See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/281820101

Pain: History, culture and philosophy

Article  in  AMHA - Acta Medico-Historica Adriatica · July 2015

CITATION READS

1 1,566

3 authors, including:

Fauzia Raza Iqbal Akhtar Khan

1 PUBLICATION   1 CITATION   
Independant Scholar
20 PUBLICATIONS   35 CITATIONS   
SEE PROFILE
SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Ibn Sinian Medicine View project

Geriatric Medicine View project

All content following this page was uploaded by Iqbal Akhtar Khan on 06 December 2015.

The user has requested enhancement of the downloaded file.

Pregledni rad Acta med-hist Adriat 2015; 13(1);113-130

Review article UDK: 612.8+1+61(091)

3$,1+,6725<&8/785($1'3+,/2623+<

BOL: POVIJEST, KULTURA I FILOZOFIJA

0XUDG$KPDG.KDQ1)DX]LD5D]D2,TEDO$NKWDU.KDQ3

Summary
Pain, one of the universals of existence, has a long and venerable history, its origin initially
attributed to godly punishment for disbelievers; and, with improved understanding, to physi-
cal and psycho-social factors. “Pain is emotion or sensation?” has been a debatable issue.
Razes developed pleasure-pain theory, founded on the theories of Socrates, Plato, Aristotle
and Epicurus. Descartes’ Dualism shifted the centre of pain from the heart to the brain but
negated the psychological contribution to its pathogenesis. Gate Control Theory, fascinated
with the idea of “neurological gates”, highlighted the important role of the brain in dealing
with the messages received. The International Association of the Study of Pain, in 1979,
coined a definition of pain which is currently in use and was last updated on 6th October
2014. Its validity has been challenged and a new definition has been suggested. Whereas the
experience is personalized, immeasurable and unsharable, different cultural groups react
differently to pain from relative tolerance to over-reaction. Gender and ethnic differences in
the perception of pain are well proven and the effects of various religious beliefs adequately
scored. Despite extensive research over centuries, understanding of pain mechanisms is still
far from optimal. Untiring efforts to identify a pain centre in the brain have been futile. Had
it been possible, millions of pain sufferers would have been relieved of their physical agony
and mental anguish by the prick of needle.
.H\ZRUGV Pain; Pleasure; History of Medicine; Culture; Philosophy; Ibn Sina
1
Department of Pharmacology & Therapeutics. RAK College of Medical Sciences RAK
Medical & Health Sciences University. Post Box: 11172. Ras Al Khaimah. United Arab
Emirates. Electronic address: murad@zeast.com
2
Department of Medicine RAK Hospital. Post Box 11393. Ras Al Khaimah. United Arab
Emirates. Electronic address: fauziarazamd@gmail.com
3
Independent Scholar. Lahore, Pakistan
Corresponding Author: Prof. Iqbal Akhtar Khan, MBBS DTM FACTM PhD.
Electronic address: profiakhan@gmail.com


 Introduction
“Halfway between the world of emotions and the realm of sensations, the
history of pain, refers back to history of experience” [1].
Pain is one of the universals of existence. Despite its long and venerable
history, the true nature has not been precisely conceptualized. The present
paper is an attempt to broaden and deepen understanding of the culture and
philosophy of pain, in its historical context.
The word “pain” is derived from “Poena”, the “Roman Spirit of
Punishment” [2]. The Greek goddess of revenge “Poine”, was sent to punish
mortal men who had dared to anger the gods [3]. In middle English (circa 1250
– 1300 AD), the word “Peine” meaning punishment, torture, pain, was deri-
ved from an old French word “Peyn” [4]. According to the ancient Egyptians,
several demons and gods were thought to inflict pain. “Sekhmet”, the most
powerful goddess, was associated with causation of pain in non-believers.
Another god inflicting painful disorders was “Seth” who was the god of de-
serts, storm and chaos. The Egyptians believed that evil spirits entered the
human body through the nostrils and ears. The ancient Indians attributed
pain to the god “Indra”. The Chinese concept of pain includes two opposing
unifying forces, the “Yin” a negative passive force and the “Yang” a positive
active force. Pain results from an imbalance of the two. Pain has different
names in different languages, Dolor in Spanish, Tong Ku in Chinese, Itami in
Japanese, Pathei in Greek, Alam in Arabic, Dard in Persian and so on.
With the passage of time, our understanding of the origin of pain has
enormously improved. Now the belief that pain is an enemy, something co-
ming from outside and invading, has many cultural and historical expressi-
ons in literature and art [5].The origin of pain can be physical and psychoso-
cial, but its persistence might be due to life conditions, norms and gender
related factors which have been unrecognised in research [6]. It has been
established that different cultures react differently to pain [7].

