"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."