Human beings have always had a love/hate relationship with pain.
While pain and suffering have always been viewed as something all humans had to endure (including Biblical stories such as childbirth pain being due to the sin of Eve or Job being afflicted with suffering to test his faith), the idea that bearing pain stoically was a sure sign of virtuous living was rarely far behind. The very word “stoic” stemmed from a philosophical school that viewed pain and suffering as essential to being truly human. In St. Paul's First Letter to the Colossians, he wrote that: "I fill up that which is behind the afflictions of Christ in my flesh". Virtually every organized religion has regarded pain as a necessary evil. At the same time, herbal remedies for dealing with pain are as old as medicine itself. While physicians and other healers often viewed pain as being an important sign of disease and that masking it with medication interfered with treatment, they were also quick to dispense whatever pain-relieving agents that they had at their disposal to patients in agony. That usually included the familiar standby, papaver somniferum (a.k.a., the opium poppy), which was cultivated for its analgesic properties as far back as neolithic times in most of Eurasia.
Even with the advent of anesthesia in the 19th century, new innovations including morphine, chloroform, and nitrous oxide were greeted with mixed feelings, especially among religious leaders who viewed such innovations as somehow being a subversion of God’s plan. Queen Victoria’s very public decision to use chloroform to ensure a painless delivery of one of her children in 1853 was greeted with alarm at first although it also helped spread the word that anesthesia was safe and effective. Despite religious qualms, the era of painless dentistry and surgery had begun.
By the dawn of the 20th century, anesthesia was already widely used in surgery. While pessimistic philosophers such as Arthur Schopenhauer stressed the inescapable nature of pain in their own writings, improvements in medicine, including the wide availability of powerful analgesics, made pain relief universally available (at least to those who could afford it). Even familiar remedies such as morphine seemed to be superseded by better and stronger alternatives, including heroin which was available in numerous locations without a prescription.
As the dangers associated with opiate addiction became better understood, an inevitable backlash set in. Many commercially available analgesics were eventually banned under international narcotics laws. Prohibition became a dominant movement in the United States while, in other countries, medical doctors, theologians, and social critics viewed the addictive properties of many popular narcotics with increasing alarm. This alarm was spurred by the thousands of wounded veterans of World War I, many of whom were left addicted to the pain medication that had been prescribed to them. This public alarm led to attempts at reconceptualizing how pain should be treated. Rather than viewing pain as something to be eliminated by any means possible, wasn't it possible that resisting pain was actually a virtue and that giving into pain by demanding medical relief was actually a form of cowardice?
By 1935, French writer and journalist, Julien Teppe, became the leading force in what had already been named the "dolorism" movement. Taken from the Latin word for pain, dolorism basically exalted the value of pain, both medically and philosophically. The two books that Teppe wrote, Apologie pour l'anormal (a.k.a. the "Dolorist manifesto") in 1935 and Dictature de la douleur in 1937 justified dolorism as a reaction against what Teppe called the "tyranny of the fit". He viewed pain as a way of learning about onself (essentially arguing that "I am suffering, therefore I am"). He also wrote that, "Pain, of all the psychological states, is the one which takes over the entire being, both the flesh and the spirit, with the greatest urgency and force. It is a disposition which sweeps away, blots out, and annihilates all the rest." Through pain, humans learn about compassion for other human beings and inability to understand suffering was the root cause for hostility and intolerance. Not only did Teppe argue for a better understanding of pain, he also suggested that students in all programs be required to visit hospitals and sanatoriums as part of their education.
While not an original concept (existentialist philosophers such as Karl Jaspers and Martin Heidegger had made similar arguments years before), Teppe's movement quickly took root. Along with his influential books, Teppe also launched the Revue Doloriste, an episodic journal that was meant to be the standard for the entire dolorist movement. On its first publication in 1946, the French conservative paper, Le Figaro, a tongue-in-cheek endorsement to the new journal and to dolorism in general: "No school ever chose its hour better than this one. Every French citizen is an unknowing Dolorist. And [then-premier] Monsieur Gouin, perhaps, is one". While never the financial success that Teppe had hoped, the first issue sold 5,000 copies and eventually included original essays from such prominent writers as Andre Gide and Colette.
That dolorism became a hotly debated subject before and after World War II is perhaps not surprising given the political and economic struggle to rebuild Europe. Theologians continued to advocate pain as a necessary evil while neurologists and physiologists weighed in on the medical aspects of pain. Teppe's chief opponent was prominent surgeon, Rene Leriche. Having gained his experience in treating pain associated with battlefield injuries in World War I, Leriche's book La Chirugie de la douler (the Surgery of Pain) quickly became a classic in treating "pain disorders" after its publication in 1937. As a militant humanist as well as a surgeon, Leriche avidly fought any attempt to glorify pain and argued against the idea that pain could be beneficial or useful in any way. Ironically, Leriche actively spoke against the use of pain medications such as morphine and argued that surgical approaches were the ideal method for pain relief.
Another prominent dolorism opponent, prominent neuropsychiatrist Jean L'hermitte, argued that "the first duty of medicine is to heal when it can, to relieve often, and to comfort always. As a result, a physician's role is not only to relieve moral suffering often but also, insofar as it is possible, to alleviate pain and its repercussions on the different organs." As an important example of pain's importance, L'hermitte described cases of syringomelia in which patients with interrupted sensory nerve fibres injure themselves due to their inability to feel pain. He also saw analgesics such as morphine as being effective in preventing suicides among chronic pain sufferers.
Still, the spectre of addiction to pain medication was ever present. Even L'hermitte was quick to argue that some physicians gave out morphine "too freely" and that it should only be prescribd by physicians who were certain that their patients were genuinely suffering. He advocated that morphine only be administered through injection and at the doctor's discretion. While he denounced dolorism as a dangerous trend, he still advocated an extremely conservative approach to pain treatment which often meant that patients were expected to "suffer in silence" rather than admit that they were unable to bear their chronic pain "maturely". Many religious hospitals, though recognizing the need to deal with pain, often stressed the virtue of endurance and advised doctors and nurses to train patients to resist pain rather than to plead for better analgesics. As formal treatment shifted towards specialized hospital wards to deal with chronic pain patients, pain clinics have become an integral part of most tertiary care hospitals.
Although today's physicians are no longer expected to allow patients to "suffer for their own good", the old dolorist arguments have never completely faded away. The reluctance to prescribe pain medications due to addiction risks, however legitimate, often masks an expectation that patients overcome pain on their own rather than rely on chemical aids. That there is an obvious economic component to this argument (medication costs money, after all) makes it all the more appealing to rein in rising health care costs. Many of the moral dilemmas and problems raised by Julien Teppe and his supporters have yet to be resolved and the stringent regulations that physicians often face in prescribing medication means that pain management remains one of the most contentious issues facing medicine today.
And that is unlikely to change any time soon.