Упрощенная HTML-версия
178
view of these detailed anatomical presentations, it is surprising that
brain functions continued to be associated with the brain
ventricles
. It
took another 150 years until the gray and white matter of the brain
was recognized as the functional substrate.
Pain happens when nerve endings in our skin and our internal or-
gans send messages through the central nervous system to our brain.
The brain itself cannot feel pain. There are two types of pain – acute
pain, which lasts a short time and is removed when the cause is cured,
and chronic pain, which can last a lifetime and cannot usually be
treated. Chronic pain must be managed using drugs or other methods.
The body’s organ contain few pain- receiving nerve endings, so inter-
nal injuries often cause referred pain, where pain is felt in another, un-
related part of the body. This is why, for example, the pain of angina
radiates centrifugally across the chest, up the neck and jaws, and down
the arms on both sides through the inner aspect of the left arm and
hand is the commonest region. The reason for this radiation of a cardi-
ac pain is that the inferior cervical sympathetic ganglion, which re-
ceives the cardiac nerve plexus, contributes fibres to the lower brachi-
al plexus.
Searching methods and ways of relieving pain have been develop-
ing for many centuries. Ambroise Pare (1510–1590), the great surgeon
of the Renaissance period, titled as “Physician to the King of France”,
provided detailed descriptions of the pain associated with wounds and
surgery, and suggested methods for pain relief. He specifically men-
tioned the different types of wounds induced by firearms and com-
pared them with lacerations from more traditional weapons, pointing
out that the bullet wounds were associated with much greater pain. He
rejected the contemporary belief that the increased pain was due to
poisoning from gunpowder.
The prevailing recommended treatment for bullet wounds was to
apply boiling oil to cauterize them. In contrast, Pare discovered that
ligation of vessels to stop bleeding and careful cleaning of the wounds
resulted in much faster healing and much lower levels of pain. In 1564
he published his
Dix livres de la chirurgie
(“Ten books of surgery”),
where he described these and many other new techniques for treating
trauma. These books also contain many novel nonsurgical treatments
and adjuvant techniques, such as advice on the reduction of disloca-
tions, a description of a chair for steam baths to alleviate pain associ-