Historical Theories of Evolution of Pain

Galen’s Theory
Claudius Galenus (130 - circa 200 AD) theorized that physical pain in-
volved intense violent irritation of nerves and viewed pain as the lowest
form of sensation. He accepted the Greek theory of humours that the influx
of toxic black bile or acrid yellow bile was usually associated with painful


diseases. He was the first to recognize referred pain and explain it on the ba-
sis of humours [8]. Interestingly, he demonstrated that sectioning the spinal
cord caused sensory and motor deficits [9]. However, he implicated heart as
the central organ for the sensation of pain.
Descartes’ Specificity Theory
The French Philosopher Rene Descartes (1596 -1650 AD), Latinized as
Cartesius, perceived pain as a sensation, like hot and cold. He was the first to
separate the body from the soul by his perception of man as a machine. He
describes pain as “fast moving particles of fire………the disturbance passes
along the nerve filament until it reaches the brain”. He theorized that pain is
due to nerve impulses that are produced by an injury and are directly tran-
smitted to a pain centre in the brain. Pain is, thus, directly proportional to
the extent of the injury [10]. Strangely, there was no room for a psychological
contribution to pain, in his theory.
Pattern Theories
Descartes’ Theory, to thoughtful clinical observers, was clearly wrong
[11]. Several theories collectively labelled as pattern theories were attempts to
find a new understanding. Notable researchers included Arthur Goldschider
(1920), William Livingstone (1945), Willem Noordenbos (1953) and Henry
Beecher (1959). However, none of their theories could explain the explicit
role of the brain other than as a passive recipient of messages.
Gate Control Theory
In 1965, a Canadian psychologist, Ronald Melzack (1929 - ) and a British
neuroscientist, Patrick David Wall (1925-2001) proposed that pain signals
were not free to reach the brain as soon as they were generated at the site
of injury. They encountered certain “neurological gates” at the level of the
spinal cord which determined whether the pain signals would reach the
brain or not. In other words, the brain is not a passive receiver of pain in-
formation but can influence the information received, deciding whether it
is important enough to be registered [12]. The theory specifically includes
psychological factors, like emotions and thoughts, as an integral component
of pain experience. Their paper has been described as “the most influential
ever written in the field of pain”. Although, certain types of pain, phantom
pain and pain in paraplegics could not be explained but this does not nega-
te the theory. To resolve the unanswered issues, Ronald Melzack produced
the “Neuromatrix Theory” which proposes that pain is a multidimensional


experience produced by characteristic “Neurosignature” patterns of nerve
impulses generated by a widely distributed neural network – the “Body Self
Neuromatrix” – in the brain [13].

Pleasure and Pain

“The history of pain problems is as long as that of human beings, however,
the understanding of pain mechanisms is still far from sufficient” [14].
“Complete physical well-being” (an integral component of the official de-
finition of health, by World Health Organization), is based on the absolute
absence of pain. There is a consensus statement that pain and pleasure are
opposites. [15]. An Ancient Greek philosopher, Epicurus (341-270 BC), the
Founder of Epicurean School of Philosophy, viewed supreme pleasure as a
total absence of every type of pain [16]. His compatriot, Plato (428-348 BC),
compared pain to pleasure so that in a situation where a person is suffering
from acute pain, there is nothing pleasanter than to get rid of that pain. Pain
and pleasure would be opposed to one another as to very great to the very
little [17, 18, 19]. Ibn Sina (980-1037 AD), a great thinker and a versatile genius,
describes pleasure as “the feeling of a harmonizing stimulus while pain was
feeling of an incongruous stimulus” [20].
“Pain is emotion or sensation?” has long been debated. . Despite this
extensive debate pain, still, has no clearly defined status, – is it an emoti-
on or a sensation? [21]. Aristotle (384-322 BC), a towering figure in ancient
Greek philosophy, labelled pain an emotion like joy saying that “pain de-
stroys the nature of the person who feels it” [22]. Sir Thomas More (1478-1535
AD), known to Roman Catholics as Saint Thomas, stated pain as the “direct
opposite of pleasure”. David Hartley (1705-1757 AD), a British philosopher,
defined pain as “pleasure carried beyond a due limit”.
William Penn Rogers (1879-1935 AD), American entertainer, asserts “pain
is such an uncomfortable feeling that even a tiny amount of it is enough to
ruin every enjoyment”. Albert Schweitzer (1875-1965 AD), a medical missio-
nary in Africa, goes further by calling pain more terrible lord of mankind
than even death itself. Roselyn Rey, the author of The History of Pain, says
“Pain always has a specific language, whether it is a cry, a sob, or a tensing of
the features, and it is a language in itself as well” [23].
The renowned Experimental Scientist Muhammad bin Zakariya al-Ra-
zi (865-925 AD), Latinized as Razes, developed a Pleasure-Pain Theory.


