Opioids and Pain Relief: A Historical Perspective
http://www.100md.com
《新英格兰医药杂志》
This book is a collection of lectures given at a two-day symposium in 2002 with the intriguing theme "Opioids, the Janus Drugs, and the Relief of Pain." Janus, the dual-faced Roman god, was chosen to symbolize the promise and problem that opioids represent for both users and practitioners. As editor Marcia Meldrum points out in the preface, "What other drug . . . is so interwoven with the . . . best and worst in humanity?" The symposium focused on the history of opioids in pain relief, to the exclusion of their more negative aspects. To that end, a distinguished group of experts was assembled. They ranged from a pediatrician who is an expert in French medieval medicine to the people who were "there" when major discoveries (endorphins and the opioid receptor) or pain treatment initiatives (the World Health Organization [WHO]'s analgesic project and the state pain initiatives in the United States) were conceived. Given the compelling theme and the eminent speakers, it would be foolish not to "listen" to what they have to say.
(Figure)
The Opium Poppy.
From Flora von Deutschland, ?sterreich und der Schweiz by Dr. Otto Wilhelm Thomé.
Courtesy of Kurt Stüber.
In his interesting leadoff chapter, John D. Loeser gives us a sweeping overview of the history of opioid use, from the first known citation on an Egyptian papyrus (in 1552 B.C.) to the 19th-century opium trade and the 1914 Harrison Narcotic Act, whose interpretation and application led to jail time for 3000 physicians. Walton O. Schalick III opens a fascinating window onto French opioid practices in the Middle Ages. However, the discussion is focused more on laxatives and the Paris of the 14th century than on opioids as analgesics. Martha Stoddard Holmes takes us to the birth of surgical anesthesia and pain treatment in the Victorian age. She also reports that the "modern" concept that improved analgesia can prolong life in patients with cancer who are terminally ill was first expounded by Herbert Snow in 1890.
Caroline J. Acker's discussion of the nonanalgesic use of opioids is interesting and informative, especially in understanding the political and legal evolution of modern law in this area, but is off the theme of opioids as analgesics. Kenner C. Rice continues this diversion but provides an authoritative tour of the personnel and the biochemistry involved in analgesia research at the National Institutes of Health from the 1930s to the present. The discussion of pain control and the hospice movement that is begun by David Clark and woven through other chapters provides a fascinating look at the "Rise and Demise of the Brompton Cocktail," as Clark's chapter is titled, and the growth of scientific method in the field of analgesia. The discussion of the place, or lack thereof, of heroin in pain relief, as framed by Christina Faull and Alexander Nicholson and continued by other authors, is likely to be worth the price of this book for most readers.
Devotees of the individual pioneers and the science of endorphins and the opioid receptor will appreciate Huda Akil's and Meldrum's "you are there" contributions. Clinicians will feel the same way about the chapters written by Michael J. Cousins, Mark Swerdlow, and June L. Dahl, which discuss spinal therapy, the WHO Cancer Pain Relief Program, and the U.S. state cancer pain initiatives, respectively. Although I found the narratives of patients in Nessa Coyle's chapter to be touching, I am not sure they fit with where the science of pain treatment needs to go. One hopes that the WHO analgesic ladder and the intervention of such agencies as the Joint Commission on Accreditation of Healthcare Organizations and the Federation of State Medical Boards have reframed this discussion so that it will be driven more by data and less by narrative. The discussion of Cicely Saunders and Robert Twycross's work in advancing pain treatment, interwoven through several chapters, is happy testimony to the power that individual scientists can have in changing practices.
The problem with the book is not that it is uninteresting or uninformative, but that the authors do not keep to the promised theme. Perhaps it was naive of me to expect a history of the use of opioids as analgesics to begin with cave paintings and end in the 21st century, ignoring all the problems that "God's own remedy" has caused. It was only a two-day meeting, after all. In the end, this book is like a graduate symposium, taught by an eminent professor, that promises a course on a specific subject but is really focused on whatever the professor wants to talk about. It saddens you that he or she did not stay on subject, but you know you have been intellectually enriched by the experience and are left wanting more.
Brian K. Bevacqua, M.D.
University of Wisconsin School of Medicine
Madison, WI 53705((Progress in Pain Researc)
(Figure)
The Opium Poppy.
From Flora von Deutschland, ?sterreich und der Schweiz by Dr. Otto Wilhelm Thomé.
Courtesy of Kurt Stüber.
In his interesting leadoff chapter, John D. Loeser gives us a sweeping overview of the history of opioid use, from the first known citation on an Egyptian papyrus (in 1552 B.C.) to the 19th-century opium trade and the 1914 Harrison Narcotic Act, whose interpretation and application led to jail time for 3000 physicians. Walton O. Schalick III opens a fascinating window onto French opioid practices in the Middle Ages. However, the discussion is focused more on laxatives and the Paris of the 14th century than on opioids as analgesics. Martha Stoddard Holmes takes us to the birth of surgical anesthesia and pain treatment in the Victorian age. She also reports that the "modern" concept that improved analgesia can prolong life in patients with cancer who are terminally ill was first expounded by Herbert Snow in 1890.
Caroline J. Acker's discussion of the nonanalgesic use of opioids is interesting and informative, especially in understanding the political and legal evolution of modern law in this area, but is off the theme of opioids as analgesics. Kenner C. Rice continues this diversion but provides an authoritative tour of the personnel and the biochemistry involved in analgesia research at the National Institutes of Health from the 1930s to the present. The discussion of pain control and the hospice movement that is begun by David Clark and woven through other chapters provides a fascinating look at the "Rise and Demise of the Brompton Cocktail," as Clark's chapter is titled, and the growth of scientific method in the field of analgesia. The discussion of the place, or lack thereof, of heroin in pain relief, as framed by Christina Faull and Alexander Nicholson and continued by other authors, is likely to be worth the price of this book for most readers.
Devotees of the individual pioneers and the science of endorphins and the opioid receptor will appreciate Huda Akil's and Meldrum's "you are there" contributions. Clinicians will feel the same way about the chapters written by Michael J. Cousins, Mark Swerdlow, and June L. Dahl, which discuss spinal therapy, the WHO Cancer Pain Relief Program, and the U.S. state cancer pain initiatives, respectively. Although I found the narratives of patients in Nessa Coyle's chapter to be touching, I am not sure they fit with where the science of pain treatment needs to go. One hopes that the WHO analgesic ladder and the intervention of such agencies as the Joint Commission on Accreditation of Healthcare Organizations and the Federation of State Medical Boards have reframed this discussion so that it will be driven more by data and less by narrative. The discussion of Cicely Saunders and Robert Twycross's work in advancing pain treatment, interwoven through several chapters, is happy testimony to the power that individual scientists can have in changing practices.
The problem with the book is not that it is uninteresting or uninformative, but that the authors do not keep to the promised theme. Perhaps it was naive of me to expect a history of the use of opioids as analgesics to begin with cave paintings and end in the 21st century, ignoring all the problems that "God's own remedy" has caused. It was only a two-day meeting, after all. In the end, this book is like a graduate symposium, taught by an eminent professor, that promises a course on a specific subject but is really focused on whatever the professor wants to talk about. It saddens you that he or she did not stay on subject, but you know you have been intellectually enriched by the experience and are left wanting more.
Brian K. Bevacqua, M.D.
University of Wisconsin School of Medicine
Madison, WI 53705((Progress in Pain Researc)