Eighteenth-Century Pain and the Modern Problem of Measuring Pain

The offending machine. A Saskatchewan example. Image credit: Daryl Mitchell, Wikimedia Commons.

I read the news about the recent study using fMRI to measure physical and emotional pain intensity right after a visit to the physiotherapist for help with my migraines. (I’ve been a migraineur since the age of eleven when a Tilt-a-Whirl ride gave me a case of whiplash.) Although there is not always a close relationship between life events and scholarly work, my migraines have shaped my interest in patients’ illness narratives. It is as both scholar and sufferer that I am troubled by the fMRI study’s implications.

Running through much of the pain scholarship is the assumption that it cannot be adequately represented by language or truly understood by others.[1] Chronic pain’s invisibility makes it difficult even for people close to a sufferer to sympathise. There has been a recent shift to trying to understand pain holistically, with the development of pain clinics where sufferers can receive treatment from a variety of health practitioners and the focus is on mind-body integration. But scientific studies of pain still often come down to one question: can you tell how much pain a patient is experiencing, either in relation to his own pain, or that of others? To this end, many have tried to find ways of measuring pain.[2]

The news is all abuzz, with headlines such as “Study shows pain is all in your head, and you can see it”. Like many previous studies, the latest attempts to provide, as Maggie Fox at NBC News puts it, an “objective way to measure pain”. Researchers applied heat-based pain to volunteers, then measured the changes within the brain using fMRI. They were able to identify a person’s relative pain, such as when one burn feels worse than another, as well as the influence of painkillers. The results of this study have the potential to be very useful when treating patients who are unable to talk or unconscious.

But there is an unsettling aspect to the study—or at least to the way in which it is being reported—in that it tries to distinguish between a real, objective pain and the experienced pain. According to the lead researcher Tor Dessart Wager quoted in the above article, the tests reveal that people really do feel pain differently: “Let’s say I give you a 48-degrees stimulus and you go ‘This is okay; I can handle it’ and I might say ‘Oh, this really hurts’… My brain is going to respond more strongly than yours. We are using this to track what people say they feel.” In other words, some people are wimps and some are stoic—and patients cannot be trusted to report the truth.

An unhelpful distinction at best: it misses out the psycho-social experience of pain of why one person might feel the pain more keenly. Age, ethnicity, status and sex all play an important role not just in a sufferer’s experience of pain, but in how others perceive what the experience should be and the trustworthiness of a sufferer’s account of pain.

It is also a potentially dangerous distinction, reinforcing as it does the idea that pain needs to be measured objectively and that technology provides the answers. The problem, as Daniel Goldberg tweeted yesterday, is that:

A report in Scientific American explains the study’s implications for chronic sufferers. The fMRI was also used to measure coping tactics for the heat-induced pain, such as mindfulness, meditation, imagination or religious belief, revealing that such methods reduce pain. Pssssst… about that: we’ve known this for a while. These sorts of methods were used long before we had effective painkillers and are frequently used by modern chronic illness sufferers.

Will measuring pain ‘objectively’ really benefit the sufferer? The use of technology for chronic pain provides a mere (if very expensive) bandaid and, to make matters worse, undermines one of the most important elements in a successful doctor-patient relationship: trust. Sometimes looking at a historical case can pinpoint the modern problems.

Lady Sondes just before her marriage. Miniature of Lady Katherine Tufton by Peter Cross, 1707. Image Credit: Victoria and Albert Museum, London.

Catherine Watson, Lady Sondes, wrote to Sloane several times between 1722 and 1734 about an unspecified illness.[3] Although she was in her late 30s, she had a litany of complaints that made her feel as “old and decayed” as someone aged fifty or sixty. Her pains ranged from headaches, gnawing leg pains, and “fullness” in her head to a stiff lip, constant fear, memory loss and “rising nerves”. She described the ways her daily life was affected. Besides being constantly distracted by pain, she worried about her legs giving out from under her or losing her memory so she would be unable to do the household accounts. These were problems for a woman who prided herself on running a large household successfully. Her descriptions were circular and repetitive, even boring, but reflected her ongoing experience: the physical pains, often not severe, nagged constantly at her throughout the day, and the fear and anxiety of what the pain might mean was all-encompassing.

