Objective: To trace how morphine was transformed during the middle of the twentieth century from a therapy of ‘last resort’ for pain relief in advanced cancer to a ‘gold standard’ treatment. This issue was explored as part of a larger UK study: ‘Innovations in cancer pain relief: technologies, practices, ethics’.
Methods: The wider study employed sociological, historical and ethical perspectives. A rigourous literature review covered peer-reviewed journals in cancer, palliative care, public health, medical history, medical sociology, and medical anthropology. Oral history collections were also used from the University of Sheffield and University of California. These include 200 oral history interviews with key founders in the fields of pain and palliative care Findings In the early post second world war period, the acceptance of the specificity theory of pain meant that neurosurgical and anaesthestic techniques for cancer pain relief were often prioritised over the use of narcotics. The search for a non addictive analgesic, and concerns about addiction to opioids, intensified this. Ironically, the search for an alternative analgesic in the US, led by Raymond Houde and Ada Rogers, helped to change this view. Their work, togther with that of key players such as John Bonica, Cicely Saunders and Robert Twycross, led to the development of a rationale for using morphine in cancer pain relief which was practicable clinically and sound scientifically. This was introduced when understandings of ‘the patient’ and concerns about suffering and chronic illness were being transformed, and a new theory of pain: ‘gate control’ theory emerged.
Conclusion: This period in the mid twentieth century saw clinical attitudes to, and theoretical understandings of morphine transformed. It set the foundations for the globalisation of the cancer pain relief agenda, in which cancer pain was recognised as a societal issue, not merely a concern of the patient and clinician.