignored. Two erroneous assumptions—that children are less sensitive to pain and that the central nervous system is relatively undeveloped in neonates—are partially responsible for this deficiency.

Early Native Americans believed that pain was experienced in the heart, whereas the Chinese identified multiple points in the body where pain might originate or might be self-perpetuating. Consequently, attempts were made to drain the body of these “pain points” by inserting needles, a concept that may have given birth to the principles of acupuncture therapy, which is well over 2000 years old.

The ancient Greeks were the first to consider pain to be a sensory function that might be derived from peripheral stimulation. In particular, Aristotle believed that pain was a central sensation arising from some form of stimulation of the flesh, whereas Plato hypothesized that the brain was the destination of all peripheral stimulation. Aristotle advanced the notion that the heart was the originating source or processing center for pain. He based his hypothesis on the concept that an excess of vital heat was conducted by the blood to the heart, where pain was modulated and perceived. Because of his great reputation, many Greek philosophers followed Aristotle and embraced the notion that the heart was the center for pain processing. Another Greek philosopher, Stratton, and other distinguished Egyptians, including Herophilus and Eistratus, disagreed with Aristotle and proposed the concept that the brain was the site of pain perception as suggested by Plato. Their theories were reinforced by actual anatomic studies showing the connections of the peripheral and central nervous systems.

Nevertheless, controversies between the opposing theories of the brain and the heart as the center for pain continued, and it was not until 400 years later that the Roman philosopher Galen rejuvenated the works of the Egyptians Herophilus and Eistratus and greatly re-emphasized the model of the central nervous system. Although Galen’s work was compelling, he received little recognition for it until the 20th century.

Toward the period of the Roman Empire, steady progress was made in understanding pain as a sensation similar to other sensations in the body. Developments in anatomy and, to a lesser extent, in physiology helped establish that the brain, not the heart, was the center for the processing of pain. While these advances were taking place, simultaneous advances were occurring in the development of therapeutic modalities, including the use of drugs (e.g., opium), as well as heat, cold, massage, trephination, and exercise, to treat painful illnesses. These developments brought about establishment of the principles of surgery for treating disease. Electricity was first used by the Greeks of that era as they exploited the power of the electrogenic torpedo fish ( Scribonius longus ) to treat the pain of arthritis and headache. Electrostatic generators were used in the late Middle Ages, as was the Leyden jar; these developments resulted in the re-emergence of electrotherapy as a modality for managing medical problems, including pain. There was a relative standstill in the development of electrotherapy as a medical modality until the electric battery was invented in the 19th century. Several attempts were then made to revive its use as an effective medical modality, but these concepts did not catch on and were largely used only by charlatans and obscure scientists and practitioners. Throughout the Middle Ages and the Renaissance, debate on the origin and processing center of pain raged. Fortunes fluctuated between proponents of the brain theory and proponents of the heart theory, depending on which theory was favored.

Heart theory proponents appeared to prosper when William Harvey, recognized for his discovery of the circulation, supported the heart as the focus for pain sensation. Descartes disagreed vehemently with the Harvey hypothesis, and his description of pain conducted from peripheral damage through nerves to the brain led to the first plausible pain theory, that is, the specificity theory . It is interesting to note that the specificity theory followed Descartes’ description by some 2 centuries. Several other theories followed the specificity theory and contributed to the foundation for understanding pain and pain mechanisms.

Pain and Pain Theories

The specificity theory, originally proposed by Descartes, was formally revised by Schiff based on animal research. The fundamental tenet of the theory was that each sensory modality, including pain, was transmitted along an independent pathway. By examining the effect of incisions in the spinal cord, Schiff demonstrated that touch and pain were independent sensations. Furthermore, he demonstrated that sectioning of the spinal cord deferentially resulted in the loss of one modality without affecting the other. Further work along the same lines by Bliz, Goldscheider, and von Frey contributed to the concept that separate and distinct receptors exist for the modalities of pain, touch, warmth, and cold.

During the 18th and 19th centuries, new inventions, new theories, and new thinking emerged. This period was known as the Scientific Revolution, and several important inventions took place, including discovery of the analgesic properties of nitrous oxide, followed by the discovery of local anesthetic agents (e.g., cocaine). The study of anatomy was also developing rapidly as an important branch of science and medicine; most notable was discovery of the anatomic division of the spinal cord into sensory (dorsal) and motor (ventral) divisions. In 1840 Mueller proposed that based on anatomic studies, there was a straight-through system of specific nerve energies in which specific energy from a given sensation was transmitted along sensory nerves to the brain. Mueller’s theories led Darwin to propose the intensive theory of pain, which maintained that the sensation of pain was not a separate modality but instead resulted from a sensory overload of sufficient intensity for any modality. This theory was modified by Erb and then expanded by Goldscheider to encompass the roles of both stimulus intensity and central summation of stimuli. Although the intensive theory was persuasive, the controversy continued, with the result that by the mid-20th century, the specificity theory was universally accepted as the more plausible theory of pain.

