John Bonica Research Articles

Dr. John Bonica’s Dueling Identities: Bringing the Pain… and Healing the Pain

Dr. John Bonica’s Dueling Identities: Bringing the Pain… and Healing the Pain

Empire of Pain: The Secret History of the Sackler Dynasty

Empire of Pain: The Secret History of the Sackler Dynasty

Bioethical correctness of integrative medicine in the treatment of chronic pain in the historical perspective

A reflection on progress in medicine – bioethics appeared in the 1970s. „Principless of biomedical ethics” – the monograph by Tom Beachamp and James Childress – was to change the concept of ethical evaluation of new possibilities of diagnostic and therapy and making decisions in medicine. In the 70’s there was also the development of chronic pain management. A pioneering concept of multidisciplinary management of a patient suffering from chronic pain by John Bonica is a part of the process of implementing four bioethical principles. The idea of integrative medicine – combining the methods resulting from the scientific and technical progress of Western medicine with the methods of traditional Eastern medicine has enabled the implementation of beneficience, nonmaleficence, autonomy, and justice. This article will present facts related to the Bonica’s concept in the first chronic pain clinic created in Poland in the 1970s.

John Bonica's Presentation Copy to Capt. Thomas Robbins.

John Bonica's Presentation Copy to Capt. Thomas Robbins.

The Origins of the Modern Pain Clinic at the Mayo Clinic

In the 1970s the practice of pain management evolved from the isolated anesthesiologist practicing pain "on the side" to a multi-disciplinary model. The impetus behind this change remains obscure. To understand how this national trend occurred locally and to examine national institutional challenges which should be reflected at the Mayo Clinic that stimulated the establishment of a modern academic pain practice, we interviewed appropriate staff members and reviewed relevant departmental meeting notes. Following the 1959 departure of Dr. John Lundy from Mayo, Dr. Robert Jones became the primary practitioner of pain procedures in addition to his anesthesiology practice. In 1973, close to his retirement, Jones wrote a letter to the department chairman, Dr. Richard Theye, expressing frustration because this divided practice hindered patient care, education, and research opportunities. In 1974 Dr. Lee Nauss joined Mayo upon residency completion at Virginia Mason where he received training in regional anesthesia and met Dr. John Bonica. Nauss introduced epidural steroid injections, which became in such great demand that other anesthesiologists needed to cover his rooms. Within two months, Theye asked Nauss to create a stand-alone pain clinic. Nauss recruited Dr. Tony Wang and opened the clinic that year. This pain clinic increased patient access, improved resident education, allowed for the establishment of a fellowship program, and produced ground-breaking research (e.g., the human administration of intrathecal morphine). The establishment of the pain clinic addressed the deficiencies of a mixed pain and anesthesia practice. The pain specialist could now focus attention on and provide better access for pain patients, keep current with clinical practice, engage in research, and educate future pain specialists.