“Pleasure consists in the restoration of that condition which preceded the
suffering of pain” [24]. This theory could be augmented by the story of the
classical Greek philosopher Socrates (470-399 BC). On the last day of his life,
when he was released from the chains, he said “What a strange thing that
which men call pleasure seems to be, and how astonishing the relation it has
with what is thought to be the opposite, namely pain. A man cannot have
the both at the same time. My bonds caused me pain in my legs, and now
after their removal pleasure seems to be following”. Socrates limited himse-
lf to asserting that the states of pleasure and pain were inseparably linked.
The Marquis De Sade (1740-1814 AD), French philosopher, has elaborated
Socrates’ assertion by saying “It is always by means of pain one arrives at
pleasure”. Don Garret, a renowned academician and philosopher, has asser-
ted that the pain of the anticipation of pain would be stronger than the ple-
asure of the anticipation of pleasure [25]. Immanuel Kant (1724-1804 AD), a
Prussian philosopher, views pleasure as the feeling of furtherance of our life
while pain as the feeling of its hindrance [26].

Pain: A Personalized, Immeasurable

and Unsharable Experience
It was evidently impossible to transmit the impression of pain by teaching,
since it is only known to those who have experienced it.
Claudius Galenus [8]
The French physiologist, Marie Francois Bichat (1771-1802 AD), labelled
pain as the “cry of life”. The British psychologist, Havelock Ellis (1859-1939
AD), describes pain and death as a part of life; to reject them is to reject
life itself. However, pain, although universal, is a personalized experien-
ce. Elaine Scarry, in her scholarly monograph “The Body of Pain”, claims
that the experience of pain is unsharable because it is a private subjective
event that does not simply resist language but actively destroys it [27]. Rene
Leriche (1879-1955 AD), commemorated by The Rene Leriche Prize of the
International Society of Surgery asserts “Physical pain is not a simple affa-
ir of an impulse, traveling at a fixed rate along a nerve; it is the result of a
conflict between a stimulus and the whole individual. It is like a storm, whi-
ch hardly admits of assessment, once it is over” [28]. Jean Jacksen, Professor
of Anthropology at MIT, views pain as “an aversive feeling experienced in
the body that cannot be measured directly” [29]. Renowned novelist and
poet Gibran Khalil (1883-1931 AD), erroneously written Khalil Gibran, in a


unique philosophical approach states “your pain is the breaking of the shell
that encloses your understanding”.

Roots and Types of Pain

Hippocrates (460-377 BC), the Founder of Medicine as a Rational Science,
considered pain as purely a clue to disease of which it is a symptom. The
Roman encyclopedist, Aulus Cornelius Celsus (circa 25 BC-circa 50 AD),
well known for his work “De Medicina”, one of the best sources of medical
knowledge in the Roman world, reiterated the Hippocratic view that pain
suggested specific disorders and provided a prognosis [30].
Ibn Sina (980-1037 AD), the author of “Canon of Medicine” which has
been justifiably labelled as “The First Textbook of Medicine on Earth” [31],
defines pain as one of the un-natural states which afflicts the animal body. He
asserts that pain is sensation produced by something contrary to the course
of nature [32]. He challenged Galen’s concept of pain that injuries (breach of
continuity) were the only cause of pain. On the contrary, he suggested that

Figure 1- Pages 54 and 55 Chapter 20 Volume 1 of the book “- Kitab al-Qanun fi

al-Tibb” Source: SAAB Medical Library-American University of Beirut [34]


the true cause of pain was a change of the physical condition (temperament
change) of the organ whether there was an injury present or not [33]. He has
used the term “Alam” (pain) interchangeably with “Waja” (hurt) to describe
the feelings of the person in pain. It is interesting to note that in old Arabic
usage “Waja” indicates the presence of disease [33].
Ibn Sina has described 15 types of pain which are enumerated below, in
the same chronological order as in the original Arabic text, along with their
English translation [20, 32, 34, 35].
Table 1: “Types of Pain”

6HULDO1R $UDELF (QJOLVK

1 Hakak Itching
2 Khasin Rough
3 Nakhes Pricking
4 Daghet Compressing
5 Moumaded Tension
6 Moufasekh Incisive
7 Moukaser Tearing
8 Rakhou Dull
9 Thaqeb Boring
10 Masalee Stabbing
11 Khader Relaxing
12 Dharabani Throbbing
13 Thaqeel Heavy
14 Ayani Fatigue
15 Lathe Irritant

Modern Definition of Pain

John J Bonica (1917-1994), a towering figure in anaesthesia and the foun-
ding father of “The International Association for the Study of Pain (IASP)”
in 1973, had the vision to envisage multidisciplinary/interdisciplinary pain
programmes. It was under his guiding hands that the IASP, in 1979, propo-
sed a definition of pain as “an unpleasant sensory and emotional experien-
ce associated with actual or potential tissue damage or described in terms
of such damage” [36, 37]. It is currently in use and was last updated on 6th
October 2014. In 1996, Anand and Craig voiced their reservations about


the validity of this definition [38], which opened a new debate. In his com-
prehensive review, Andrew Wright, in 2011, argued that IASP’s definition
lacks the clarity and coherence necessary to provide an adequate definition
of pain. Notable among the issues raised in support of his criticism were the
following:
‒ the definition does not apply to those incapable of self-report
(newborn, small children, mentally retarded, comatosed, demented
or verbally handicapped)
‒ the definition excludes actual pain experience from being classified as
pain because self-report is necessary for attribution of pain
‒ the vagueness of the word “associated” might be thought to imply that
the pain is always caused by tissue damage [39]
To resolve the issue, Andrew Wright has proposed an “Alternative
Definition of Pain” as follows:
“Pain is the unpleasant sensation that has evolved to motivate behaviour
which avoids or minimizes tissue damage or promotes recovery”. This de-
finition, according to him, is “more accurate, more parsimonious and less
ambiguous than the IASP’s definition” [39].

