John Bonica

"I have declared war on pain."

"The proper management of pain remains, after all, the most important obligation, the main objective, and the crowning achievement of every physician."

"The crucial role of psychological and environmental factors in causing pain in a significant number of patients only recently received attention. As a consequence, there has emerged a sketch plan of pain apparatus with its receptors, conducting fibers, and its standard function which is to be applicable to all circumstances. But... in doing so, medicine has overlooked the fact that the activity of this apparatus is subject to the a constantly changing influence of the mind."

"Pain—one of the most pressing issues of out time."

"Nearly one-third of the population has persistent or recurrent chronic pain—and of those, one-half to two-thirds are either partially or totally disabled for periods of days, weeks, or months, and sometimes permanently."

"No medical school has a pain curriculum..."

"What the hell kind of conclusion can you come to there? The most important thing, from the patient's perspective, they don't talk about."

"If I wasn't as busy as I am... I would be a completely disabled guy."

"The continuum—stretching from a pole of "healing through techniques" to the pole of "healing through management"—is not specific to France. ...the gate control theory of pain—had played a crucial role in the development of pain medicine as proposed by John Bonica. The proposals of this anesthetist date from as early as 1944, but only became widely accepted in 1974. ...with the concept of pain clinics launched in 1953 by John Bonica, physicians had access to an organizational model. By the end of the 1970s, this model was widely accepted in the world of pain medicine. It stipulated that lasting pain—chronic pain... should be treated in specific pain clinics or pain centers by multidisciplinary teams... The justification for such a grouping of people stems from Bonica's 1953 book The Management of Pain, where he analyzes the complexity of problems associated with intractable pain that has resisted any traditional treatment in a number of disciplines. ...any evaluation of pain must be carried out on both the physical and the psychological level."

"Some fragmentation of the principles espoused by Dr. Bonica more than forty years ago has occurred, and unidisciplinary "pain clinics" have become commonplace."

"Dr. John Bonica, professor of anesthesiology at the University of Washington and founder of the Multidisplinary Pain Center, Seattle, spearheaded the movement to recognize pain as an entity unto itself. Bonica and other pain specialists are alarmed by an epidemic of pain throughout the industrialized world. ...He estimates that pain results in the loss of some 700 million workdays a year—in litigation, in compensation, and, mostly, in search for relief."

"Doctors practice in the isolation of their private offices, treating patients with the tools of their particular specialties. Compounding what John Bonica calls this "tubular vision" in the medical profession, the specialists don't compare notes or join forces; often they don't even realize whom else the patient has seen or what's already been done. ...sometimes they become impatient with pain—especially when there's no observable pathological reason for a person's complaint."

"The practical turn in modern pain therapy is primarily traced back to American anesthesiologist John Bonica. In the early 1950s, he first tried to found the management of pain on the methods of regional anaesthesia. In 1953, he published a book... Focusing on regional anaesthesia, it was intended to list all known options for treating pain. ...regional anaesthesia alone is not the way to obtain regular therapeutic success in cases of chronic pain. However... it started a move toward detachment from the components of cultural theories that, while suitable for wordy explorations of chronic pain, only considered the statements of patients in a distanced manner, in practice leaving the patients to themselves with their pain."

"Pioneering pain researcher John J. Bonica (1990) believed that being rewarded for pain behaviors is a key factor that transforms acute pain into chronic pain. According to Bonica, people who receive attention, sympathy, relief from normal responsibilities, and disability compensation for their injuries and pain behaviors are more likely to develop chronic pain than are people who have similar injury but receive fewer rewards. Consistent with Bonica's hypothesis, headache patients report more pain behaviors and greater pain intensity when their spouses or significant others respond to pain complaints with seemingly helpful responses, such as taking over chores, turning on the television, or encouraging the patient to rest (Pence, Thorn. Jensen & Romano, 2008)"

"It is... with perfect timing that Dr. Dermot Fitzgibbon... with the collaboration of Dr. John D. Loeser... have provided us with a comprehensive interdisciplinary, patient-centered, guide to the assessment, diagnosis, and management of cancer pain. With a combined experience of over 50 years in pain management and in the spirit of Dr. John Bonica, both Drs, Fitzgibbon and Loeser have composed a detailed treatise that covers not only pain (with a lower case p) as a symptom, but also Pain (with a capital P), as a disease, with all its physiologic, pathologic, emotional, social, and existential dimensions."

"Dr. John Bonica decided that the most effective way to combat pain is to treat the person as a whole."

"The challenge of managing chronic pain and suffering born of injuries to troops in WWII galvanized John Bonica and other pioneers, representing several specialties, into action. They refused to consider that their duty to these soldiers, and by extension their brethren in chronic pain of all causes, was finished once pain was controlled after an acute injury or during a surgical procedure."

"The practice of pain rehabilitation increasingly developed during the twentieth century by evolving medical specialties of physical medicine and rehabiltitation, anesthesia, psychiatry, and occupational medicine. John Bonica, one of the fathers of pain medicine, championed a more comprehensive biopsychosocial multidisciplinary approach in the United States in 1947. This approach expanded to include a team of clinicians at the University of Washington in the 1960s. Bonica's collaboration with Wilbert Fordyce, a psychologist, incorporated operant conditioning and other behavioral approaches with more specialized, structured, and in-patient multi-week programs. In the 1980s, John Loeser formalized a more structured program at the University of Washington. This 3-week long, daily program became a model for interdisciplinary treatment."

"The full array of nociceptors is now deluging the nervous system with a blitz of chemical and electrical signals that the late American pain-management pioneer John Bonica called "the inflammatory soup of prostaglandins, protons, serotonin, histamine, bradykinin, pourines, cytokines, eicosanoids, and neuropeptides. Pain now echoes and amplifies itself as nociceptors form circuits and feedback loops, each link in the chain stimulating its neighbors to greater activity."

"Dr. John Bonica and I became good friends quickly, a great benefit to me then and much more later. ...John seemed to take an interest in my having trained in the surgery of children and in two weeks taught me many basic principles of anesthesiology. Little did I know at the time how useful this information would be for me—when I became chief of anesthesia at a hospital army unit in a strange country."

"John J. Bonica... recognized during his experience in World War II that he was unable to provide adequate pain relief for many of his patients if he utilized only the methods afforded to him by his training in anesthesiology. He realized that health care providers who had been trained in other specialties and had managed pain for their patients could add a new dimension to both the evaluation and treatment of complex pain conditions that did not respond to his particular treatment. Although perceived by some to be more complicated and more costly because of the intitial multispecialty evaluations and treatments, multidisciplinary team management of pain has proven to be more effective and less costly overall than when pain is managed by different specialists working independently."

"John Bonica formalized the recognition of pain as a clinical entity; the work emphasized the pain syndrome's individualized consideration, as opposed to it being thought of as little more than an accompaniment of acute trauma, or an even worse myth, the miserable complaints of neurotic patients who stubbornly refuse to heal. Bonica's formal conceptualization of pain as a disease state within its own right stimulated an ever widening wave of research and clinical application culminating in the newest specialty recognized in Medicine..."

"Willard Fordyce, working with physician John Bonica, reconceptualized subjective ( and therefore unreachable) "pain" into observable and measurable "pain behaviors," and showed that these respond to reinforcement contingencies just like all other behaviors. Fordyce and Bonica's program at the University of Washington was the first modern, interdisciplinary, and effective pain clinic."

"John Bonica, the indefatigable champion of the multidisciplinarity of pain, took heart at the new interest generated by the gate control method. Since 1960, he had influenced a generation of young anesthesiologists, who were trained as fellows at the University of Washington... He also collected the names of researchers and clinicians interested in pain and had begun correspondences with many of them. Between 1969 and 1975, this evangelical work bore fruit, when Bonica was invited by the Japanese Ministry of Health and by corresponding agencies in several European and Latin American nations to consult on the development of pain clinics and facilities. In May, 1973, he brought 350 pain researchers together in the Seattle suburb of Issaquah for 3 days of papers and discussion and gained the group's approval to launch an international, interdisciplinary professional organization devoted to pain research and management. The International Association for the Study of Pain (IASP) was formally incorporated the following year, and the first issue of the journal, Pain... was sent to members in January 1975."

"It was a summer day in 1941. The circus had just arrived in the tiny town of Brookfield, New York. Spectators flocked to see the wire-walkers, the tramp clowns -- if they were lucky, the human cannonball. They also came to see the strongman, Johnny "Bull" Walker, a brawny bully who'd pin you for a dollar. ...Now, the strongman hadn't told anyone, but he was actually a third-year medical student. He toured with the circus during summers to pay tuition ...over the next five decades, he'd draw on these dueling identities to forge a whole new way to think about pain. It would change modern medicine; so much so, that decades later, Time magazine would call him pain relief's founding father."

"Right around D-Day, Bonica showed up to Madigan Army Medical Center, near Tacoma. At 7,700 beds, it was one of the largest army hospitals in America. Bonica was in charge of all pain control there. He was only 27. ... Bonica tracked down all the specialists at his hospital -- surgeons, neurologists, psychiatrists, others. And he tried to get their opinions on his patients. It took too long, so he started organizing group meetings over lunch. It would be like a tag team of specialists going up against the patient's pain. No one had ever focused on pain this way before."

"Bonica's years of wrestling caught up to him. ...Still in his mid-50s, he suffered severe osteoarthritis. Over the next 20 years he'd have 22 surgeries, including four spine operations, and hip replacement after hip replacement. He could barely raise his arm, turn his neck. He needed aluminum crutches to walk. His friends and former students became his doctors. ... Already a workaholic, he worked even more -- 15- to 18-hour days. Healing others became more than just his job, it was his own most effective form of relief."

"It has been thirty years since John Bonica, the great anesthesia-based pain educator, expressed concern that pain was not well controlled because of the failure of physicians to apply available knowledge."

"In 1946, Dr. John Bonica began the first multidisciplinary pain center in Tacoma, Washington, based out of a private practice. It arose from his recognition that chronic pain was optimally treated by a team of specialists. For the first time, patients suffering pain were routinely evaluated by different medical specialties, physical therapists, and psychiatrists. ...Other multidisciplinary pain programs began to emerge around the country, carrying forward the original Bonica model."

"John Bonica, himself an army surgeon during World War II, recognized the gross inadequacy of managing war injuries and other painful states of veterans with the existing unidisciplinary approaches. This led him to propose the concept of multidisciplinary, multimodal management of chronic pain, including behavioral evaluation and treatment. Bonica also highlighted the fact that pain of all kinds was being undertreated; his work had born fruit in that he is considered the "father of pain," and he was the catalyst for the formation of many established national and international pain organizations. ...As a result of his work, the American Pain Society (APS) and the International Association for the Study of Pain (IASP) have been formed, are still active, and continue to lead in pain research and pain management. Bonica's lasting legacy is The Management of Pain..."

"The first pain management systems were set up in the 1940s and 1950s and initially focused on chronic pain and palliative care in the UK. Although palliative care services dealt with more than pain they did bring to bear a whole systems approach to the problems which eventually influenced other types of pain management services. Both these services were led by charismatic figures, such as Dame Cicely Saunders in the UK and Dr John Bonica in the USA, who advocated a multidisciplinary and multiprofessional approach to pain management. However, the reality was that historically these service arose locally out of special interest rather than any coherent strategic planning."

"John Bonica was an anesthesiologist and is recognized as the father of pain management, a field that has now evolved into the well-recognized medical specialty called Pain Medicine. After completing residency in 1944, Bonica joined the United States Army and was appointed Chief of Anesthesiology at Michigan Army Medical Center in Fort Lewis, Washington. For the next three years, he gained first hand experience while treating painful injuries in World War II veterans. As an anesthesiologist, Bonica found that the tools at his disposal, opioid analgesics and peripheral nerve blocks using local anesthetics, were just a small part of what was needed to adequately diagnose and treat patients with complex, chronic painful disorders. He went on to pioneer the concept of bringing multiple medial specialists together to evaluate patients and and construct a comprehensive treatment plan for each patient. Thus, the multidisciplinary approach to pain management was born."

"Bonica, the anesthesiologist and former pro wrestler, had founded the clinic. He wrote a classic pain-management textbook from what he learned. ...Later, his disciple, Dr. John Loeser, expanded Bonica's clinic. Hundreds of clinics followed across the country. But insurance companies gradually stopped paying for the services that made the clinics multidisciplinary. Prescription pills were easier and cheaper, and at least for a while they worked well. In 1998 Loeser resigned as the multidisciplinary clinic was marginalized at the school that had invented the idea. A decade later, [Alex] Cahana said, "it was as if [the clinic] didn't exist. It was a metaphor for what happened to multidisciplinary pain management."

"Bonica... was the first to treat pain as a disease all its own, using the multiple disciplines of neurology, orthopedics, psychology, and physical therapy, along with alternative therapies such as acupuncture. I was captivated by Bonica's ability to successfully treat a multitude of patients whose pain had previously confounded doctors for years. His book revealed how, with dedication and the proper tools, pain could be eiliminated, even if the primary illness remained. This was revolutionary in the 1940s, and it was still considered revolutionary, fifty years later."

"Anesthesiologist John Bonica faced one of those life-threatening scenarios when his wife, Emma, gave birth to their first child in 1943. Aware that anesthesiologists avoided obstetrics, Bonica personally trained the chief obstetric resident at St. Vincent's in New York in anticipation of Emma's labor. When she was ready to deliver, the chief resident was performing a cesarean section. ...To his dismay, Bonica discovered that the obstetrician wanted to avoid anesthesia. ...But even this wary doctor believed that a small amount of ether was necessary... The nervous intern... administered too much ether too quickly. ...Bonica pushed the intern aside and stepped in to save the lives of his wife and baby. From that unsettling moment on, the development of safe obstetric anesthesia was all-important to Bonica."

"He became the first anesthesiologist to experiment with the segmental epidural; he pinpointed exactly which portion of the spine needed to be anesthetized during labor... He became an outspoken advocate for expertise in obstetric anesthesiology, complaining in the Journal of the American Medical Association in 1985 that it was an old custom to assign the least experienced anesthetist and the most antiquated equipment to the maternity ward. ...he observed that interns, residents, and nurses with no training were often ordered to administer anesthesia in delivery rooms at the last minute, a situation that would never be tolerated in the operating room. Bonica urged the creation of twenty-four-hour anesthesia services dedicated to maternity wards, unheard of then, but fairly routine today."