Her symptoms did eventually pass, allowing her to once again go “about Busiynesse”, but the treatment had been difficult. Lady Sondes began to consult Sloane by letter when she disagreed with her regular physician’s diagnosis of hysteria. While Dr. Colby considered her ailment to be hysteria, Lady Sondes did not feel that she could trust her full story to him. Hysteria was associated with overly delicate women and a mixture of imagined problems alongside real ones, suggesting that such a diganosis may have predisposed Colby to disregard her accounts of pain. She wrote instead to Sloane who treated her “with great kindness and care”. It was not until Colby rediagnosed her as having a blood condition that she began to trust him again. A large part of Lady Sondes’ healing came from the ability to express her narrative. Sloane was not physically present; the greatest therapy he could have provided was reading her letters and answering her specific, stated concerns.

Chronic pain, with its messy emotional bits and day-to-day dullness, is encompassed within an entire life, not just a few moments spent inside a machine while clutching something uncomfortable. A crucial component of effective therapy is the trust between doctor and patient, allowing the patient to create a narrative, to be heard and to be understood. If a physician is primed to distrust a patient’s account, whether through a diagnosis or reliance on technology, the healing process will be thwarted. Sure we can measure pain, but when it comes to chronic pain, it’s not really the question we should be asking.

[1] This comes from Elaine Scarry’s influential book, The Body in Pain: The Making and Unmaking of the World (Oxford: Oxford University Press, 1985).

[2] For example, the famous McGill Pain Questionnaire. See R. Melzack, “The McGill Pain Questionnaire: Major Properties and Scoring Methods”, Pain 1, 3 (1975): 277-299.

[3] I discuss this case and others from Sloane’s letters in my article, “ ‘An Account of an Unaccountable Distemper’: The Experience of Pain in Early Eighteenth-Century England and France”, Eighteenth-Century Studies 41, 4 (2008): 459-480.

6 comments on “Eighteenth-Century Pain and the Modern Problem of Measuring Pain

  1. gabrielablandy on

    Lisa – what I love about this post is that it’s so meaty with information, and yet just glides through the brain so that all the information goes in without too much confusion. It made me think about Hilary Mantel as one of the books I read when I was away travelling is her memoir, Giving up the Ghost, which talks about her history of misdiagnosis. For a long time her endometriosis was considered psychosomatic and led to her being institutionalised for a short period. I absolutely agree with you that even though pain can be measured, those stats will not provide the whole picture. I read a Zen teaching, which talks about the fact that riding a horse is hard enough, so why put another horse onto the original horse and try and ride both. I think the ‘pain debate’ is the same – pain is difficult, and even if it can be measured, this doesn’t take into account the whole arena, which is our response to pain – essentially the second horse that we add into the bargain.
    Lovely writing as always – it’s good to be back here. Thanks!

  2. Max Taylor on

    I appreciated your piece reflecting the effect of Lady Sondes’s relationship with her doctor on her experience of pain. I am curious whether you are acquainted with the Dutch phenomenological psychiatrist J. H. van den Berg’s book, Divided Existence and Complex Society: An Historical Approach, published in 1963 in Dutch and in 1974 in English. A portion of the book pertains to the psychosocial context of the experience of pain in the late eighteenth and early 19th century. Examining the gap between the discovery of the principle of chemical anaesthesia in, I think, the 1770s, and its adoption by physicians to induce anaesthesia for surgical purposes in and after the 1820s, van den Berg asks, why this delay in its surgical use, if the principle was known? After examining a variety of interesting accounts of soldiers of that era undergoing horrific amputations or other procedures without much fuss, van den Berg hypothesizes, startlingly, that chemical anaesthesia wasn’t used because it was not thought to be necessary, and posits that there may have been a generalized increase in the experience of pain in the late eighteenth and early 19th century. (Such a thesis may seem preposterous, yet the beauty of the book is how the author’s arguments seem to emerge naturally from the evidence; he does not venture his thesis until he has already discussed the evidence.) Van den Berg’s proposition, I think, is that this posited increase in the experience of pain correlates with, and reflects, eighteenth-century social derangements, especially French Revolution and the industrial revolutions. His focus is very much on psychosocial context and on human experience as a reflection of social context.

    • Lisa Smith on

      I have not read that book, though it sounds very interesting. It is always tempting to blame big structural changes, but much of the groundwork for change was already in place before either happened. e.g. new body models (such as nerves and fibres rather than humors) started to frame the experience and causes of pain in different ways.


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