“Those who pursue knowledge about pain or attempt to relieve pain and suffering in their patients should recognize that John Bonica had the vision and laid out the road that made our careers feasible. Those who travel this route will be forever indebted to him.” IASP
Check out an entertaining, inspiring and revealing talk on the man who got medicine to start focusing on pain. A former professional wrestler turned doctor, John Bonica revolutionized the American medical establishment’s approach to pain in the most basic way possible: he got to start actively researching and treating it.
Bonica called pain the most complex human experience we face. Despite the paucity of research on it (he found 17 pages out of thousands of pages of text on it) nothing about it he felt, was simple. The most common pain relief procedure of his day – applying nerve blocks – were almost useless in the complex, chronic pain many people suffered from.
Early on Bonica realized that pain was a multidimensional problem. In what was probably the first organized multidisciplinary approach to pain, Bonica gathered colleagues in neurology, neurosurgery, orthopedics and psychiatry together, weekly, to examine patients and compare notes.
After a stint in the Army, Bonica established pain centers at two Universities. He created the first formalized training programs in the treatment of pain and authored the book “The Management of Pain”, now regarded as a “monumental classic” in the field, in 1953. (Bonica’s Management of Pain is now in it’s fourth edition. Clocking in at a cool $359.00 it’s still called the leading textbook and clinical reference in the field of pain medicine.)
At the University of Washington his work with a psychologist established the significant roles that stress and depression can play in exacerbating pain. After seeing his wife almost die while under ether during childbirth, he helped produce the epidurals that help so many women today. In the 1970’s he created an organization dedicated to the multidisciplinary treatment of pain – the International Association for the Study of Pain and the PAIN journal.
Bonica himself suffered from years of chronic pain
Bonica knew of which he spoke. His years of professional wrestling (he is in the Professional Wrestling Hall of Fame) to put himself through college and support his family, took their toll. Living in severe pain, he underwent dozens of operations including multiple hip transplants and received hundreds of nerve blocks and trigger point injections. Without the focus, his work provided him (he worked 15-18 days), he acknowledged he’d probably be a cripple. He worked to help people, he worked because he was fascinated, and he worked to escape his pain.
Bonica died in 1994 just six months after his wife of 50 plus years passed away. The organization he founded, the IASP, continues his focus on bringing pain treatments to those in
Among the many unusual approaches (for the time) to pain Bonica examined was acupuncture.
need. It’s Global Year Against Neuropathic Pain launched in October of last year, is dedicated to ensuring that people with neuropathic pain have full access to possible treatments. Stating that many people with neuropathic pain are under-treated, the organization mobilized its 8,000 members and 90 chapters to inform doctors about how to treat neuropathic pain.
If Bonica was alive today he’d probably be both encouraged and appalled by the distance the pain field has come. Twenty-five years later pain is acknowledged to be one of the most complex and common problems the medical establishment faces but no pain institute exists at the NIH which only started tracking pain research funding in 2014. Still miserably silo’ed, the research approach to pain little resembles the rich multidisciplinary mileu Bonica uncovered.
Despite the barriers that remain significant, progress is, however, being made. No one in the medical field is unaware that the standard approach to chronic pain relief – opioid drugs – is significantly flawed and new approaches are needed. Bonica would undoubtedly be fascinated by the creative turn the research has taken. From magnetic brain to vagus nerve stimulators, to microglial inhibitors, to immune modulators, to ion channel effecting drugs, to antidepressants, to mind/body approaches, pain research is indeed in a fertile era.
(Thanks to J. William for bringing Bonica’s fascinating story to me.)
Love this!!!❤️
It’s nice to be inspired and know there are people working hard. I think we lose sight of that sometimes.
Glad you felt it worthy of more research and a blog post, Cort. Thank fate for these people who seem to come from out in left field with insights that fit so well. You’re one of those too!
this is a video of De Jarred Youmger of Stanford, who is a pain specialist. He has a very human and empathetic approach.
https://m.youtube.com/watch?v=ma_lY7NFLQk
Thank you for the interesting article, Cort. Starting out with that, because now I’m going to rant…
😉
“No one in medical field is unaware that the standard approach to chronic pain relief – opioid drugs – is significantly flawed and new approaches are needed.”
