What WW2 taught us about pain
It’s WW2, the Nazis are sweeping across Europe. You’re an American doctor, fresh out of med school, when you get enlisted and immediately sent as part of the med team for the campaign at the Anzio beachhead in Italy.
You arrive in the middle of the night right behind the soldiers’ front, and things are looking bad. Bullets whizzing by your tent, shells exploding every few moments, and you see the field medics coming back with injured man after man.
And these aren’t injuries that you've ever seen before. On rotation in the hospital, you saw the occasional broken bone or heart surgery. But this. This was unimaginably worse. Men with multiple bullet holes through their chest, whole limbs blown off by grenades, liters of lost blood.
Hundreds of these men, in the worst condition you’ve ever seen.
There is one saving grace though. You are heavily equipped with painkillers. Liters and liters of morphine — it’s more than enough to treat the entire squadron. So you take some comfort in being able to offer some chemically induced pain relief. It’s the least you can do for the soldiers.
But something weird begins to happen. You walk over to one man, lying on his back with a freshly bandaged leg that had been amputated, and ask if he would like pain relief. He looks up at you, pauses, and shakes his head.
You go over to another man, who had a bullet pass through his ribcage, shattering a lower rib, offering the same. He tells you he’s good.
The same thing happens again. You talk to him to make sure he’s not just shell-shocked, and he’s able to have a normal conversation with you. You wonder if it’s because they’re terrified of the morphine, but no — they explain that it’s mostly just that the pain isn’t so bad. These men all seem fine.
This is strange. You were taught to expect that everyone with serious damage would be in major pain. How was it that only a minority wanted any painkiller?
This was exactly the situation that Henry Beecher found himself in. He began to document statistics about the men in pain, which he later published in his famous paper Pain in Men Wounded in Battle.
It was stunning to the medical establishment because they thought of pain as synonymous with damage.
But what Beecher saw firsthand, and which we’ve had confirmed in dozens of other studies, was that pain was not the same as damage. The men at the Anzio Beachhead sustained the most serious injuries that a person can have, yet a huge fraction of them simply didn’t experience significant pain.
The state of scientific understanding of pain has made leaps and bounds, but much of the world hasn’t learned from Henry Beecher.
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