With this official, though not unanimous blessing of the contemporary scientific community, strategies for pain therapy began to focus on identifying and interrupting pain pathways. This tendency was both a blessing and a curse. It was a blessing in that it led many researchers to explore surgical techniques that might interrupt pain pathways and consequently relieve pain, but it was a curse in that it biased the medical community for more than half a century into believing that pain pathways and their interruption were the total answer to the pain puzzle. This trend was begun in the late 19th century by Letievant, who first described specific neurectomy techniques for treating neuralgic pain. Afterward, various surgical interventions for chronic pain were developed and used, including rhizotomy, cordotomy, leukotomy, tractotomy, myelotomy, and several other operative procedures designed to interrupt the central nervous system and consequently reduce pain. Most of these techniques were abysmal failures that not only did not relieve pain but also on occasion produced much more pain than was previously present. A major consequence lingers today—the notion that pain can be “fixed” by a surgical procedure or other modality.

Pain and the Ancient Cultures

Disease, pain, and death have always been considered undesirable. The principles on which medicine was founded were based on measures to overcome human suffering from disease. Thus pain was usually thought of as either emanating from an injury or originating from the dysfunction of an internal organ or system. Traditionally, pain after physical injury (e.g., a gunshot wound or spear injury) was not considered problematic since as soon as the offending injurious agent was removed or once the consequences of the offending injury were corrected, the patient either recovered rapidly or, on occasion, died. On the other hand, pain from disease (e.g., the pain of an inflamed gallbladder or ruptured appendix) was regarded with more mystique, and treatment was usually tinged with superstitious tradition. The tribal concept of pain came from the belief that it resulted from an “intrusion” from outside the body. These “intruders” were thought to be evil spirits sent by the gods as a form of punishment. It was in this setting that the role of medicine men and shamans flourished because these were the persons assigned to treat the pain syndromes associated with internal disease. Since it was thought that spirits entered the body by different avenues, the rational approach to therapy was aimed at blocking the particular pathway chosen by the spirit.

In Egypt, the left nostril was considered the specific site where disease entered. This belief was confirmed by the Papyri of Ebers and Berlin, which stated that the treatment of headache involved expulsion of the offending spirit by sneezing, sweating, vomiting, urination, and even trephination. In New Guinea it was believed that evil spirits entered via a spear or an arrow, which then produced spontaneous pain. Thus it was common for the shaman to occasionally purge the evil spirit from a painful offending wound and neutralize it with his special powers or special medicines. Egyptians treated some forms of pain by placing an electric fish from the Nile over the wounds to control the pain. The resulting electrical stimulation that produced relief of pain actually works by a mechanism similar to transcutaneous electrical nerve stimulation (TENS), which is frequently used today to treat pain.

The Papyrus of Ebers, an ancient Egyptian manuscript, contains a wide variety of pharmacologic information and describes many techniques and recipes, some of which still have validity. This papyrus describes the use of opium for the treatment of pain in children. Other concoctions for treating pediatric pain have included wearing amulets filled with a dead man’s tooth (Omnibonus Ferraruis, 1577) as treatment of teething pain. Although early documents specifically address the management of pain in children, it is unfortunate that even today treatment of pediatric pain is far from optimal. This glaring deficiency was highlighted in 1977 by Eland, who demonstrated that in a population of children 4 to 8 years of age, only 50% received analgesics for postoperative pain. The results are even more unsatisfactory for the treatment of chronic pain and cancer pain in children. It is unfortunate that the observations of earlier scholars have been ignored. Two erroneous assumptions—that children are less sensitive to pain and that the central nervous system is relatively undeveloped in neonates—are partially responsible for this deficiency.

Early Native Americans believed that pain was experienced in the heart, whereas the Chinese identified multiple points in the body where pain might originate or might be self-perpetuating. Consequently, attempts were made to drain the body of these “pain points” by inserting needles, a concept that may have given birth to the principles of acupuncture therapy, which is well over 2000 years old.

The ancient Greeks were the first to consider pain to be a sensory function that might be derived from peripheral stimulation. In particular, Aristotle believed that pain was a central sensation arising from some form of stimulation of the flesh, whereas Plato hypothesized that the brain was the destination of all peripheral stimulation. Aristotle advanced the notion that the heart was the originating source or processing center for pain. He based his hypothesis on the concept that an excess of vital heat was conducted by the blood to the heart, where pain was modulated and perceived. Because of his great reputation, many Greek philosophers followed Aristotle and embraced the notion that the heart was the center for pain processing. Another Greek philosopher, Stratton, and other distinguished Egyptians, including Herophilus and Eistratus, disagreed with Aristotle and proposed the concept that the brain was the site of pain perception as suggested by Plato. Their theories were reinforced by actual anatomic studies showing the connections of the peripheral and central nervous systems.

