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For more than 50,000 years, pain has been part of the human experience. Pain has had different meanings for different people. Likewise theories about the causes and mechanisms of pain reflect the state of knowledge of the societies devising the theories. In all ages pain has been a very real and immediate concern, but always the attitudes and responses of people have been shaped by magical, demonological, theological, philosophical, and practical influences in varying degrees and with shifting emphasis. It is our purpose to capture and examine some of these changing interpretations of pain through time.

Pain as a specific object of scientific inquiry was unrecognized until the early modern era. Attention was paid instead to illnesses and cures, anatomy and physiology. Until recently scientists sought a sensorium commune, an undetermined site somewhere in the body where the nature of pain would be revealed. However, in every language more than one word can refer to pain. Awareness of pain and suffering has been part of the feelings of compassion, sympathy, and forgiveness that serve to bond us with each other. Now, instead of looking for a locus for pain we are developing explanatory models that take into account contemporary knowledge of physiology, psychology, and technology.

As the hunter-gatherers migrated from northern African to Asia, Europe, and eventually the Americas, their small communities found ways to deal with the illnesses and accidents that occurred to people subject to environmental stress and human frailty. Wars and conflicts led to the development of curative potions and surgical techniques, some of which remain in use to this day. By performing rituals the communities appealed to their gods for help against their enemies, whether human or natural. The people appointed members of their groups to become proficient in the ways that would satisfy their gods and help individuals feel less pain. These early communities used heat and cold, mud packs and poetics, intoxicants and analgesics, simple techniques of extracting foreign bodies, and bone-setting procedures to deal with pain. They also had trephinations and ceremonial mutilations such as circumcisions, castrations, and piercing operations that suggest well established surgical skills.1

Evidence of their practice remains in fossils, carvings and cave paintings, and primitive tools. In the fertile crescent of land between the Euphrates and Tigris rivers known as Mesopotamia, a practical system of writing was first invented. The Code of Hammurabi portrays the expectations for a stable and organized society in which medical practice relied on omens, divination, and astrology. It was eminently safer to diagnose and treat in accordance with revelations conjured out of livers and other entrails of sacrificed animals than to rely on surgical skills, for it was expressly stated in the Code: “If a surgeon has opened an eye infection with a bronze instrument and so saved the man’s eye, he shall take ten shekels. If a surgeon has opened an eye infection with a bronze instrument and thereby destroyed ...

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