Pain: Should We Curse It All the Time?

Pain might be called a protector, a predictor, or simply a hassle/discomfort
[40].
Clifford J Woolf, Neurobiologist at Harvard, classified pain under three
headings: as an early warning physiological protective system, as adapti-
ve and protective, and as mal-adaptive [41]. This approach seems logical.
Considering that lepers are unable to feel pain in affected parts of the body,
the renowned orthopedic surgeon Paul Wilson Brand (1914-2003 AD), a pi-
oneer in developing tendon transfer in the hands of affected patients, said
“If I had the power to eliminate human pain, I would not exercise that right.
Pain’s value is too great”. This is a protective purpose of pain. Adrian Roger
(1931-2005 AD), President of the Southern Baptist Convention, in “Love
Worth Finding” said, “I can tell the health of a human body by its reaction
to pain. If the body does not react to pain, I know that something there is
dreadfully wrong”. He believes pain to be a sign of God’s love and that it has
predictive and corrective purposes. Imam Ruhollah Khomeini (1902-1989
AD) asserted that realistically life without anguish or pain, and happiness
without grief exist only in imagination.


 Richard Sternbach, a pain specialist, reviewed 17 probable cases of ina-
bility to experience pain in whom the ability to survive was seriously im-
paired [42, 43]. The condition is now described as Hereditary Sensory and
Autonomic Neuropathy, together with another group which has congenital
indifference to pain, in which pain is felt but the response is deficient [44].
The Ancient Greek philosopher Epicurus (341-270 BC), was the first to
assert that the “State of No Pain is Not a Pleasure” [15]. In the modern era,
David Morris, author of “The Culture of Pain”, admitted that “Painlessness
is not a gift but a disguised curse” [45]. John Milton (1608-1671 AD) in his
famous poem “Paradise Lost”, says “But pain is perfect miseries, the worst
of evils, and, excessive, overturns all patience”. He seems, however, to have
over-reacted in these remarks. A more balanced opinion is that of Michael
Houdmann, the Founder President of “Got Questions Organisation”. He be-
lieves “although pain is not pleasant, we should thank God for it because it
alerts us that something is wrong in our body” [46].

Cultural Influence on Pain

Physical experiences such as pain are strongly determined by culture and
religion. (Dr.Jan Frans Dijkhuizen) [47]
While the pain is a ubiquitous condition of human beings, its perception
is “composed of highly interactive emotional and cognitive as well as sensory
components” [48].
The perception and behaviours associated with pain are significantly in-
fluenced by the socio-cultural context of sufferers. Religious beliefs, in addi-
tion, play an important role in reaction to painful stimuli.
The two commonly used terms, for describing pain perception need to
be explained. According to IASP’s Taxonomy (updated 6th October 2014),
the pain threshold is defined as the minimum intensity of a stimulus that
is perceived as painful; the pain tolerance level is defined as the maximum
intensity of a pain-producing stimulus that a subject is willing to accept in
a given situation [49].The other important term is stoicism which literally
means endurance of pain without a display of ill feelings. It also denotes an
Ancient Greek School of Philosophy founded in Athens by Zeno of Citium
– characterised by indifference to pleasure and pain.


 Pain and Christianity
Dear God, Help my unbelief. When I am in pain, I forget that you care about
me. I forget that you have helped me through my trials. I forget that you hold
me in your arms to keep me safe. I forget that you are feeling my pain with me.
I forget that you love me. I forget that I am important to you. Show me your
presence, let me feel your enveloping love. Heal my hurting soul. Thank you
for staying with me even in my unbelief [50].
Arthur John Gossip (1873-1954 AD), Professor of Christian Ethics at the
University of Glasgow concluded “Pain is a kindly hopeful thing, a certa-
in proof of life, a clear assurance that all is not yet over, that there is still a
chance” [51]. The word pain or some form of it appears 70 times in Scripture.
The word’s first usage explains the origin of pain in childbirth. “I will gre-
atly multiply your pain in childbirth, in pain you will bring forth children”
[Genesis-3:16 NASB].
According to the Old Testament in Job 33:19 “Man is also rebuked with
pain on his bed and with continual strife in his bones”. The commentary
tells us that Job complained of his disease, and judged by it, that God was
angry with him; his friends did so too but Eliha (one of Job’s friends) shows
that God often afflicts the body for the good of the soul. Pain is the fruit of
sin, yet by the grace of God, the pain of the body is often made a means of
good for the soul. It is noteworthy that, according to Islam, Job was Ayyub
(Apostle of God).
In certain cultures, endurance of pain is considered to be a praise-worthy
attitude. Certain Christians, in remembrance of the sufferings endured by
Holy Christ try to idealize him by accepting naturally occurring pain or even
by self-chastisement [52].
Pain and Hinduism
The renowned Hindu mystic philosopher and Nobel Laureate
Rabindranath Tagore (1861-1941 AD) said “Let me not beg for the stilling of
my pain but for the heart to conquer it”. In Hinduism, the third largest reli-
gion of the world, pain and suffering, both mental and physical, are thought
to be part of the unfolding of “Karma” (consequences of past inappropriate
actions - mental, verbal or physical - that occurred in either one’s current life
or in a past life). It is not seen as a punishment but as a natural consequence
of the moral laws of the universe in response to past negative behavior [53].


