PAIN, CONSCIOUSNESS AND ANESTHESIA

Since time immemorial man has tried to avoid pain and to manage it in some way in order to alleviate or suppress it.

Without wishing to make a historical review of the many written references on pain, since ancient times there has been an evident concern to try to control it.

An interesting concept of modern medicine is how physical pain is blurred with psychic pain, often becoming confused. The boundary between the one and the other has always been very tenuous and easily crossed, making it difficult to distinguish well between pain and suffering, so it is easier to consider it as a whole; Aristotle already described the two “with center in the heart”.

The relationship between the state of consciousness and pain perception has always been recognized, hence the most effective against pain was to disconnect “the conscious”.

History provides us with examples in which, by influencing consciousness, it was possible to attenuate or suppress the perception of pain, by means of different degrees of manipulation or depression of the central nervous system.

The earliest written evidence of the use of sedation as a pain treatment comes from the Sumerians and Egyptians who used opium, an alkaloid from the “poppy” (papaver somniferum), a plant native to Asia Minor, to produce a “pain-suppressing” sleep.

Opium was probably the first drug discovered by humans and has served since prehistoric times to relieve pain, as a specific against fever and gastrointestinal ailments, and to induce sleep. In 1803 Sertürner isolated the active principle of this alkaloid and named it morphine (from “Morpheus”, the Greek god of sleep).

But throughout history all kinds of sedative concoctions and potions were used, such as máfèisàn or dwale, mixtures of extracts of different herbs containing substances such as cannabis or blue-flowered matalobos (Aconitum napellus), a poisonous plant; others contained belladonna, one of the most toxic plants in the northern hemisphere; or mandrake and henbane, capable of inducing deep and lasting unconsciousness, widely used to sedate in Europe, Asia and the Islamic world from the 15th century until well into the 19th century.

Other methods used to influence consciousness as a treatment for pain (much less effective than “potions” which, in inexperienced hands, could end up poisoning the patient) were: hypnotic suggestion and alcohol intoxication, used to practice bloody cures. Another classic example is controlled anoxia, which is related in the Hebrew tradition to perform circumcision on children. And finally, as an extreme case, when all this failed or was not available, a craniocerebral trauma was used to render unconscious those patients who needed to undergo surgery, a common method in 18th century medicine.

With this brief “historical brushstroke” we can get an idea of how interventions were in the past and remember how pain, consciousness and anesthesia have always gone hand in hand.