Painkillers: The Problem of Pain

Pain has accompanied humans throughout their history, as a loyal but importunate ally. Popular punishments like the one that must suffer a woman while giving birth were seen as unavoidable. Without the necessity of appearing in any religious book, it existed different types of pain associated with the unbearable. Imagine that 300 years ago, teeth were extracted without anesthesia, and surgeons had to cut limbs with knives and saws, again, without any drug to kill the pain. Moreover, there was a 60% chance of dying in some interventions. This was the reason why many people with huge tumors (according to records, some of them were so big that they have to be carried using a wheelbarrow) refused to be taken to an operation. During centuries, it was believed that a creature located in the teeth roots, was the cause of pain, like a woodworm but it ate away the teeth and bones.

The Morphine - Santiago Rusiñol (1894).

Solutions to kill the pain were already known in ancient civilizations, most of them carried high risks though. There are medicine manuals and other texts that suggested the use of some plants to relieve the pain, or at least, to induce relaxation in the patient so that they could confront more easily the pain. The Papaver somniferum, known as the "opium poppy", was widely used in ancient times, especially by the Arabs who used it during their rapid and effective expansion to the west and east. In the 18th and 19th centuries, in Europe, opium became a recreative drug. It's only necessary to take a look at the autobiography of Thomas de Quincey (1785-1859), "Confessions of an English Opium-Eater" to verify that statement and see how the drug was used by the English romantic poets of the time. The author talked about how he got laudanum (an opium-based tincture) in a pharmacy:

"I took it - and in an hour - oh, heavens! what a revulsion! what an upheaving, from its lowest depths, of inner spirit! what an apocalypse of the world within me! That my pains had vanished was now a trifle in my eyes".

However, at the time when Quincey was writing these words, remedies to kill the pain were already being used, many of them synthesized by chemists. The anesthetic function of nitrous oxide, described by Joseph Priestley (1733-1804) and by Humphry Davy (1778-1829) was widely known, as well as the use as anesthetic of ethyl ether and chloroform. The latter one was an already known substance used scarcely and exclusively as a solvent. However, later someone figured out that it could also be used as a very powerful anesthetic. The application of chloroform as anesthetic was gradually gaining prestige during the mid 19th century; it was used in experiments with animals and also in operations of relatively "little importance", like the extraction of a tooth. However, the most important moment for the acceptation of chloroform was thanks to James Young Simpson and John Snow; both studied with detail the properties of chloroform and defended its use as an anesthetic. They carried out separately, a lot of operations using chloroform, but the most memorable one was when they were called to come to the Buckingham Palace on April 7, 1853, which was the day Queen Victoria gave birth to his son Leopold. The Queen, on that occasion, accepted the use of chloroform to relieve the pain from the childbirth and legitimated the use of that substance as an anesthetic, going against the biblical command, which condemned people to pain (especially to women).

Besides chloroform, other substances were used as anesthetics like ether, known for a long time and used as an anesthetic by Paracelsus, but it didn't popularize till the mid 19th century when killing the pain became one of the goals of medicine.

There were hundreds of medical works and studies made during the 19th century to test the painkilling and anesthetic properties of different natural and synthetic substances. Claude Bernard (1813-1878) defended the properties of the curare, a drug which was used by Native Americans to paralyze animals while hunting, morphine, an opiate that was first synthesized at the beginning of the century and cocaine, a drug located in the leaves of the coca plant which grows in South America, which became the first local anesthetic used. This meant that, after cocaine's discovery, it was possible to put under anesthesia certain parts of the body without having to knock down the patient. However, it was aspirin the substance that became extremely popular for its beneficial effects for a wide range of everyday-life aches and because of its prize, which made the drug available to almost the entire population. The story could be told from the end when a German chemist, Felix Hoffman (1868-1946) communicated on August 10, 1897, the medical, antipyretic and analgesic properties of the acetylsalicylic acid. Bayer, the company where he worked, patented the substance under the name of Aspirin and opened a fascinating story in pharmacology because aspirin is still widely used nowadays. Today, we know that Hoffman wasn't alone in the discovery, because Arthur Eichengrün (1867-1949) worked with Hoffman during his research years. Also, the properties of acetylsalicylic acid were being under research in the previous decades to 1899, the year when Bayer patented the compound. It has also been discovered that in ancient times, the acetylsalicylic acid was used as an antipyretic drug. It's not hard to find myths about the wonderful properties of Aspirin.

As a final detail from the work of Hoffmann, it is important to mention that he provided another patent to the company Bayer, a morphine-derived compound, a semi-synthetic opiate called diacetylmorphine, 3 times as powerful as morphine, which would lead to serious consequences, such as dependence or death. Its trademark name was Heroin, because of the euphoric effects that this drug produced. It was given to people, even kids as a good and effective remedy for colds, flu symptoms, toothache, morphine addiction... it was soon taken out the market because they finally found out that actually heroin was converted to morphine once it crosses the brain barrier, so it was as addictive as morphine, to say the least, but with much more side effects.

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