 Pain and Buddhism
Buddha is a Sanskrit word meaning “the awakened one”. The core tea-
chings of Gautama Buddha (circa 563 or 480 BC—circa 483 or 400 BC), the
Founding Figure [54], are contained in the “Four Nobel Truths” as following:
‒ Dukkha (Life is characterized by pain)
‒ Sumudaya (The cause of pain is craving - tanha)
‒ Nirodha (Pain can be ended by cessation of craving)
‒ Magga (There is way to achieve the cessation of pain)
In Pali (a language near to Sanskrit), the term “Dukkha” is generally tran-
slated as “pain” or “suffering” even though it has a wider philosophical me-
aning including dissatisfaction, unhappiness, distress, sorrow, affliction,
anxiety, anguish and so on. Buddha refers to all of these things, which are
unpleasant, imperfect and which we would like to be otherwise [55].
Pain and Islam
Pain receptors are present in the skin without which a person would not
be able to feel pain. Although pain receptors were discovered by the Nobel
Laureate and British physiologist Sir Charles Scott Sherrington (1857-1952
AD) in 1906 [56], there is an interesting mention in Sura Al-Nisa (4:56) of
Holy Quran. This verse has been translated from the original Arabic text, by
the British Orientalist Arthur John Arberry (1905-1969 AD), in “The Koran
Interpreted” as following:
“Surely those who disbelieve Our signs; We shall certainly roast them at a
Fire; as often their skins are wholly burned, We shall give them in exchange
other skins, that they may taste the chastisement. Surely God is Al-mighty,
All-wise”.

Pain and Ethnicity

Dr. James Marion Sims (1813-1883 AD), considered by some “Father of
Gynaecology”, is well remembered for developing the first consistently succe-
ssful surgical technique for repair of vesico-vaginal fistula. He assumed that
people of African descent were less sensitive to pain than those of European
origin. Consequently, during 1845-1849 AD, he operated upon many African
slave women for repair of the fistula without administering anesthesia to any
one of them [57]. Dr. Sims, because of his speciality, could experiment on
women only. It is, therefore, not known what he thought of men of African
descent. Moreover, it is uncertain if his assumption was based on personal


observation or if he was influenced by the unknown quote “Man endures
pain as an undeserved punishment. Woman accepts it as a natural heritage”?
How different cultural groups have been known to react to painful events
has been summarized by Wolff as follows:
“Scandinavians are tough and stoic with a high tolerance to pain; the
British are more sensitive but, in view of their ingrained “stiff upper lip”,
do not complain when in pain; Italians and other Mediterranean people
are emotional and overreact to pain and Jews both overreact to pain and are
preoccupied with pain and suffering as well as physical health” [58]. Anthony
Alvarado, while discussing cultural diversity in reaction to pain, concluded
that in Mexican-Americans emotional self-restraint and stoic inhibition
of strong feelings and emotional expressions are evident while in African-
Americans, the pain expression may be open and publicly voiced. Chinese-
Americans may exhibit stoicism, restraint of anger and pain. The behaviour
of Japanese-Americans is similar to that of Chinese-Americans [59].

Pain and Gender

Wise et al have developed a pain specific “Gender Role Expectations of
Pain” (GREP). The findings indicate that women report lower threshold and
tolerance comparable to men and enduring pain for relatively less time and
conversely,more willing to report pain. [60]. Unruh, while discussing gender
variations in clinical pain experience, has shown that women report clini-
cal pain more frequently, with longer duration and greater severity, than do
men [61]. The meaning of pain for males and females is quite often different
[62]. In a survey conducted by the United States National Center for Health
Statistics, to assess the perception and reaction to pain in both sexes, the
following consistent clinical observations were observed [63,64]:
‒ males and females report differing symptomatology associated with
the same disease process
‒ females report higher levels of pain with the same clinical conditions
‒ females report elevated levels of pain with similar amount of tissue
injury
‒ females have a higher propensity to use analgesics than do males.
In an interesting study in pain clinics in North London, Bendelow found
that the perception of physical pain was gender related. Women were better
equipped for pain in relation to childbirth. For women, pain was natural and
common, whereas for men, it was unnatural and uncommon [65]. Rhudy and


Williams suggest there are gender differences in the experience and percep-
tion of emotions that, in turn, differentially alter the processing of pain [66].
The following ways of inducing positive emotions have been shown to redu-
ce pain:
‒ Experimental induction of positive mood [67]
‒ Sexual excitation [68]
‒ Relaxation [69]
Conversely, negative emotions have been found to be associated with in-
creased pain. Situational anxiety results in greater sensitivity to pain [70].

