Pain Theory

1891: Sir Victor Horsely and colleagues report on surgical relief of pain
1899: Bayer introduces aspirin, an effective, easily tolerated analgesic for mild to moderate pain
1905: Alfred Einhorn synthesizes procaine, first injectable local anesthetic
1906: Charles Sherrington describes nociception in The Integrative Action of the Nervous System
1916: WWI surgeon Rene Leriche describes his procedure of periaterial resection and procaine injection for pain following nerve injuries
1929: Committee on Drug Addiction formed in the United States to find strong nonaddictive analgesic
1936: Emery Rovenstine opens first nerve block clinic for pain at Bellevue
1943: William Livingston suggests “vicious circle” model in Pain Mechanisms
1946: Henry Beecher suggests the influence of the cognitive and emotional “reaction component” of pain in “Pain in Men Wounded in Battle”
1947: Multidisciplinary pain clinics founded by Livingston in Oregon and by John Bonica in Tacoma, Washington
1948: Bernard Brodie and Julius Axelrod isolate acetaminophen (later marketed as Tylenol [1955])
1953: John Bonica publishes Management of Pain, begins promotion of multidisciplinary approach
1958: Raymond Houde and Walter Modell publish guidelines for clinical evaluation of analgesics, based on work of Beecher and Houde
1959: Willem Noordenbos’s Pain describes pain in the context of an interactive neural network
1962: Ronald Melzack and Patrick Wall publish joint article on “sensory mechanisms”
1964: Cicely Saunders first suggests the concept of “total pain”
1965: Melzack and Wall propose the “gate control” model of pain modulation
1967: Cicely Saunders founds St. Christopher’s Hospice, flagship of modern hospice movement, in SE London
1968: Wilbert Fordyce, Roy Fowler, and Barbara DeLateur describe behavior modification therapy for pain
1968: Richard Sternbach writes about pain as a learned response of the nervous system
1971: David Mayer, Huda Akil, John Liebeskind, and David Reynolds report analgesia from electrical stimulation of brainstem
1971: Melzack and W.S. Torgerson introduce the McGill Pain Questionnaire for pain assessment
1972: Presidential trip to China stirs new interest in acupuncture and other complementary therapies
1973: Bonica organizes international meeting of 350 pain researchers at Issaquah, Washington; group founds International Association for the Study of Pain
1973: Candace Pert and Solomon Snyder isolate the opiate receptor in neural tissue
1975: Journal Pain launched under editor Patrick Wall
1975: John Hughes and Hans Kosterlitz report on the discovery of enkephalin, the first known endogenous opioid
1975: John Loeser and colleagues report on pain relief through transcutaneous stimulation (an application of the gate control theory)
1977: American Pain Society founded
1977: R. Lee and P.S.J. Spencer publish review article on the use of tricyclic antidepressants in pain relief, spurring further research
1978: Robert Twycross presents evidence that cancer patients on long-term opioid therapy do not inevitably develop tolerance or addiction
1982: WHO expert group on cancer pain relief convenes and develops “threestep ladder” for analgesia
1983: American Academy of Algology (later the American Academy of Pain Medicine) founded as a multidisciplinary group to accredit and advocate for physicians specializing in pain management
1983: D.C. Turk, D. Meichenbaum, and M. Genest publish Pain and Behavioral Medicine: A Cognitive-Behavioral Approach
1986: WHO publishes Cancer Pain Relief
1988: Gary Bennett and Y.-K. Xie develop chronic constriction injury rat model, which mirrors chronic regional pain syndrome in humans
1988: Richard S. and Kathryn A. Weiner found the American Academy of Pain Management to accredit and represent pain practitioners from nonmedical disciplines
1991: C.J. Woolf and S.W. Thompson demonstrate induction and maintenance of central sensitization through NMDA receptor activation, a mechanism that perpetuates severe pain even after original triggering event ends
1994: K. Seibert and colleagues report on the role of cyclo-oxygenase 2 in inflammation and pain
1995: SUPPORT Study reports that 50 percent of patients in the study who were conscious when they died, were in moderate to severe pain at least half the time, according to their families
1995: The Federal Drug Administration (FDA) approved Tramadol.
1997: James N. Campbell, Kathleen Foley and John Liebeskind establish the American Pain Foundation, the first grassroots organization to represent people in pain
1998: U.S. Federation of State Medical Boards (FSMB) adopts Model Guidelines for the Use of Controlled Substances for Pain
2000: Joint Commission on Accreditation of Healthcare Organizations develops new mandatory standards for pain assessment and management
2000: M. A. Ruda and colleagues demonstrate that neonatal inflammation can lead to changes in neural processing – that pain during early development may affect an individual throughout life
2001: U.S. Congress declares 2001 to 2010 the Decade of Pain Control and Research
2001: Drug Enforcement Administration and twenty-one leading healthcare organizations publish a joint statement on achieving balance between good pain management and control of drug abuse
2001: Reports of OxyContin abuse appear in the press and trigger new actions against physicians who prescribe opioids for chronic pain
2004: DEA publishes jointly authored “Frequently Asked Questions and Answers” regarding opioid use for pain treatment on its website, then abruptly withdraws them
2004: FDA removes Vioxx, a cox-2 inhibitor analgesic, from the market after it is linked to increased risks of stroke and heart attack; Bextra, also a cox- 2 inhibitor, will be removed the following
year
2004: FSMB adopts Model Policy for the Use of Controlled Substances in the Treatment of Pain and initiates six conferences to train medical board directors
2005: Virginia physician William Hurwitz sentenced to 25 years for “drug trafficking” for his prescription of opioids to chronic pain patients. DEA administrator Karen Tandy affirms the agency’s balanced policy and states: To the million doctors who legitimately prescribe narcotics to relieve patients’ pain and suffering, you have nothing to fear from Dr. Hurwitz’s prosecution and no reason to refrain from providing your patients with pain medications when you deem it medically necessary.
2005: The Supreme Court rules that federal authorities may prosecute patients who smoke marijuana to relieve pain and other symptoms under doctor’s orders, even where state laws have legitimized this practice

Marcia L. Meldrum, PhD,