A personal experience learning from two pain pioneers, J.J. Bonica and W. Fordyce: Lessons surviving four decades of pain practice
Authors: Butler Stephen 
Published: December 2009

This article was requested by the Editor, Professor Harald Brevik after listening to a lecture I gave in a similar vein. Harald wanted the information in print and I have done this in a partly autobiographical form to explain how I came to work and learn from both the late John J. Bonica and the late Wilbert Fordyce.

Both of these men have been important in different ways to our present pain world. John J. Bonica made many contributions not only in pain but in regional anesthesia and obstetrical anesthesia but not on the same level. His conviction and drive in the pain field actually revolutionized pain research and practice. Dr. Bonica early on knew he needed help with difficult cases and began a multidisciplianary clinic that served as a model for all. He wrote and published the first really comprehensive text on pain (The Management of Pain) that has appeared in two subsequent revisions and a third revision is in progress. He succeeded in founding the International Association for the Study of Pain to bring clinicians and researchers together so that we could learn from each other. Again, Dr. Bonica felt that the multidisciplinary approach to research was the key to unlocking the secrets of pain. Dr. Bonica also succeeded in persuading the American Congress and the WHO that pain was a significant problem not only for all Americans but for all humanity. His drive was an inspiration to all who came in contact with him and he touched my life in several ways as a teacher, a colleague and a patient.

Bill Fordyce was not a larger than life individual like John J. Bonica but he also had a profound effect on the pain world and on me. Bill was one of the first real champions of the application of behavioural principles to the treatment of chronic pain. His visionary and inventive use of operant behavioural therapy in a multidisciplinary pain setting set the mark for all comprehensive pain clinics and the principles he used are still in effect world wide and are making converts of more and more practitioners frustrated by the lack of advances using the biomedical model. Bill created a whole new area of treatment that has made pain rehabilitation a thriving business and has made practical use of the biopsychosocial model of Engel as an explanation for much of the disability and suffering in chronic pain.

For me, John J. Bonica was an inspiration for hard work and constant learning. Bill Fordyce taught me new tools to use to understand many complicated pain patients but also many practical aphorisms to guide evaluation and treatment. I have been extremely lucky in being able to have had a long relationship with both of these pain giants who were always open to discussion and debate over the difficult problems. Their teaching both by example, discussion and in their writing had and still has a strong effect on my life as a physician, a pain practitioner and a teacher. I would like to pass on some of that information to all interested in research, teaching and pain management. As they say in Sweden, “Var så god!”.