Conclusion
“It is a shame that we possess such insufficient knowledge concerning the
character of pain - those symptoms which represent the essential part of all
body sufferings of man”[Arthur Goldschider-1894]
Pain has a long and venerable history, with origins attributable initially
to godly punishment for disbelievers; and with improved understanding, to
physical and psycho-social factors. Aristotle did not include a sense of pain
when he enumerated the five senses. Hippocrates and Galen theorized that
pain was caused by an imbalance in the vital fluid of humans. However, ne-
ither was convinced of any role of the brain in the causation of pain. They
viewed the heart as the central organ for the sensation of pain. Ibn Sina
challenged Galen’s concept of pain that injuries (breach of continuity) were
the only cause of pain. To him, the true cause of pain was a change in the
physical environment, with or without an injury.
Descartes’ Specificity Theory perceived pain as a sensation, like hot and
cold but had no room for a psychological contribution. However, the center
of pain was shifted from the heart to the brain. The Gate Control Theory,
of Melzack and Wall, was a great breakthrough demonstrating that the bra-
in was not a passive receiver of messages. The idea of “neurological gates”
at spinal cord level was fascinating to those not convinced by the previous
theories. Cartesian Dualism (holding that the mind is a non-physical entity),
which had dominated the scientific literature for more than 300 years, was
absolutely negated by the Gate Control Theory.
Whereas experience is personalized, immeasurable and unsharable, di-
fferent cultural groups react distinguishably to pain from relative tolerance
to over-reaction. Gender and ethnic differences in the perception of pain are


well proven. Razes developed a pleasure-pain theory, founded on the the-
ories of Socrates, Plato, Aristotle and Epicurus. This theory was enriched
by Baruch Spinoza and Immanuel Kant. Although, pain is said to “destroy
the nature of the person who feels it”; its predictive, protective, adaptive
and corrective roles cannot (and should not) be underestimated. However,
it frequently exceeds its protective function and becomes destructive. The
state of painlessness is not to be taken as a blessing or a divine gift. It is rather
disguised misery because life is inseparable from and unthinkable without
pain.
The International Association of the Study of Pain, founded in 1973,
coined an official definition of pain which was first published in 1979. It is
currently in use and was last updated on 6th October 2014. However, it met
strong criticism from certain quarters on the grounds that the definition lac-
ked the necessary clarity and coherence. The debate goes on and an alter-
native definition has been suggested by Andrew Wright. Now the ball is in
the court of a Working Group of the IASP to reach an agreeable solution, in
consultation with experts in academic and hospital medicine.
A fitting closing sentence would be a quote from Ronald Melzack (2001)
“Pain may be the warning signal that saves the lives of some people, but it
destroys the lives of countless others” [13].

References
1. Thomas S, House P (Translators), Javier Moscoso’s. Pain: A Cultural History
2012 (Hampshire: Palgrave MacMillan 2012).
2. PerI ER. Ideas about Pain: A Historical View (London: Nature Reviews
Neuroscience 2007), 8(1):71-80.
3. Robbins J. Dissolving Pain: The Conventional Understanding of Pain . Google
Books 2010 September 2010 Shambhala Publishers), Chap 3.
4. Whitworth ML--The History of Pain (Indiana Pain Society).
5. Bourke J.The History of Medicine as the History of Pain (London: History
Today) 2011, 61(4).
6. Mc Donough PA.The Social Production of Housework Disability (Philadelphia:
Women Health 1996), 24(4):1-25.
7. Kern E. Cultural-Historical Aspects of Pain (Pain 1987), 38: 165-181.
8. Finger S. Origin of Neuroscience:A History of Explanations into Brain
Function-Oxford 1994 Oxford University Press


