Pain: A Literature Review

Reckoning with pain, in its acute form, is an essential aspect of human existence. Indeed, pain and pain behavior, in the Darwinian sense, are understood as a beneficial part of our genetic lineage, one that, the analogy goes, operates as a warning system in order to prevent tissue damage. The perennial illustration of the value of such a system is the rare medical condition called congenital analgesia. Because this condition prevents the maintenance of important sensory neurons that create the slew of sensation we take for granted in everyday life, those born with this unfortunate disorder often lose their digits to repeated trauma or otherwise mutilate tissue in mundane acts, such as in eating, and have significantly shortened life spans (Wolf 2007). This, of course, is due to the absence of pain behaviors that are a part of the reaction to pain, from removing one's hand from the stove to retreating to a safe location after an injury. Behaviors like these and others, such as facial and verbal expression, may also serve as selected-for reflexes to alert entire groups of danger and to signal the need for medical attention (Williams 2002). Acute pain, then, is not only (almost) ubiquitous, it is also useful. It is a biological event and also an adaptive one, to greater or lesser degrees. Chronic pain, however, is not experienced by everyone, nor is it clear to what epidemiological extent it has occurred across history and cultures (Kleinman et al. 1992:3). In many cases, chronic pain persists well after the original site of injury has healed. In many more, there was never a clear organic origin in the first place.

Chronic pain has constantly challenged the biomedical model of disease, where signs and symptoms are usually subsequent to discrete entities, and has led to a rather remarkable rethinking of pain—acute and chronic—that can be found inside and outside of medicine. This change, although by no means universal or homogeneous, manifested after World War II. Three key examples from the 1960s illustrate this: in 1961, the anesthesiologist John Bonica founded the first multidisciplinary clinic in Seattle; in 1965, Melzack and Wall (a psychologist and physician, respectively) proposed the Gate Control Theory, a framework for the mechanics of pain that emphasized the descending modulatory effects of psychological factors on the experience of pain; and, in 1969 Mark Zborowski, an anthropologist, published his ethnography documenting the effects of ethnicity in a Bronx VA hospital.

Pain—all pain—besides being a medical or adaptive event, then, is something that occurs in context of the individual and the sociocultural factors that mold its experience and display. It is thus a highly appropriate field of study for anthropology and other social sciences. The study of pain also allows for an opportunity to reflect on biomedical values and assumptions, the power structures of medicine, and the larger political economic factors that help mold the medical encounter (or otherwise prevent it from occurring). Indeed, many of the themes found in these areas of research in general manifest in the management of pain and are discussed in this review.

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