Objectifying “Pain” in the Modern Neurosciences: A Historical Account of the Visualization Technologies Used in the Development of an “Algesiogenic Pathology”, 1850 to 2000

Abstract

Particularly with the fundamental works of the Leipzig school of experimental psychophysiology (between the 1850s and 1880s), the modern neurosciences witnessed an increasing interest in attempts to objectify “pain” as a bodily signal and physiological value. This development has led to refined psychological test repertoires and new clinical measurement techniques, which became progressively paired with imaging approaches and sophisticated theories about neuropathological pain etiology. With the advent of electroencephalography since the middle of the 20th century, and through the use of brain stimulation technologies and modern neuroimaging, the chosen scientific route towards an ever more refined “objectification” of pain phenomena took firm root in Western medicine. This article provides a broad overview of landmark events and key imaging technologies, which represent the long developmental path of a field that could be called “algesiogenic pathology.”

Crying out in pain—A systematic review into the validity of vocalization as an indicator for pain

“…Little high-quality evidence is available on the association between vocalization and pain. Even less evidence is available when it comes to pain measurement tools for those who cannot self-report their pain, as self-report is the gold standard in the measurement of pain (Gregory, 2015;Stahnisch, 2015). Some of the available literature on vocalization is based on the assumption that vocalization and pain correlate, leaving other factors that can influence vocalizations out of the theoretical model.…”

“…It is a personal and subjective experience (Davis, 2011). Therefore, self-report, either spontaneous or after being asked about pain with questionnaires and/or rating scales (Oosterman & Brazil, 2015), is considered the gold standard (Gregory, 2015;Stahnisch, 2015) for pain assessment. Those who are unable to verbally communicate their pain, such as older people with cognitive impairment caused by dementia and people with stroke or brain injuries, but also younger children, are completely dependent on others to be attentive to nonverbal signs of pain (Craig, 2009).…”

Contextualizing ovarian pain in the late 19th century—Part 1: Women with “hysteria” and “hystero-epilepsy”

“…Gallard also reflected on the fact that ovarian pain might be similar to the form of severe and throbbing facial pain that occurs as a result of dental problems (Gallard 1886, 361). This could be seen as an example of an early understanding of the noxious stimulation from inflammation appreciated today (Stahnisch 2005).…”

“…Death would be preferable to this painful existence to this state of perpetual nervous troubles; with this erotic madness, sometimes appalling and distressing stupidity is associated, which makes miserable young girls populate our hospitals. (Négrier 1858, 159) Négrier's detailed examination of a woman in pain now would be seen as demonstrating the recent apprehension of clinical signs of hyperalgesia (enhanced sensitivity to pain) and allodynia (pain from a nonpainful stimulus; Stahnisch 2005). During his own time, Négrier was already able to link hysterical behavior to a physiological theory of ovarian function (ovulation) and based his assumptions on nervous activity along with what he saw as undefined inflammatory processes.…”

Orofacial Pain During Rest and Chewing in Dementia Patients Admitted to Acute Hospital Wards: Validity Testing of the Orofacial Pain Scale for Non-Verbal Individuals

“…Adequate diagnosis is essential as a first step in provision of effective treatment. The 'gold standard' for the diagnosis of pain, is self-report 15,16 . For a successful self-report pain assessment, it is important that the person is able to verbally communicate 8 .…”