9. Ochs S-A History of Nerve Functions:From Animal Spirits to Molecular
Mechanisms Cambridge 2004 Cambridge University Press
10. Descrates R-Treatise of Man with Translation and Commentary by TS Hall
Harvard 1972 Harvard University Press
11. Melzack R-Pain:Past,Present and Future-Can J Experimental Psychology 1993
47(4):615-629
12. Melzack R,Wall PD. Pain Mechanisms:A New Theory –Science New Series
1965 150(3699):971-979
13. Melzack R---Pain and the Neuromatrix in the Brain—J Dental Education
December 2001 65(12):1378-1382
14. Chen J--- History of Pain Theories (Shanghai: Neuroscience Bulletin, October
2011), 27(5): 343-350.
15. Jim Robbins J, Les Fehmi. Dissolving Pain:Simple Brain-Training Exercises for
Overcoming Chronic Pain-Google eBooks 2011
16. Nash TP. Editorial ii What Use in Pain? British J Anaesthesia – 2005,
94(2):146-149.
17. Berden WH. Plato’s Theory of Pleasure (Chicago: Master of Arts Thesis Loyola
University Chicago August 1942).
18. Tuozzo TM. The General Account of Pleasure in Plato’s Philebus (Berkley: J
Hist Philos 1996), 34(4):495-513.
19. George Coevals S, Usher MT. Pain and Pleasure in Plato’s Physiology (Adelaide:
Flinders University Department of Languages 2005).
20. Gruner OC, Shah MH(Translators). The Canon of Medicine by Avicenna (New
York: AMS Press New York 1973).
21. Rollman GB. Culture and Pain in “Cultural Clinical Psychology: Theory,
Research and Practice” (Editors SS Kazarian SS, DR Evans DR Oxford
University Press 1998).
22. Dow J. Aristotle’s Theory of Emotions: Emotions as Pleasure and Pain -In Moral
Psychology and Human Action in Aristotle (Oxford: Oxford University Press
2014), 47.
23. Wallace LE, Cadden JA, Cadden SW(Translators). The History of Pain by
Roselyn Rey (Paris: Palais de la Decouverte 1993).
24. Myers E. Arabic Thought and the Western World in the Golden Age of Islam
(East & West 1964).
25. Garrett D. The Cambridge Companion to Spinoza-Cambridge University Press
1996.


26. Makkreal RA. Imagination and Interpretation in Kant: The Hermeneutical
Import of the Critique of Judgement (Chicago: University of Chicago Press
1990).
27. Scarry E. The Body in Pain: The Making and Unmaking of the World (Oxford:
Oxford University Press April 1987).
28. Young A (Translator) -----The Surgery of Pain (Rene Leriche 1939).
29. Jackson JC. Stigma, Liminality, and Chronic Pain: Mind-Body Borderlands
(Malden: American Ethnologist 2005), 32(3): 332-353.
30. Spenser WG. Translator), Celsus on Medicine (De Medicina vol 1 Harsard/
Henemann/Loef Classical Library January 1935), vol 1-Book 1-4.
31. Ronan Von CA. The Cambridge Illustrated History of the World’s Science
(Cambridge: Cambridge University Press 1983).
32. Bakhtiar L(Translator). The Canon of Medicine by Avicenna (Chicago: Kazi
Publications Inc 1999).
33. Tashani OA, Johnson MI. Avicenna’s Concept of Pain –Libyan J Medicine 2010
5.5253
34. Ibn Sina, Kitab al-Qanun fi al-Tibb Original Arabic Text (Rome: Typographia
Mediceal 1593).
35. Abu Asab M, Amri H, Micozzi MS. Avicenna’s Medicine: A New Translation
of the 11th Century Canon with Practical Applications for Integrative Health
Care (Rochester: Healing Arts Press 2013).
36. Merskey H, Bogduck N. Classification of Chronic Pain (Seattle: Pain Terms part
iii:, A Current List with Definitions and Notes on Usage IASP Task Force on
Taxonomy-IASP Press, Seattle 1994), Second Edition.
37. Merskey H. An Investigation of Pain in Psychological Illness (Oxford: DM
Thesis 1964 Oxford University
38. Anand KJS,Craig K-New Prospectives on the Definition of Pain-Pain 1996
67:3-6
39. Wright A. A Criticism of the IASP’s Definition of Pain-J Consciousness Studies
2011 18(9-10):19-44
40. Alam MT, Ansari AH, Ahmad W et al, Pain: Concept and Description in Unani
System of Medicine (Ardabil: Int J Tradit Herb Med 2013), 1(5)147-152.
41. Woolf CJ. What is this thing called pain? -Michigan: J Clinical Investigation
2010), 120(11): 3742-3744.
42. Sternbach RA. Congenital Insensitivity to Pain: A Critique (Washington:
Psychological Bulletin 1963), 60: 252-264.
43. Sternbach RA. Pain: A Psychophysiological Analysis (New York: New York
Academic Press 1968), 95-115.


