Opioids and Pain Relief: A Historical Perspective (review)

How do we make historical sense of seemingly senseless pain, and render the subject of pain tractable to historical and social analysis? This elegant volume is the outcome of a 2002 symposium on "Opioids, the Janus Drugs, and the Relief of Pain," which situated the problem of pain within our current range of social and historical understandings of it, as well as regimes for its relief. The natural and chemical compounds with which we have sought to relieve pain have long been understood as double-edged swords: they simultaneously display, in editor Marcia Meldrum's words, a discomfiting "property of euphoria" (pp. 193, 200), while raising the specter of chronic dependency. The topics represented here were thoughtfully chosen—ranging from the social movement that has arisen around the provision of palliative care, to the history of regulatory legislation, to the history of pain relief—and the collection is truly multidisciplinary. This discursive range, however, is both the collection's strongest and its weakest point. The topics are dazzling in their variety, yet some of the more technically oriented chapters are less accessible than they might be for even a relatively elite audience of health professionals and historians (namely, the Kenner C. Rice article on analgesic research, and the Michael J. Cousins article on spinal administration of opiates). While Huda Akil's delightfully anecdotal account of the "dawn of endorphins" is much more readable, it also reminds the reader of the inconsis-tent tone displayed throughout the volume. Additionally, the humanistic approaches are underrepresented, including the philosophical, literary, and artistic work on the representation of pain and pain narratives.

However, the value of the collection supersedes its faults: it captures the incomplete state of our knowledge of pain and responses to it, while offering an enriched sense of the highly eclectic state of our current approaches. Its most valuable contribution in my view is the thematic interweaving of pain professionals, scientific researchers, and historians who would otherwise be talking with one another only within the confines of a small arena. In that sense the volume imparts the experience of speaking across rhetorical registers that those present at the symposium must have experienced. The collection reminds us how vast have been the social changes in our approach to pain, and how enduring and compelling remain the debates concerning our responses to the persistence of pain. The volume's shift from centering on the drugs themselves to contextualizing their use within a set of social constraints is especially valuable. Finally, the collection sounds a cautionary note about the unlikelihood that a universal panacea for pain will appear.