Nevertheless, controversies between the opposing theories of the brain and the heart as the center for pain continued, and it was not until 400 years later that the Roman philosopher Galen rejuvenated the works of the Egyptians Herophilus and Eistratus and greatly re-emphasized the model of the central nervous system. Although Galen’s work was compelling, he received little recognition for it until the 20th century.

Toward the period of the Roman Empire, steady progress was made in understanding pain as a sensation similar to other sensations in the body. Developments in anatomy and, to a lesser extent, in physiology helped establish that the brain, not the heart, was the center for the processing of pain. While these advances were taking place, simultaneous advances were occurring in the development of therapeutic modalities, including the use of drugs (e.g., opium), as well as heat, cold, massage, trephination, and exercise, to treat painful illnesses. These developments brought about establishment of the principles of surgery for treating disease. Electricity was first used by the Greeks of that era as they exploited the power of the electrogenic torpedo fish ( Scribonius longus ) to treat the pain of arthritis and headache. Electrostatic generators were used in the late Middle Ages, as was the Leyden jar; these developments resulted in the re-emergence of electrotherapy as a modality for managing medical problems, including pain. There was a relative standstill in the development of electrotherapy as a medical modality until the electric battery was invented in the 19th century. Several attempts were then made to revive its use as an effective medical modality, but these concepts did not catch on and were largely used only by charlatans and obscure scientists and practitioners. Throughout the Middle Ages and the Renaissance, debate on the origin and processing center of pain raged. Fortunes fluctuated between proponents of the brain theory and proponents of the heart theory, depending on which theory was favored.

Heart theory proponents appeared to prosper when William Harvey, recognized for his discovery of the circulation, supported the heart as the focus for pain sensation. Descartes disagreed vehemently with the Harvey hypothesis, and his description of pain conducted from peripheral damage through nerves to the brain led to the first plausible pain theory, that is, the specificity theory . It is interesting to note that the specificity theory followed Descartes’ description by some 2 centuries. Several other theories followed the specificity theory and contributed to the foundation for understanding pain and pain mechanisms.

Pain and Pain Theories

The specificity theory, originally proposed by Descartes, was formally revised by Schiff based on animal research. The fundamental tenet of the theory was that each sensory modality, including pain, was transmitted along an independent pathway. By examining the effect of incisions in the spinal cord, Schiff demonstrated that touch and pain were independent sensations. Furthermore, he demonstrated that sectioning of the spinal cord deferentially resulted in the loss of one modality without affecting the other. Further work along the same lines by Bliz, Goldscheider, and von Frey contributed to the concept that separate and distinct receptors exist for the modalities of pain, touch, warmth, and cold.

During the 18th and 19th centuries, new inventions, new theories, and new thinking emerged. This period was known as the Scientific Revolution, and several important inventions took place, including discovery of the analgesic properties of nitrous oxide, followed by the discovery of local anesthetic agents (e.g., cocaine). The study of anatomy was also developing rapidly as an important branch of science and medicine; most notable was discovery of the anatomic division of the spinal cord into sensory (dorsal) and motor (ventral) divisions. In 1840 Mueller proposed that based on anatomic studies, there was a straight-through system of specific nerve energies in which specific energy from a given sensation was transmitted along sensory nerves to the brain. Mueller’s theories led Darwin to propose the intensive theory of pain, which maintained that the sensation of pain was not a separate modality but instead resulted from a sensory overload of sufficient intensity for any modality. This theory was modified by Erb and then expanded by Goldscheider to encompass the roles of both stimulus intensity and central summation of stimuli. Although the intensive theory was persuasive, the controversy continued, with the result that by the mid-20th century, the specificity theory was universally accepted as the more plausible theory of pain.

With this official, though not unanimous blessing of the contemporary scientific community, strategies for pain therapy began to focus on identifying and interrupting pain pathways. This tendency was both a blessing and a curse. It was a blessing in that it led many researchers to explore surgical techniques that might interrupt pain pathways and consequently relieve pain, but it was a curse in that it biased the medical community for more than half a century into believing that pain pathways and their interruption were the total answer to the pain puzzle. This trend was begun in the late 19th century by Letievant, who first described specific neurectomy techniques for treating neuralgic pain. Afterward, various surgical interventions for chronic pain were developed and used, including rhizotomy, cordotomy, leukotomy, tractotomy, myelotomy, and several other operative procedures designed to interrupt the central nervous system and consequently reduce pain. Most of these techniques were abysmal failures that not only did not relieve pain but also on occasion produced much more pain than was previously present. A major consequence lingers today—the notion that pain can be “fixed” by a surgical procedure or other modality.