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HISTORY OF PAIN: THE HEART OF THE MATTER?

Pain is as old as time itself. Some of our ancestors must have been profoundly mystified by pain associated with disease. An attempt was made to explain this as an intrusion into the body by evil spirits, or objects, thus requiring their removal by extracting the object, exorcising demons or placating the Gods. The Ancient Egyptians and Babylonians believed disease caused pain.

The heart of the matter?

Five hundred years before Christ, the sensation was thought to be experienced in the blood vessels and the heart — and not the brain. Until modern times this was also a common belief throughout the Eastern world. Pain was recognised as a sensation by the ancient Hindus and Buddhists in India, but they gave greater significance to its emotional aspects. They believed it was experienced in the heart.

In The Yellow Emperor’s Canon of Imperial Medicine,published in approximately 500 BC and dating back possibly 2000 years before that, the Chinese attributed the causes of pain and disease to imbalances of the life force called Qi. They believed it could be corrected using acupuncture or by the application of heat or herbs.

In Ancient Greece there was also a lively debate about whether the brain was the centre of sensation and reason, and not the heart. Some philosophers believed pain was due to changes in extremes of sensation. Furthermore, they were convinced that pain could be caused externally as well as by emotional response. Around 300 BC pain was perceived in the brain, with two kinds of nerves said to exist — ‘sensation’ and ‘movement’.

It was not until the second century AD that these concepts were rediscovered. A third type of nerve was described as carrying the sensation of pain. As well as witch-burning and dunking, fear and superstition, the Dark Ages in Europe saw a shift of the centre of medicine to Arabia. Philosophers and pain practitioners described fifteen different types of pain including their causes and mechanisms.

The Renaissance in Europe brought more significant advances in chemistry, physics, physiology and anatomy.These advances were particularly seen in the nervous system, with many considering pain to be a sensory event carried by the nerves of touch, to be experienced in the brain.

For twenty-three centuries Aristotle’s belief persisted that pain was a passion of the soul felt in the heart. Even the great seventeenth century English anatomist, William Harvey, believed the heart was the site of pain.

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