The Challenge of Pain (Updated Second Edition)

"Over the years a scientific revolution has taken place in the field of pain research and therapy. A major catalyst for this change was the introduction in 1965 by Professor Ronald Melzack and Professor Patrick D. Wall of the ‘gate control’ theory of pain, which led to an explosion of research studies and new therapeutic approaches. In this informative and important study they explore the current status of pain research and treatment. Divided into four sections, the book describes the psychological and clinical aspects of pain, presents the rapidly increasing physiological evidence and examines the major theories of pain and their implications for its control. The authors emphasize the need to promote education regarding the treatment of pain among both health professionals and patients, arguing that many people suffer needlessly through ignorance of medical advances. In the final section they explain the exciting developments in pain control, in particular the radical approach to the control of chronic pain being pioneered by pain clinics and hospices. ‘The most valuable introduction to the subject of pain available at the undergraduate level ... a clear and enthusiastic account’ — Ray Hill in the New Scientist ‘A very good and useful book ... recommended very highly’ — H. J. Eysenck ‘A marvellous book... there are few books dealing with the problem of pain that are as worthy’ — I. S. Cooper in the American Journal of Psychiatry" "We consider ourselves extremely privileged to have taken part in a genuine scientific revolution in the past two decades. Until the middle of this century, pain was considered primarily to be a symptom of disease or injury. We now know that chronic, severe pain is a problem in its own right that is often more debilitating and intolerable than the disease process which initiated it. The problem of pain was therefore transformed from a mere symptom to be dealt with by the various medical specialities to a speciality in its own right which is now one of the most exciting, rapidly advancing fields of science and medicine. When we proposed the gate-control theory in 1965, we hardly dreamed of the explosion in research studies and new therapeutic approaches that followed. It was our unexpected good fortune that the theory came at a time when the. field was ripe for change. In the 1960s, a wave of new facts and ideas (that had evolved gradually) was beginning to crest, and the gate-control theory rode in on the wave of the times. No one was more astounded at its success than we were. Naturally, acceptance was not immediate or total, but in spite of continuing controversy about details, the concept that injury signals can be radically modified and even blocked at the earliest stages of transmission in the nervous system is virtually universally accepted. In recent years, our understanding of pain mechanisms has increased enormously and new,effective treatments for pain have evolved. There is now an urgent need for education. Despite the obvious progress in our knowledge, many people who suffer cancer pain, post-surgical pain, labour pain and various chronic pains are inadequately treated. We are appalled by the needless pain that plagues so many people. Part of the problem lies with the health professionals who have failed to keep up with the advances in our field. Part lies with the patient who is often too meek to demand the basic human right to pain relief. Every human being has a right to freedom from pain to the extent that our knowledge permits health professionals to achieve this goal. Our purpose in this book is to describe the current status of pain research and treatment as well as to point to future goals and ways to achieve them. The book contains four major sections. The first section describes the psychological and clinical aspects of pain and outlines the scope of the challenges of pain. The second section presents the physiological evidence regarding pain, which continues to grow at a breathtaking pace. The third section examines the major theories of pain in terms of their ability to explain pain phenomena and their implications for the control of pain. The final, fourth. section describes the exciting new approaches to pain control and the rapidly evolving conception that the terrible suffering of patients with chronic pain, such as pain due to nerve injury or cancer, need an entirely new approach characterized by the pain clinic and the hospice." "Ronald Melzack is Professor of Psychology at McGill University and Research Director of the Pain Center at the Montreal General Hospital. After receiving his Ph.D. from McGill, he carried out research at the University of Oregon Medical School, the University of Pisa and University College London. When he was Associate Professor at the Massachusetts Institute of Technology, he and Professor Wall began an exchange of ideas which led to the publication of the gate-control theory of pain in 1965. The theory has subsequently had a profound impact on research and treatment related to pain. Professor Melzack is the author and editor of several books and many scientific articles on pain. He is a former President of the International Association for the Study of Pain and has won many awards for his contributions to understanding pain. Patrick D. Wall is Professor Emeritus at the University of London and does research on the physiology of pain at United Medical and Dental Schools, St Thomas’s Campus, London. After receiving his medical degree from Oxford, he worked at the Universities of Yale, Chicago and Harvard, and at the Massachusetts Institute of Technology. It was his research which established the physiological basis of the gate-control theory of pain and he continues his physiological studies particularly in relation to the chronic as well as to the acute effects of injury. Professor Wall is editor, with Professor Melzack, of the Textbook of Pain, and has published numerous articles on pain. He has received many honours for his work from a number of countries and is the founding editor of the journal _Pain_. He is a Fellow of the Royal Society."