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August 18, 1969

Anxiety and Pain

JAMA. 1969;209(7):1080. doi:10.1001/jama.1969.03160200044014

For years it has been held that, when a given number of pain endings are injured and stimulated, a given degree of pain will be experienced; and that, for a given degree of pain, a given dose of morphine or similar agent is required. These propositions need to be examined.

Any small boy in a fist fight feels no pain at the time of injury. This comes later, when his bloody nose begins to drip or his mother arrives to console him. The severely wounded soldier, not in shock but clear mentally, has surprisingly little need for a narcotic.1 In the early hours after wounding, only a minority request it, whereas the civilian recovering from surgery with a much smaller wound receives two to three times as much narcotic as the soldier with his more extensive wound. We can conclude from this that our first proposition is false: There is

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