This engraving illustrates different possible types of stab wounds. However, different causes of pain produce different types of painful sensations, which are difficult to objectify, list and name: “the word Pain, as simple as it is, contains a thousand kinds of painMarin Cureau de La Chambre, Les Charactères des Passions, t. IV, De la douleur , Paris, Jacques d’Allin, 1662, p. 36-37.“, according to the physician Cureau de La Chambre (1659).
Some doctors attempted to establish a typology for types of pain, to facilitate diagnoses. But this project faced two obstacles, often mentioned in their writings:
We cannot hope to systematically connect types of pain to their different causes. This pain chart is thus not sufficient for making a diagnosis. Not to mention that it is not always easy for the patient to distinguish between similar types of pain – for example, between a burning pain and a biting one.Laurence Sterne - When a Scholar Dissects his Pain
Some terms for types of pain that were used by physicians, such as obtuse, astringent or ulcerative, are technical concepts that patients do not spontaneously use to describe their own sensations. However, having a common lexicon facilitates communication between doctor and patient, which is crucial for the diagnostic. According to Galen, who continued to be a fundamental source for medical knowledge in this period, “if the diagnosis is not based on what the patients themselves tell us, all that we might say about suffering is nothing more than a lot of idle chatterGalen, Les lieux affectés [De Locis Affectis], in Œuvres anatomiques, physiologiques et médicales, transl. Charles Daremberg, t. II, Paris, J.-B. Baillière, 1854-1856, p. 532. ” (On the Affected Parts).
The risk, then, is that of naming pain types using specialized terminology that is more obscure than illuminating.
In the patient's own words
Instead of naming characteristic types of pain, some doctors adopt the comparisons apparently used by their patients: one type of pain is as piercing “as if stakes were being driven into one's limbKaspar Peucer, Les devins, ou différentes sortes de devinations [Latin orig. Wittemberg, 1553], Antwerp, Heudrik Connix, 1584, p. 416.” ; another feels as if “one's head was being smashed with a malletAmbroise Paré, Les Œuvres, 4th edition, Paris, Gabriel Buon, 1585, book 17, chap. III, p. 604.”.
Sometimes, what a patient asks for can be used to measure the intensity of his or her pain. Doctor Lazare Rivière, in 1629, writes of a 7-year-old patient with an “unbearable pain in her head”: “she was asking that her head be opened up with a knifeLazare Rivière, Les Observations de médecine , transl. into French from Latin by F. Deboze, Lyon, Jean Certe, 1680, obs. XXXVII “Une douleur de tête mortelle“, p. 43.”. The physician did not comply, of course. “Opening up the head”, as suggested by this patient, who could no longer bear the pain, might sometimes be recommended to relieve migraines, but most doctors consider trepanning to be haphazard and dangerous and recommend it only for certain types of fractures.
Evaluations in the past and today
Here are the types of pain most often mentioned by doctors in the 16th and 17th centuries:
like a stake
cutting or lacerating
Today, we still distinguish between various types of pain, though the terms have changed. For example, the “McGill Pain Questionnaire” invites patients to indicate which words best describe their pain within a list of 56 terms. This self-assessment assumes that the patient has a highly developed vocabulary. In particular, it contains the following concepts: