“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 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
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.)