Some (mostly Scottish) local anaesthetic heroes.

In 1884 a young Viennese doctor, Carl Koller, was the first to recognise the significance of the topical effects of the alkaloid cocaine and thus introduced drug-induced local anaesthesia to clinical practice. Most subsequent development took place in Europe and the United States, with British interest not becoming apparent for over twenty years. This is surprising because a number of doctors working in Scotland, or with Scottish connections, had made important contributions to the earlier evolution of local anaesthetic techniques. This paper reviews the relevant work of James Young Simpson, Alexander Wood, James Arnott, Benjamin Ward Richardson and Alexander Hughes Bennett and the role of John William Struthers in the later promotion of the techniques.

Breve historia del dolor y de la analgesia / Brief history of pain and analgesia

El dolor ha acompañado al ser humano desde el mismo momento en que éste apareció sobre la tierra. Desde entonces, y a lo largo de toda su historia, el hombre ha tratado no sólo de buscar la razón del mismo, sino también de encontrar remedios para su alivio(AU)

Pain has accompanied human beings since the moment this species appeared on Earth. From that moment on, and throughout his long history, mankind has tried not only to look for the causes of pain but also to find remedies to relieve pain(AU)

The role of acupuncture in the management of subfertility.

OBJECTIVE: To review systematically the use of acupuncture in the management of subfertility. DESIGN: A computer search was performed via several English and Chinese databases to identify journals relevant to the subject. RESULT(S): The positive effect of acupuncture in the treatment of subfertility may be related to the central sympathetic inhibition by the endorphin system, the change in uterine blood flow and motility, and stress reduction. Acupuncture may help restore ovulation in patients with polycystic ovary syndrome, although there are not enough randomized studies to validate this. There is also no sufficient evidence supporting the role of acupuncture in male subfertility, as most of the studies are uncontrolled case reports or case series in which the sample sizes were small. Despite these deficiencies, acupuncture can be considered as an effective alternative for pain relief during oocyte retrieval in patients who cannot tolerate side effects of conscious sedation. The pregnancy rate of IVF treatment is significantly increased, especially when acupuncture is administered on the day of embryo transfer. CONCLUSION(S): Although acupuncture has gained increasing popularity in the management of subfertility, its effectiveness has remained controversial.

Management of childhood diseases in the Byzantine period: I -- analgesia.

Evidence on the use of pain relievers for medical purposes in childhood was traced in medical treatises during Byzantine times (4th to 15th century ad). The texts of Aetius, Paulus Aeginitis, Orivasios and others strongly reveal influences from ancient Greek medicine. Greek physicians of the times, who helped the medical thinking of antiquity to stay alive, used opium with mandragoras, hyoscyamos and other sedative herbs to produce a kind of anesthetic state and to relieve pain. However, in children's cases they chose to selectively use substances in more standardized quantities, mainly in mixtures. Less aggressive methods such as warm baths, or appropriate food were highly respected by them and recommended for the treatment of sick children.

[Pain--life's dreaded companion. Cultural history of algology and the most important achievements]. / Smärta--livets fruktade följeslagare. Algologins kulturhistoria och de viktigaste landvinningarna.

Pain is a comprehensive phenomenon which concerns not only physiology, biochemistry and molecular biology but also music, art, religion, philosophy and everyday life. The early contributions to the development of the specificity theory is described, as are some of the important discoveries in the history of algology, such as Baillou's description of rheumatism, Heberden's description of angina pectoris and the development of the gate control theory. Despite a number of important discoveries and a much improved knowledge in basic science pain is still the dreaded companion of mankind.

The history of algology, algotherapy, and the role of inhibition.

Cephalalgia (1st century AD), nostalgia (1678), neuralgia (18th century), causalgia (1872) were terms followed in the 1950's by Bonica's 'algology... a disease state of its own', addressed by ever-growing numbers of pain clinics, strongly foreshadowed by Leriche's douleur maladie in the 1930's. (Hence also 'algotherapy'). Philosophers first, then early academic physiologists began to exhibit interest in pain, that all too common phenomenon, only too often unyielding to theoretical as well as practical efforts. Was it, after all, an instance of built-in self-preservation, a reflex? Identification of the nervous energy and its anatomical pathways in the 19th century, endless arguments as to their 'specificity', led to new surgical attempts to control and interpret pain, by now supported by general, then local anesthesia. Early in this century Henry Head's much-discussed notion of 'epicritic' sensation exerting some control over 'protopathic' pain was soon followed by Otfried Foerster's insistence on a central role of inhibition providing pain relief. Almost forgotten, Foerster's idea found expression in Melzack and Wall's 'gate control theory' of 1965. Gasser and Erlanger's classification of sensory nerve fibers began to dominate research in the 1930's thanks to the cathode ray oscillograph invented in 1897. The pain inhibition concept was given another boost in the seventies when the role of the midline mesencephalic and oblongata nuclei was established as both opium receptors and producers of opioids. Finally, inhibition may also be seen as the principle underlying the age-old therapeutic effect of 'counter-irritation', mostly in the form of electrical stimulation.

[Historical aspects of pain relief during normal parturition]. / Historische aspecten van het stillen van pijn tijdens de normale baring.

Traditional methods used for the relief of pain during normal delivery are few and the medical literature remained silent on this topic up to the middle of the 19th century. Indeed, the first effective method was etherization, and it was introduced by Simpson (Edinburgh) in 1847. Obstetric inhalation analgesia was followed by many other methods the development of which was based on new discoveries in chemistry, pharmacology, physiology, and psychosomatic medicine. This paper reviews the milestones in the historical development of obstetric analgesia.

Intraspinal analgesia: an historical overview.

The application of opioids in the proximity of the spinal cord is a recent addition to the forms of treatment available for pain relief. During the last 20 years we have learned more about the intimate mechanisms of the action of opiates then we had in the preceding 5 millennia. Opium, in fact, has been used for medical purposes from prehistoric times. On the basis of the newly acquired knowledge, we are now applying opioids in more effective ways and providing more patients with long overdue relief of their pain.