Brochure announcing the University of Washington Multidisciplinary Pain Clinic, c.1969

The young anesthesiologist John J. Bonica (1917-1994), assigned to take charge of pain control at Madigan Army Hospital in Washington State in 1944, found himself seeing "cases that baffled me." He sent the patients for consultations with colleagues: an orthopedist, a neurosurgeon, a psychiatrist, but "they knew less than I did." He proposed that the four meet twice a week at lunch for conversation and exchange of information on difficult pain problems. The success of this informal collaboration prompted him to establish a multidisciplinary pain clinic at Tacoma General Hospital in 1947, which he brought to the University of Washington in 1960.

	John Bonica

Bonica saw the idea of interdisciplinary collaboration as the key to the understanding of pain. He described his clinic as "a totally different thing, much more fruitful and efficient. . . The basis of my program is patient care; the frosting is the research."   (Quotations from the Oral History of John Bonica, 1993)

	Brochure announcing the Issaquah conference, 1973

In 1973, encouraged by the response to the gate control theory, John Bonica (shown here at another conference in 1972) organized a highly productive scientific meeting of some 300 pain researchers in Issaquah, (Seattle) Washington, where he won their unanimous endorsement of a new International Association for the Study of Pain based on the concept of interdisciplinary collaboration.

William K. Livingston, too, had been inspired by his wartime experiences in pain management with a multidisciplinary team, which he described as "one of the most exciting and profitable periods of my life." He also saw the collaboration of laboratory and clinic as the most likely approach to lead to more effective management of chronic pain and, in 1947, began his "Pain Project" at the University of Oregon, where he had been appointed Chair of Surgery:

"I let it be known. . . that I wanted to organize a 'Pain Project' in which a team of investigators would undertake a simultaneous study of the physiological and psychological aspects of pain in our clinics and research laboratories. The response was enthusiastic and the team was soon organized by members drawn from both basic science and clinical departments."   (From: Pain and Suffering, W.K. Livingston's unpublished manuscript)

Acupuncture

	Acupuncture mannikin			Manual for acupuncture wall charts, published and printed in Hong Kong, 1972

The Chinese practice of acupuncture is based on ancient practice, but modern techniques may owe a debt to Western anatomy. Following President Richard Nixon's visit to the People's Republic in 1972, many U.S. practitioners and clinics began experimenting with acupuncture for the relief of chronic pain.

Pain Therapy Today

Since 1973, the multidisciplinary pain clinic has come into its own. Many clinics now offer a variety of therapeutic approaches to effective pain management, including physical therapy, acupuncture, TENS (transcutaneous electronic nerve stimulation), hypnosis, and behavioral modification based on the methods pioneered by Bonica's colleague, Wilbert Fordyce. However, not all patients have access to good pain clinics and, in the US, many pain therapies are not covered by insurance.

Richard Sternbach, of the Pain Treatment Center at Scripps Clinic and Research Foundation in La Jolla, offered 7 steps on how to live despite pain in his 1977 pamphlet (How Can I Learn to Live With Pain When It Hurts So Much?, revised in 1983):

1. Accept the fact of your pain
2. Set specific goals of work, hobbies and social acitivities towards which you will work
3. Let yourself get angry at your pain if it seems to be getting the best of you
4. Pace your activities
   • Get in shape, and keep fit
   • Learn to relax, and practice it
5. Time your medications, then taper off them
6. Have family and friends support only your healthy behavior, not your invalidism
7. Be open and reasonable with your doctor

Taxonomy of Pain Terms

One of John Bonica's first goals for the International Association for the Study of Pain was to develop a taxonomy of pain terminology and definitions--a common language for the different disciplines. Harold Mersky chaired the IASP task force that created the first Taxonomy in 1979. He continued to revise and update the definitions with the input of Marshall Devor, Nikolai Broduk, and others. The most recent version of Pain Terms appeared in 1994.