Perspectives in Biology and Medicine

ELECTRICAL STIMULATION FOR THE RELIEF OF PAIN: TWO LESSONS IN TECHNOLOGICAL ZEALOTRY ARTHUR TAUB, M.D., Ph.D.* The development of solid-state electronic technology has been stimulated by war and by space exploration. It has brought with it unprecedented possibilities for the introduction ofelectrical stimuli in a controlled fashion into the peripheral and central nervous systems. Such stimulation is increasingly being used in an attempt to relieve otherwise intractable pain [I]. The expectations and desires of physicians and surgeons with respect to the possibility of relief of pain by this means have been aroused without regard for clinical reality. Clinical activity proceeds with therapeutic zealotry, with an apparent imperception of physiology, fallen theories, and the lessons of the recent past. In this essay, I shall try to place some ofthese lessons into historical perspective. Electrical Stimulation ofPeripheral Nervefor Analgesia A presentation ofthe history of percutaneous local electrical analgesia from antiquity is detailed elsewhere [2]. A representative account of the production of analgesia by electrical stimulation of the ulnar nerve in man was published in 1859 by Althaus: ... as he wished personally to experience the benumbing effect of the electric current applied to the trunk of a nerve. I consented to his request, and applied a rapidly interrupted current to Dr. R.'s ulnar nerve, placing one moistened conductor between the olecranon and the internal condyle; while the other conductor was placed in his hand. I began a current of low tension, such as was not powerful enough to produce contraction of the muscles animated by the ulnar nerve. After the current had acted for a few minutes, I increased the intensity, so that a strong flexion of the fourth and little finger was produced. The action of this current was at first painful to bear, and the pain continued to increase during the first few minutes of application; but it soon became less, so that I could further increase the intensity of the current, without causing much inconvenience to Dr. R., who became again gradually insensible to stronger shocks. ?Section for the Study and Treatment of Pain, Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06510. Supported by NIH grant NS 10174. Perspectives in Biology and Medicine · Autumn 1975 I 125 The intensity of the current was then increased a third, fourth, and fifth time, and every additional increase was felt distinctly and immediately, but after a certain time the pain excited by very severe shocks was comparatively little. At last the normal sensibility of the ulnar nerve was so much diminished, that a current of such a high tension was borne without inconvenience by Dr. R., as would have been perfectly unendurable in the beginning of the experiment. Besides, Dr. R. mentioned a sensation of numbness in the tips of the fourth and little finger and that he did not feel the board upon which his fingers rested. The intensity ofthe current was then diminished, and Dr. R. was now quite insensible of shocks which had caused him much inconvenience previously. After the current had ceased to act, numbness was still perceived by Dr. R. in his arm for a certain time. It is therefore obvious that a direct reduction of sensibility of the ulnar nerve was accomplished by electricity, but although the intensity of the current was very high and the velocity of the intermittences very considerable, no complete anesthesia of the skin was produced, as the skin of the hand is not only animated by the ulnar, but also by the median and radial nerve. [3] A representative American success with this technique was reported in 1892 [4]. Peterson and Keneally, who had been studying the effects of electromagnetism and alternating current at the Thomas Edison Laboratory at Orange, New Jersey, came upon the observation that analgesia and anesthesia could be produced by transcutaneous electrical peripheral nerve stimulation at frequencies above 2 kilocycles. They assisted at a surgical procedure utilizing this technique, which was performed in the autumn of 1892 at the Nervous Department (sic) of the Vanderbilt Clinic in New York City [5]. In 1928, Thompson and Inman, of the University of California at Berkeley, discovered, or rather rediscovered , that "the cutaneous...