SPECIAL REPORT

MAKING A BREAKTHROUGH

HOW TWO MEN REWROTE THE PAIN BOOK

CHRIS WOOD February 27 1989
SPECIAL REPORT

MAKING A BREAKTHROUGH

HOW TWO MEN REWROTE THE PAIN BOOK

CHRIS WOOD February 27 1989

MAKING A BREAKTHROUGH

SPECIAL REPORT

HOW TWO MEN REWROTE THE PAIN BOOK

It is the standard reference on the subject: an imposing, dictionary-sized red book running to 866 pages and titled simply Textbook of Pain. Between its covers, there are detailed descriptions of the anatomy of nerves, precise analyses of the chemistry of the brain and graphic accounts of pain’s many manifestations. It is required reading for specialists in the treatment of people in pain, and a fixture in medical libraries from London to Tokyo. On its spine, credited as editors and authors of several of the book’s chapters, are the names of two men:

Melzack and Wall. The second name is that of a British physiologist Patrick Wall.

The first belongs to a Canadian psychologist: Ronald Melzack, at 59, a genial, greying professor at McGill University and possibly the world’s leading authority on the enigma of pain.

Accident: It is a role Melzack assumed almost by accident. The son of a prosperous Montreal bookseller, he entered McGill as an undergraduate in 1946 with no particular ambitions beyond escaping the confines of his father’s store. “College seemed about the best dodge I could muster,” he says now. But at McGill, Melzack met the first of several powerful personalities who were to shape his later obsession. Psychology professor Donald Hebb sparked Melzack’s curiosity with an experiment designed to explore the influence of early experiences on the later development of intelligence. Hebb, with Melzack’s help, raised several terrier puppies in complete isolation. Later, when the puppies were released, they seemed strangely insensitive to pain. Recalls Melzack: “I lit a match to see how they would respond to flame. They kept sticking their noses in it, and although they would back off as though from a funny smell, they did not react as if it hurt.”

For Melzack, that observation was the start of a quest that continues to this day. It led him swiftly into the mainstream of research on pain at two leading U.S. academic institutions. At

the second of those, the Massachusetts Institute of Technology (MIT), he forged his seminal partnership with Wall. Together, in the teeth of bitter opposition from outraged colleagues, the two men evolved an explanation of the nature of pain that has replaced a centuries-old theory in the world’s textbooks. On the way, Melzack, the father of two now-grown-up children, crafted a second career as an author of popular tales for the young. But the study of pain continues to preoccupy him in Montreal, where he holds the E. P. Taylor chair of psychology at McGill.

Curiosity: While his experience with the puppies gave Melzack what he terms “an intellectual curiosity” about the nature of pain, his next appointment brought him dramatic evidence of its human dimension. He accepted an invitation to pursue postdoctoral research at the University of Oregon medical school in Eugene, one of the oldest U.S. pain clinics. In his first visit to the clinic, he met Emily Hull, a

diabetic in her early 70s whose left leg had been amputated above the knee to halt the spread of gangrene. Despite the surgery, she continued to feel pain in the missing limb. “Mrs. Hull kept pointing to her foot that wasn’t there, and describing burning pains that felt like a red-hot poker being pushed through her toes,” Melzack remembers. “And I was sitting staring at this phantom foot which became real to me.” The encounter transformed the young man’s intellectual curiosity about pain into a passionate concern for those who suffer it.

Later, unable to find work in Canada, Melzack began teaching at MIT. There, in 1959, Melzack began an academic partnership that would overturn a 300-year-old medical belief. Working in a laboratory not far from Wall, who was exploring the structure of spinal pathways that pass sensory information upward to the brain, Melzack recalls, “I had concluded that the brain must intervene at a very early

stage in the experience of pain and I was trying to understand how.” The clear connections between the two fields of inquiry led to long discussions about the physiology and perception of pain, and to a growing friendship.

The collaboration continued after Melzack, newly married to his wife, Lucy, returned to Montreal to accept a position at McGill in 1963. Once or twice a month, he would fly to Boston, picking up a bottle of duty-free rye whisky on the way, to visit Wall. “We would sit in his living room and sip Crown Royal and toss ideas around,” Melzack says now. The first product of those brainstorming sessions, an academic paper published in 1962 outlining a theory they called the Action-Demand pattern of pain, received little notice. But when they published their ideas for the second time in 1965 under the new rubric of the Gate-Control Theory, they ignited a furious academic debate.

Explanation: In advancing the Gate-Control Theory, Melzack and Wall overturned a widely accepted explanation first advanced in the 17th century by French philosopher René Descartes. Descartes compared the way in which pain registered in the brain to a man pulling on a rope at the bottom of a tower and ringing a bell in the belfry. Instead, Melzack and Wall said that nerve gates at the level of each vertebra assessed incoming pain signals and might either open in order to pass the pain on to the brain, or close, to block the sensation. Thoughts, expectations and even culture, they added, could influence whether the gates admitted, rejected, diminished or amplified pain. “We had to overthrow a whole academic line,”

recalled Wall. “The idea met tremendous resistance.” Melzack, too, remembers the traditionalists’ fierce counterattacks. “Almost monthly, there was a paper trying to disprove the theory.”

In the end, while many of the processes Melzack and Wall described have turned out to be far more complex than they realized, their vision of how the brain receives pain has proven largely correct. Indeed, its influence continues to grow. When they restated their theory, together with new research, in the 1982 book The Challenge of Pain, the volume was quickly translated into Russian, Hungarian, Japanese and several other languages. And a questionnaire based on the theory, which Melzack first devised in 1972 to assess the quality and degree of pain felt by individual sufferers, has become a standard diagnostic tool in pain clinics around the world.

Meanwhile, Melzack continues to wrestle with the many mysteries that remain to be solved before pain can be conquered. “There are an awful lot of pains that we really don’t

understand,” he acknowledges. Among them are the extremely severe pains suffered by women during childbirth, one focus of his current research. Other projects involve examining the factors that make some people resistant to the pain-killing effects of morphine and the specific areas in the brain that respond to painful stimulation.

Encounter: Away from his McGill office, Melzack has fashioned a minor second career as a children’s author. An encounter with native Indian culture in Mexico led him to explore the legends of Canada’s Inuit. He found an eager audience for the stories in his children, Joel, 26, who now works for the federal government in Ottawa, and Lauren, 27, who is studying criminal justice at the University of Maine—and, in 1967, he published a collection of the tales. Two more volumes followed, and the stories have been broadcast several times—once to an eager Inuit audience, although their author has never been to the Arctic.

But the study of pain continues to preoccupy Melzack, in particular, the memory of Emily Hull. He says that he is still looking for explanations of what he calls “phantom” pain. And while that search has yet to produce a remedy that might have eased Emily Hull’s discomfort, his reflections have led him close to “a new way of looking at problems, a new theory of psychology.” He refuses to discuss that development in detail, but he is planning to write a book about it within the next year. Having already overturned one piece of conventional wisdom, Ronald Melzack could be ready to upset another.

CHRIS WOOD in Montreal