Cancer pain: assessment, diagnosis, and management

Cancer pain: assessment, diagnosis, and management Dermot R Fitzgibbon and John D Loeser. Lippincott Williams & Wilkins, 2010. Pp 464, £94.00. ISBN 978-1-60831-089-0 Pain in cancer is one of the most common and feared symptoms that can occur at any disease stage. This book is written by two experts in the fi eld— an Emeritus Professor of Neurological Surgery and Anesthesiology, and an Associate Professor of Anesthesiology and Adjunct Professor of Medicine. The authors attempt to develop the book in the spirit of the renowned pain expert, John Bonica, and based on their experience at the University of Washington Pain Centre. The book has two sections: the fi rst on assessment and diagnosis, the second on management. The section on the background of the anatomy, physiology, and psychology of pain is excellent. Seeing these three components integrated was particularly pleasing. The mechanisms of transmission are well illustrated and described, making it accessible to readers from a wide range of backgrounds without being oversimplifi ed. Diff erent causes of pain in a patient with cancer are considered, and there is a discussion of issues aff ecting wellbeing in which depression and fatigue predominate. Also of particular value is the consideration of pain syndromes, especially those that are associated with diff erent chemotherapy regimens. Cancer pain is well discussed in individual cancers. Some of the issues described as aff ecting wellbeing were rather narrow—there are many more related issues beyond depression and fatigue, although clearly these are important. Communication, information giving, social and spiritual factors, and total pain could have been further highlighted. The section on management reviews radiotherapy, surgery, pharmacological approaches (including opioids and adjuvant analgesics), and pain management (including neuro surgical ablative procedures and neuraxial analgesia). A useful table on oral and transdermal opioids used in treatment of cancer pain is included. However, the subcutaneous route could have been reviewed in further detail, and the reporting of some of the common adverse events is a little uneven. Constipation is mentioned only for some opioids, but it is a consequence of all of them, as explained in a later section on side-eff ects. There are also useful sections about longterm use of opioids and hyperalgesia and serotonin syndrome. I was pleased to see information on sleep included, as it is often poorly reviewed. Sadly, there is little information about management of pain in advanced disease, and less than half a page on the role of specialist palliative care and hospices. The book will be of value for pain specialists and oncologists, particularly those training in the fi eld, and its broad accessibility will make it highly readable.

Edward Nigel Armitage

Edward Nigel Armitage was born in Huddersfield in 1935. His education at Oundle was mainly in classics, and he did not start science subjects until he was 15. His career...

John Bonica Did Not Recognize John Lundy as an Inspiration of His Pain Clinic Model

John Bonica Did Not Recognize John Lundy as an Inspiration of His Pain Clinic Model

Exploring Origins: Was John Bonica’s Model of Modern-Day Pain Management Influenced by John Lundy’s Earlier Work?

Contemporary pain medicine is a multimodality and multidisciplinary field. Many of the current ideas and styles of practice that influence the specialty today can be traced back to John Bonica, M.D., and his model of pain management introduced more than 50 years ago. Although much of the foundation that Bonica helped form involved several original concepts, historically, other anesthesiologists who were Bonica's predecessors also laid the groundwork for what the practice of pain medicine is today. In particular, Emery Rovenstine, M.D., and John Lundy, M.D., had early block clinics to treat painful conditions. While in the army during World War II, Bonica worked closely with his Chief of Surgery, Joel Deuterman, M.D., a physician who had trained at the Mayo Clinic, where he was exposed to Lundy and his techniques. Deuterman may have influenced Bonica's ideas concerning the treatment of chronic painful conditions.

Emerging subspecialties in neurology: Pain medicine

Traditionally neurologists have been considered masterful diagnosticians. Fellow physicians often rely on neurologists to sort out complex historical and examination data in order to arrive at a diagnosis and plan of action. Our specialty is also known for its expertise in the continuing longitudinal care of patients with serious illnesses that impact social and occupational function. Several neurologic diseases result in chronic pain, e.g., stroke, multiple sclerosis, and radiculopathy. For these reasons, neurologists are well suited to the practice of pain medicine. One of the first US neurologists to contribute to pain medicine was Silas Weir Mitchell. In Injuries of Nerves and Their Consequences, he gave detailed case descriptions of causalgia (complex regional pain syndrome) and phantom limb pain. Subsequently, the concept of multidisciplinary pain management was pioneered by John Bonica, who founded the first interdisciplinary pain clinic in 1947 at Tacoma General Hospital. Currently, the practice of pain medicine involves physicians from multiple specialties including physiatry, psychiatry, anesthesiology, neurosurgery, and neurology. In a survey of practicing US neurologists, 77.4% of respondents reported that they manage patients with chronic headache, whereas 47.6% cared for patients with chronic spine and limb …