What is MORE flawed is the attitude towards opioids… the myths, misunderstandings, and outright prejudice against not only opioid medications (still the most effective and safest pain medications available) but the prejudice heaped on patients who benefit from them. Such a strange society: because some people actually like the way a medication makes them feel, the medication is bad, the patients that use it are bad, doctors who prescribe them are bad and we must make sure that as few people as possible can benefit from it.
Actually, I’d argue that the “standard” approach to chronic pain is to ignore it or prescribe psychological therapy. I actually had an attending anesthesiologist tell me that opioids should NEVER be used for chronic pain. And I was only able to be there, as a functioning resident, listening to this drivel, because of opioids treating my chronic pain.
Let me reiterate, however: Cort, thank you for the article and EVERYTHING you do.
Vlynx said: “What is MORE flawed is the attitude towards opioids… the myths, misunderstandings, and outright prejudice against not only opioid medications (still the most effective and safest pain medications available) but the prejudice heaped on patients who benefit from them.”
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I have to agree; thought you might enjoy this read:
A significant minority of the population only feel truly well on opioids. It would indeed be extraordinary if, alone among the neurotransmitter systems of the brain, the endogenous opioid families were immune from dysfunction. Enkephalins (endorphins) are critical to “basal hedonic tone” i.e. whether we naturally feel happy or sad. Yet the therapeutic implications of a recognition that dysfunctional endogenous opioid systems underlie a spectrum of anxiety-disorders, pain disorders and depression are too radical, at present, for the medical establishment to contemplate. In consequence, the use of opioid-based pharmacotherapies for “psychological” pain is officially taboo. The unique efficacy of opioids in banishing mental distress is neglected. Their unrivalled efficacy in treating “physical” nociceptive pain is grudgingly accepted.
Drug-deprivation makes the habitual opioid user feel ill with characteristic anxiety, depression, sickness behaviour and sometimes raw physical pain (sound familiar?). A recognition of the crucial role of dopamine and endorphins in pain, anxiety and depression disorders may result in higher rates of remission.
Source: http://opioids.com/I
Sorry, above link doesn’t open. Use this link: http://opioids.com/
🙂
I just finished for the 3rd or 4th time reading about the Lewis and Clark Expedition.
Also how the Indians were using Opioids on a regular basis.
When the White man found out about this-they offered the Indians
Chocolate for the Opioids.
We came up with the Opioids and the Indians the Chocolates.
Who is the smarter of the two?
The Indians were a lot more laid back than we were.:)
They have been used for centuries and very few were truly addicted!!
Carole
Thanks Cort!!!!
So, chocolate is all I need to cure my ME/CFS? Thanks Carole! I wish I had known that thirty years ago. Did these Native Amercans also have ME/CFS and did chocolate cure them?
Whens next bua to Stanford?
I felt so warm after the reading!
This is great,very interseting ! What a hero of modern medicine! We need more Drs. and medical people like this in the world.
Great share Cort. I wrote a blog that included a review of the presentation on Dr. Bonica at the Center for Practical Bioethics Symposium Pain and Politics, and I met the author of Pain: A Political History, professor of history at Princeton, Keith Wailoo. (It’s a great book if you are interested in history.)
Sounds interesting – thanks Celeste.
Great article. He was One of Us! And Thank you as always Cort for the LDN articles this year. Pain levels going from an 8-10 to a 2-4 has been such a blessing. A few weeks ago there was a production problem w/the ldn Shipment and I was out for 5 days. Boy for those last 2 days ‘I thought I was gonna die.’ Granted, a euphemism, but how is it LDN has been available for years and the first I hear of it was January?! Ugh!
Anyway, great article. And thanks for Dr Younger doing his work on our behalf as well.
I think he would have been all over LDN :). I hope others try it. There are just too many reports of how it has helped.