stravers - PERSPECTIVES TIMELINE Ideas about pain, a...

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The word ‘pain’ and its synonyms commonly refer to conscious experiences associated with bodily injury or disease, but are also used to describe discomfort related to other unpleasant feelings. These different circumstances are the bases of a long-standing uncertainty regarding how to think about pain and its mechanisms. This article aims to provide a historical perspective on changing views over the past two centuries. There is a legacy from distant times. Aristotle (384–322 BC) considered the heart to be the seat of feelings. Taking cognizance of pain’s usual importance for disposition, he argued it to be an emotion. Not all ancient Greek philosophers agreed; however, Aristotle’s influence on philo- sophical thought endowed his views with an enduring impact. ±enturies later, Galen (²D 130–201), a leading physician–surgeon of Alexandria, used experimental studies along with earlier observations to disagree. Galen recognized the brain as the organ of feeling and placed pain into the sphere of sensation. Avicenna (²D 980–1037), a renowned Muslim philosopher and physician, noted that, in disease, pain can dissociate from touch or temperature recog- nition, and proposed pain to be an inde- pendent sensation 1–3 . ³espite much work and thought since these ideas were aired, fundamental issues about pain remain unresolved. Notably, these include whether pain results from the activity of a dedicated neural apparatus or is the product of less specific processes 4 . Much attention was given to nervous system anatomy after the Middle Ages; however, progress in thinking regarding pain awaited developments in understanding of the natural world and scientific tools. For example, until the beginning of the nine- teenth century, ideas about sensation were mired in the belief that the senses depend on the transport of an agent from the outside world to the heart or brain. That concept lost favour in the eighteenth century due in part to changing insight into the physical world and proposals by Newton (1642–1727) and Hartley (1705–1757) that neuronal messages were vibrations of substance in nerves 2 . This article highlights the sequence of ideas and observations since 1800 that have contributed to concepts about the nature of pain and its neural mechanisms (TIMELINE) . Although it is a focused history, it also pro- vides insight into progress in understanding the function of the mammalian nervous system. Nineteenth century issues Afferent pathways for somatic senses. How different information from the body is trans- mitted to and from the spinal cord and brain was seriously addressed in the nineteenth century. In 1811, ´ell, a Scottish physician and anatomist, proposed that the dorsal and ventral spinal roots differ in function, with the ventral roots being responsible for control of muscle contraction 5 . However, ´ell was vague about the role of the dorsal roots and Magendie (1822) is generally credited with demonstrating their sensory function 6 . These discoveries provided crucial tools for subsequent experimentation. ´ell
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stravers - PERSPECTIVES TIMELINE Ideas about pain, a...

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