Narrative, Pain, and Suffering

Vol. 34 D Carr, J Loeser, D Morris, eds. IASP Press, Seattle, Washington, 2005, 364 pages, $89.00, ISBN 0-931092-57-4 Listen up! Laboratories and rays do not tell the story. All physicians should have this book for the insights and guidance it provides. Good doctors and healers and popular alternative medicine practitioners, of whatever variety, have one characteristic in common—they really listen. This volume explains why and how medical students and practitioners, particularly in the field of pain medicine, should improve their ability to elicit the true story from each patient and improve their own clinical performance. Interest in the stories of patients has always been important, perhaps more so in the fields of medicine with a less secure evidence base and fewer diagnostic laboratory studies. However, interest in narrative has had a renaissance in pain medicine. This is evidenced by increasing attendance in formal and informal discussions at pain meetings. A formal workshop in Bellagio, Italy, was convened in October 2003 to explore the issues of narrative, pain, and suffering. This volume is the result of this conference. Three of the wisest men in pain medicine and the humanities have edited this volume, to make it comprehensive, readable, educational, challenging, and enjoyable. Daniel Carr is an anesthesiologist with a long history of intellectual and practical contributions to the scientific basis and practice of pain medicine. These range from publications on fundamental biochemistry to evidence-based pain practice guidelines. His perspectives and opinions are widely sought and highly regarded, and he has had an enduring impact on the development of pain medicine in medical schools, graduate schools, and in the community. John Loeser is a neurosurgeon at the University of Washington. He was trained in and continues to advance the multidisciplinary model of pain medicine put into practice at that institution by John Bonica all those years ago. He has not just moved with the times; he has been and still …

Brian Dwyer and the St. Vincent's Pain Clinic 1962 to 1989

Brian Dwyer was the Director of the Department of Anaesthetics at St. Vincent's Hospital in Sydney from 1955 to 1985. He developed a major interest in the management of intractable pain and was most impressed by the multidisciplinary pain clinic which was commissioned at the University of Washington in Seattle by John Bonica in 1960. In August 1962, Dr Dwyer established the first pain clinic in Australia, based on the Seattle model. Initially the St. Vincent's Pain Clinic specialized in the management of pain of malignant origin but in the 1970s and 1980s the work expanded to include the treatment of pain arising from a variety of benign conditions. The great strengths of the Pain Clinic were its multidisciplinary approach to pain problems and the realisation of the importance of psychological factors in the persistence of pain. As a result of his work, Brian Dwyer received international recognition as a pioneer in the field of chronic pain management and the St. Vincent's Pain Clinic served as a model for the establishment of similar units, both in Australia and overseas. Brian Dwyer was the first chairman of the Clinic and remained in that position until his retirement in 1989.

Pain: Disease or Dis‐ease? The John Bonica Lecture: Presented at the Third World Congress of World Institute of Pain, Barcelona 2004

Chronic pain has only recently been recognized as an important health care issue. There is no widely shared agreement as to the best ways to diagnose and treat chronic pain patients. Pain management is a chaotic component of contemporary medicine. I argue that we need to think of chronic pain as a disease in its own right and develop our specialty of pain management on the basis of evidence for treatment outcomes. The current chaotic state confuses patients, health care providers, and payers. It is possible that pain management may disappear from health care if we do not improve our understanding of chronic pain and how to best treat those who suffer.

Assessing the Past and Shaping the Future of Anesthesiology

Assessing the Past and Shaping the Future of Anesthesiology

Pain and palliative care: the emergence of new specialties

In the second half of the twentieth century, the clinical management of patients suffering pain from advanced cancer was transformed. This paper describes cancer pain management during this period, identifying three key elements that promoted innovation: First, the development of a patient-centered approach to analgesic evaluation, which resulted from the search for an alternative analgesic to morphine in studies led by Raymond Houde. Second, the re-introduction by John Bonica of the idea that pain is what the individual feels and thinks it is. Third, the work of Cicely Saunders in establishing the foundations of the modern hospice and palliative care movement. The work of these three clinicians must be set in the context of a time when new hopes emerged that cancer could be cured and, at the same time, the cancer patient began to be remolded from a passive participant in treatment and care to an active collaborator.

