Bridging Old and New in Pain Medicine: An Historical Review

Abstract

Pain is both one of the oldest complaints known to medicine and a field for some of medicine's latest breakthroughs and innovations. Pharmacologic treatment of pain is one of the oldest remedies, and opioids have been used since ancient times as an effective pain reliever but with certain specific risks for abuse. Greater knowledge of opioids led to a more thorough understanding of the complexities of pain, which may have any number of mechanisms. A greater understanding of nerve fibers and pain signaling led to the development of more drugs and the more targeted delivery of analgesics using the hollow needle. The hollow needle changed pain treatment and led to percutaneous injections and what would later become interventional pain medicine with regional anesthesia and nerve blocks. Today, imaging can be combined with interventional techniques for more precise localization of nerves for diagnosis and treatment. The role of artificial intelligence in interventional pain medicine, especially in imaging for interventional procedures, remains unknown but will likely become extremely beneficial.

Keywords: gate control theory of pain; history of pain medicine; hypodermic needles; opioids; pain medicine.

Figure 1. Heroin was originally marketed by Bayer & Co. as a pain reliever less addictive than morphine and as an antitussive. It was synthesized by Felix Hoffmann of Bayer; Hoffmann later created aspirin. Photograph courtesy of the Drug Enforcement Administration Museum in Arlington, Virginia.

Figure 2. An example of an original Pravaz metal syringe with narrow-tipped hollow needle in its original velvet-lined case. Novel with this syringe was the transparent barrel and the screw at the proximal end of the syringe, which could be manually adjusted for control of the dose. This photo by unknown artist is licensed under Creative Commons.