Pain Relief's Founding Father

By Dick Thompson

He uses an aluminum wrist cane to walk across the expansive living room of his Mercer Island, Wash., home. He walks surprisingly quickly, despite the ar thritis and 22 operations that have left his left leg 1 Yi in. shorter than his right. He cannot stand for more than seven minutes at a time without great pain. Says Dr.

John Bonica, 67, onetime professional wrestler and a prime mover in establishing the study of pain as a science: "If I wasn't as busy as I am, I would be a completely disabled guy."

Those millions of Americans who suffer from chronic pain have cause to be thankful for Bonica's tenacity. He has helped make much of the medical profession aware of both the compassion and the specialized approach needed to deal with the agony of pain. Twenty-three years ago he helped found the University of Washington Medical Center's Clinical Pain Service, in Seattle, which has be come a model for similar clinics across the country. Here, sufferers from chronic pain can be examined by medical specialists in a variety of fields, from orthopedics to psychiatry, in an attempt to isolate the often mysterious causes of a patient's constant agony.

Bonica's grizzled features and no-nonsense bedside manner belie the depth of his feeling for the suffering. Recently, when talking of treating a woman in Saudi Arabia whose face had literally been eaten away by cancer, his eyes began welling with tears.

"He spoke of reading her hospital chart and realizing that she had been enduring needless suffering because her doctors had given her inadequate doses of pain-killing drugs. "I've seen patients and I've cried," he admits. "It stresses me emotionally to see a patient in severe pain who could be relieved and is not." And yet, according to his asso ciates, Bonica never discusses his own pain. Says Bill Fordyce, a psychologist at the Seattle clinic: "He's a tough old son of a gun."

The need for a radical new approach to the treatment of pain became obvious to Bonica while serving as chief of anesthesiology at Fort Lewis, near Tacoma, during World War II.

Traditionally, pain therapy had not been regarded as an area for specialists, and the treatment of choice was drugs, usually morphine. But combat produced a record number of patients with severe trauma. The war in the Pacific alone regularly filled the 7,700 beds at the military hospital at Fort Lewis with troops enduring amputations, nerve injuries and multiple fractures. Bonica became responsible for finding ways of alleviating their suffering.

Desperate for answers, he began consulting with other doctors: internists, neurosurgeons and, for some cases, dentists. He recalls: "There was no one else in the area doing pain work. I realized I didn't know anything about pain. There was little information available, and that was scattered throughout the medical literature." Out of Bonica's experiences with the wounded came his theory that the treatment of pain must borrow from a number of medical specialties.

Bonica is now semiretired, but he still writes and lectures. A singular contribution continues to be his personal example that a normal existence is possible despite the constant presence of pain. Although he has had eleven operations to correct arthritic deformities in his hips, he scuba-dives, both in Hawaii and off the coast of Filicudi, the small island near Sicily where he was born. His only concession to infirmity is that he no longer water-skis daily. And the days when he worked his way through the New York University School of Medicine as Johnny Bull Walker, professional wrestler, are but a distant memory. To his many colleagues and former patients he is still a vital presence. So much so that every year the University of Washington School of Medicine holds a John Bonica night. Says Dr. John Loeser, the director of the Seattle clinic: "Two hundred people come from all over simply to have dinner with John."

-- By Dick Thompson/Seattle