ABSTRACT
As part of their 'back to basics' campaign in the early '90s, Conservative Party politicians attempted to retrieve what might be called the positive view of pain that Mrs Thatcher had associated with Victorian values. 'No pain, no gain', 'if it's not hurting, it isn't working': those were the slogans of the day.1 Such starkly punitive outlooks run counter not just to liberal cultural and moral values but also to certain trends in modem medicine, which, albeit rather belatedly, is now engaging with the problem of pain as never before. Powerful new physiological explanations have emerged, notably the 'gate' theory, developed from the 1960s by Ronald Melzack and Patrick Wall. Discarding as simplistic the old mechanical'fire-alarm' theories, they emphasized how, when messages from the nerve ends reach the spinal cord, a fine tuning takes place regulating the degree of pain suffered; this is, pain can be enhanced or inhibited by brain signals. Emphasizing the symbiosis of physiological and psychological factors, 'gate theorists' have shown how pain's intensity depends on circumstances - depression may make us supersensitive. With the aid of new interactive approaches like this which stress how pain is not a mere sensation but a perceptual product, modem medicine can at last begin to shoulder its responsibilities for pain control. This is manifest in the Widespread setting
up of pain clinics, in pain counselling, and in the foundation of the International Association for the Study of Pain and its journal Pain.2
