UCSF

A Disease Itself: The Transformation of Pain After 1945

By Stephen Beitler

A Disease Itself examines a fundamental shift in the understanding and clinical status of pain in the United States after 1945. Pain was transformed from a simple, rote, well understood, and largely treatable event into a clinical syndrome defined by variability, chronicity, and complexity. Pain became subjective, rooted in individual experience, beliefs, and circumstances as much as in organic illness and injury. An insurgent model of pain refashioned the primary clinical challenge as chronic pain, asserted dense interconnections among pain’s psychological and physical dimensions, and advocated multidisciplinary treatment. Together, these changes refashioned how people experienced pain, how clinicians treated it, legislative actions, and the fortunes of dozens of pharmaceutical companies. They reflected as well substantial cultural shifts in ideas and practices of identity, selfhood, authority, and autonomy.

A Disease Itself explores the history of how pain has been measured, managed, and organized professionally in order to track the origins and contours of this fundamental change. The dissertation begins with a historical review of the development of scientific, medical, and cultural understandings of pain from 1800 to 1945. It then examines the measurement, management, and professionalization of pain through three in-depth case studies. The first case study examines how a new model of pain was operationalized clinically in an assessment instrument, the McGill Pain Questionnaire (MPQ), published in 1975. The second explores how wider debates over risk and reward in treatment were reflected in enduring clinical ambiguities surrounding a highly successful pain reliever, Darvon, between its debut in 1957 and its removal from the market by the Food and Drug Administration (FDA) beginning in 2010. The third case study depicts how a new pain paradigm was central to the launch of International Association for the Study of Pain (IASP) after 1973. A Disease Itself draws on an extensive array of research studies on the MPQ, government and industry documents on Darvon, and the published works of early leaders of the IASP in its portrayal of a fundamental shift in the understanding and clinical status of pain.