Stumbled on this quite by accident, but it is a rather nice potted history of some thinking about pain. The History of Biopsychosocial Pain – A tale of Gladiators, War, Papal Doctrine and a Wrestler, by Dr Harriet Wordsworth. The essay was a previous winner of The Anaesthesia History Prize awarded by The Association of Anaesthetists of Great Britain and Ireland. Selected excerpts below (all the words in italics).
George Engel and the origin (?) of the biopsychosocial model of illness
The ancient Greeks
Galen and the Romans
The Dark Ages, ‘poena’ and the Pope
Von Frey and the Victorians
“Von Frey in 1895 attempted to divide the senses into four broad groups, each with their own free nerve endings and pathways in the nervous system. He termed these the cutaneous senses – touch, cold, warmth and pain and so coined the Specific theory of Pain, in which pain was described as a separate sensation.
The Great War
World War II and the post war era
Melzack, Wall and the Gate
The swinging ’60s
The ’70s, the founding of IASP, and Wall’s ‘need state’
The ’80s and onwards
Because it’s you and me, we’re history
It’s a great essay from Dr Wordsworth (sorry, couldn’t find a link to a professional page or bio), available in full for anyone to read here. Perhaps the abiding lesson of history is that at any point in time, we are not as clever/novel/forward thinking as we’d like to think we are. If the biopsychosocial model was a person, it might be a Kardashian – nothing new, better known for its curvy figure and picture than for any substance, in and out of fashion, good to name-drop in the right circles, has had way too much of the same things written about it over and over, is talked about by many, but is understood by few (talk about burying the lede…). This doesn’t take away from Dr Wordsworth great essay, or Engel’s original idea, but it does suggest that knowing a little history may be humbling and have some benefits – Plato was on to the ‘placebo effect’ thousands of years ago; Galen’s philosophical thinking made him a better physician; strongly held, dogmatic beliefs (religious or otherwise) can harm people; by carefully listening to, and observing soldiers with terrible injuries Beecher was aware of the tenuous link between tissue damage and pain over 70 years ago; Bonica was advocating multidisciplinary approaches to pain in the ’50s but was ignored; Wall and Melzack’s gate control theory was never just a theory of dorsal horn ‘gating’; and very few people to this day understand Wall’s idea of a need state. And there’s so much more – of course.
Back to the future – ‘Understanding Pain in 2025’
My sincere thanks here must go to Mick Thacker for giving his 2015 Louis Gifford Lecture talk the title Understanding Pain in 2025: Top Down before Bottom Up! and allowing a nice way to wrap this post up on an upswing, going back a few years to peer into the future. Discussing perhaps the most truly biopsychosocial (in Engel’s original formulation) model of pain around, Louis Gifford’s Mature Organism Model, Mick explores his own, embodied, formulation of the MOM, introduces the idea of Predictive Processing (PP), and discusses the work he is doing with one of the PP aficionados, Andy Clark, to take a PP approach to pain. Mick highlights along the way Louis’ prescient understanding of where pain science is heading, evident in his top down before bottom up maxim. Click on the image below for a link to the video. It’s long – but put aside the time, you’ll be smarter for having watched it.-Tim Cocks