The Last Four Centuries of Pain: Philosophical Roots, Physiological Discoveries, and the Neurocognitive Frontiers of treatments

Abstract

This paper traces the evolution of pain theory from René Descartes’ 17th-century mechanistic model, which linked pain to neural signals and the pineal gland, through the Enlightenment’s integration of physiology and psychology by von Haller, Cabanis, and Bichat. The 19th century’s Specificity Theory, advanced by Bell, Magendie, and Müller, identified distinct neural pathways and sensory receptors but faced debate over pain’s uniqueness. The 20th century introduced temporal and integrative perspectives, highlighting central modulation and cognitive influences on pain perception. Melzack and Wall’s Gate Control Theory revolutionized pain science by demonstrating spinal gating mechanisms modulated by both peripheral and brain signals. Later, multidimensional models emphasized sensory, emotional, and cognitive components, supported by neuroimaging evidence of complex brain networks involved in pain processing. This historical and scientific overview underscores pain as a dynamic, multifaceted experience shaped by biological, psychological, and social factors, informing contemporary approaches to pain diagnosis and treatment.