Bonica's Management of Pain.

Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. pstaats@jhmi.eduBonica's Management of Pain. By John D. Loeser, M.D. Lippincott Williams & Wilkins, Philadelphia, 2001. Pages: 2,178. Price: $299.00 new or $162.50 used from an on-line bookstore.Many years ago, when I was a fellow in the Department of Anesthesiology and Critical Care Medicine, I searched the library to find the best resource to learn about the field of pain management. At that time, I found two books: Prithvi Raj's, “Practical Management of Pain” 1and, of course, John Bonica's, “The Management of Pain .”2Bonica's two-volume edition provided a wealth of information that was not easily found from other sources. The basic pathophysiology, the differential diagnosis, technological techniques, and a few of the neurosurgical techniques were nicely covered in this edition. I can't say that I ever got to the point of reading this two-volume edition cover-to-cover. Whenever an issue arose that required an in-depth review, however, I turned to Bonica's The Management of Pain . Unfortunately, this meant that I lugged two volumes of this text back and forth on a daily basis, giving myself acute back pain in the process. This book, which was the second edition, had been updated in 1990 from the first edition, which was published in 1953. It truly was amazing how thorough this book was for the clinician.Ten yr have gone by, however, since the second edition was published, and this decade has seen a veritable explosion of information on the basic science of pain, techniques associated with appropriate pain therapy, and methods to control acute and chronic pain. Hence, I purchased John Loeser's 2001 edition of Bonica's Management of Pain with great enthusiasm. This latest edition has the benefit of being the first published in a single volume. It maintains the strong, critical foundation contained in the earlier editions and is updated with current information and references to the literature. If I had to point to one area that could have been developed more in this text, it would be the role of interventional therapies for chronic nonmalignant pain. Spinal cord stimulation, intrathecal infusion therapy, and spinal injection techniques have become the mainstay of interventional pain management. These techniques, while covered, are not addressed in the same depth that is applied to considerations of medically- or psychologically-oriented approaches for pain.John Loeser needs to be commended, however. He has accomplished the almost impossible task of updating John Bonica's thorough and expansive text on the management of pain while simultaneously producing a single-volume edition. Nothing was lost in this new edition and much has been gained.

Psychosocial Factors in Pain

Article AbstractFrom our regular book review column. Pain accounts for over 80% of physician visits. The importance of psychological factors has been demonstrated by the observations of Henry Beecher at the Battle of Anzio, experience with multidisciplinary treatment by John Bonica and Wilbert Fordyce, and formulation of the Gate Control Theory by Ronald Melzack and Patrick Wall. This book places particular emphasis on chronic musculoskeletal pain such as low back pain, the most expensive benign medical condition in industrialized countries. In response to this problem, hundreds of pain clinics have been opened in the United States. Mainstream medical practitioners have been reluctant to refer patients to pain clinics, perhaps owing to overstated treatment results, skepticism about behavioral science, and barriers from managed care organizations and workers†compensation underwriters.