44. EM Nagasako EM, Oaklander AL, DwarkinRH. Congenital Insensitivity to
Pain: An Update (Philadelphia: Pain 2003), 101: 213-219.
45. Morris DB----The Culture of Pain (Berkley: University of California Press 1991).
46. S. Houdmann M. What Does Bible Say about Pain? (Got Questions
Organization).
47. van Dijkhuizen JF. Pain and Compassion in Early Modern English Literature
and Culture-Boydell and Brewer Publishers November 2012.
48. Gijsberg K, Niven CA. Women and the Perception of Pain In Health Psychology
of Women Harwood Academics Geneva Switzerland 1993.
49. IASP. Taxonomy of Pain-International Association for the Study of Pain –Last
Updated 6th October 2014
50. Dailey TJ. Healing Through the Power of Prayers: What the Bible says about
Healing (Lincolnwood: Publications International Limited 1998).
51. Gossip AJ. The Galilean Ascent (Edinburg T&T Clark 1926), 277.
52. Hardy JD, Wolff HG, Goodell H----Pain Sensations and Reactions (Baltimore:
Williams and Wilkins Company 1952).
53. Whitman SM. Pain and Suffering as viewed by the Hindu Religion Philadelphia:
J Pain 2007 8:607-613.
54. O’Brien B. The Four Nobel Truths-The Foundation of Buddhism---Religion
and Spirituality-About.Com.Buddhism.
55. Harvey P. An Introduction to Buddhism:Teachings,History and Practices
(Introductions to Religion) Cambridge University Press 1990.
56. Burke RE. Sir Charles Sherrington’s The Integrative Action of The Nervous
System: A Centenary Appreciation (Oxford: Brain 2007), 130: 887-894.
57. Wall LL. The Medical Ethics of Dr. James Marion Sims: A Fresh Look at the
Historical Record (London: J Med Ethics 2006), 32(6): 346-350.
58. Wolff BB. Ethnocultural factors influencing pain and illness behavior (Seattle:
Clinical J Pain 1985 1: 23-30.
59. Alvarado AJ. Cultural Diversity:Pain Beliefs and Treatment among Mexican-
Americans, African-Americans , Chinese-Americans and Japanese-Americans-
Senior Honors Theses Eastern Michigan University 2008 page127.
60. Wise EA,Price DD,Myers CD et al--Gender Role Expectations of Pain:
Relationship to Experimental Pain Perception.J Pain 2002 April 96(3):335-342
61. Unruh AM. Gender Variations in Clinical Pain Experience (Philadelphia: Pain
1996), 65: 123-167.
62. Johansson EE, Hamberg K, Westman G et al-----The Meaning of Pain: An
Exploration of Women’s Description of Symptoms (Philadelphia: Social Science
& Medicine 1999), 48: 1791-1802.


 63. Berkley KJ. Sex Differences in Pain (Behavioral and Brain Sciences 1997), 20
(3): 371-380.
64. Miaskowski C-. The Role of Sex and Gender in Pain Perception and Response
to Treatment in Gatchel R, Turk D (Editors) (Psycho-social Factors in Pain 1999
New York Guilford Publications), 401-411.
65. Bandelow G. Pain Perceptions, Emotions and Gender (Sociology of Health and
Illness 1993), 15(3): 273-294.
66. Rhudy JL, Williams AE. Gender Differences in Pain: Do Emotions Play a Role?
(Philadelphia: Gender Medicine 2005), 2(4): 208-226.
67. Zelman DC, Howland EW, Nicholas SN et al. The Effect of Induced Mood on
Laboratory Pain (Philadelphia: Pain 1991), 46: 105-111.
68. B Whipple B, Komisaruk BR. Elevation of Pain Threshold by Vaginal
Stimulation in Women (Philadelphia: Pain 1995), 21: 357-367.
69. Cogan R, Cogan D, Waltz W et al. Effects of Laughter and Relaxation on
Discomfort Thresholds –J Beh Med1987 10: 139-144.
70. Schumacher R, Veldon M. Anxiety, Pain Experience and Pain Report-A Single
Detection Study (Missoula: Perceptual and Motor Skills 1984), 58: 339-349.

$FNQRZOHGJHPHQW
The authors are highly grateful to Dr. J. Paul Miller for reviewing the manuscript
and editing the language.

SAŽETAK
Bol, jedna od univerzalija egzistencije, ima dugu i štovanja vrijednu prošlost, čiji se izvori
mogu primarno pripisati božjoj kazni za nevjerne; i s unaprijeđenim shvaćanjem fizičkog i
psihosocijalnog. “Da li je bol osjećaj ili utisak?” pitanje je za raspravu. Razes je razvio teoriju
zadovoljstva-boli, na temeljima Sokratove, Platonove, Aristotelove i Epikurove teorije.
Descarteov dualizam premjestio je centar boli sa srca na mozak, ali je negirao psihološki
doprinos u patogenezi. Teorija ulaznih vrata (Gate Control Theory) fascinirana idejom “ne-
uroloških ulaznih vrata” pokazala je važnu ulogu mozga u prenošenju poruka. Nepobitnost
njenih pojedinih elemenata bila je dovedena u pitanje, te je predložena alternativa, nova
definicija. Međutim iskustvo je osobno, nemjerljivo i nedjeljivo, različite kulturološke skupine
različito reagiraju na bol: od relativne tolerancije do pretjeranih reakcija.
Spolne i etničke razlike u percepciji boli jasno su dokazane, kao što su adekvatno zabilježeni
učinci različitih vjerskih uvjerenja na nju. Unatoč višestoljetnim opsežnim istraživanjima,
razumijevanje mehanizma boli, vrlo je udaljeno od optimalne razine. Neumorni napori kako
.OMXĀQHULMHĀL Bol; zadovoljstvo; povijest medicine; Kultura; Filozofija; Ibn Sina



View publication stats