History of Pain Research and Management in Canada

Scattered accounts of the treatment of pain by aboriginal Canadians are found in the journals of the early explorers and missionaries. French and English settlers brought with them the remedies of their home countries. The growth of medicine through the 18th and 19th centuries, particularly in Europe, was mirrored in the practice and treatment methods of Canadians and Americans. In the 19th century, while Americans learned about causalgia and the pain of wounds, Canadian insurrections were much less devastating than the United States Civil War. By the end of that century, a Canadian professor working in the United States, Sir William Osler, was responsible for a standard textbook of medicine with a variety of treatments for painful illnesses. Yet pain did not figure in the index of that book. The modern period in pain research and management can probably be dated to the 20 years before the founding of the International Association for the Study of Pain. Pride of place belongs to The management of pain by John Bonica, published in Philadelphia in 1953 and based upon his work in Tacoma and Seattle. Ideas about pain were evolving in Canada in the 1950s with Donald Hebb, Professor of Psychology at McGill University in Montreal, corresponding with the leading American neurophysiologist, George H Bishop. Hebb′s pupil Ronald Melzack engaged in studies of early experiences in relation to pain and, joining with Patrick Wall at Massachusetts Institute of Technology, published the 1965 paper in Science that revolutionized thinking. Partly because of this early start with prominent figures and partly because of its social system in the organization of medicine, Canada became a centre for a number of aspects of pain research and management, ranging from pain clinics in Halifax, Kingston and Saskatoon ‐ which were among the earliest to advance treatment of pain ‐ to studying the effects of implanted electrodes for neurosurgery. Work in Toronto by Moldofsky and Smythe was probably responsible for turning ideas about fibromyalgia from the quaint concept of ′psychogenic rheumatism′ into the more fruitful avenue of empirical exploration of brain function, muscle tender points and clinical definition of disease. Tasker and others in Toronto made important advances in the neurophysiology of nociception by the thalamus and cingulate regions. Their work continues while a variety of basic and clinical studies are advancing knowledge of fundamental mechanisms, including work by Henry and by Sawynok on purines; by Salter and by Coderre on spinal cord mechanisms and plasticity; by Katz on postoperative pain; by several workers on children′s pain; and by Bushnell and others in Montreal on cerebral imaging. Such contributions reflect work done in a country that would not want to claim that its efforts are unique, but would hope to be seen as maintaining some of the best standards in the developed world.

The Myth of Painless Childbirth (The John J. Bonica Lecture)

Abstract We are all familiar with John Bonica's magnificent contributions to the management and understanding of acute and chronic pain. But some people are not aware that John is also a world authority on obstetrical anesthesia. He developed a special interest in obstetrical problems early in his career, after his wife Emma had a near-disastrous experience with improperly administered ether anesthesia during the birth of their first child. He worked hard at acquiring skill and expertise in administering epidural analgesia, and subsequently organized the first 24-h medical anesthesia service for obstetrics in the United States. After two decades of experience, he wrote the 2-vol set Principles and Practice of Obstetric Analgesia and Anesthesia [4] which is an acknowledged modern medical classic. Every aspect of childbirth is addressed with the same thoughtfulness, insight and meticulous detail that are characteristic of John's books and papers on chronic pain. John has repeatedly argued [5,6] that labor is often extremely painful and that severe, prolonged pain can be dangerous to women with cardiovascular problems and to the fetus whose oxygen supply may be at risk during protracted, complicated deliveries. My recent work supports John's contention that most women suffer severe pain during labor.

The myth of painless childbirth (The John J. Bonica Lecture)

We are all familiar with John Bonica's magnificent contributions to the management and understanding of acute and chronic pain. But some people are not aware that John is also a world authority on obstetrical anesthesia. He developed a special interest in obstetrical problems early in his career, after his wife Emma had a near-disastrous experience with improperly administered ether anesthesia during the birth of their first child. He worked hard at acquiring skill and expertise in administering epidural analgesia, and subsequently organized the first 24-h medical anesthesia service for obstetrics in the United States. After two decades of experience, he wrote the 2-vol set Principles and Practice of Obstetric Analgesia and Anesthesia [4] which is an acknowledged modern medical classic. Every aspect of childbirth is addressed with the same thoughtfulness, insight and meticulous detail that are characteristic of John's books and papers on chronic pain. John has repeatedly argued [5,6] that labor is often extremely painful and that severe, prolonged pain can be dangerous to women with cardiovascular problems and to the fetus whose oxygen supply may be at risk during protracted, complicated deliveries. My recent work supports John's contention that most women suffer severe pain during labor.