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INTRODUCTION

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Dr. John Bonica was a pioneer in establishing pain medicine as a medical discipline; he died on August 15, 1994, at the age of 77. His obituary in The New York Times,1 in which he is described as a leader in the effort to understand and cope with pain, reads:

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He committed himself to the alleviation of pain while tending to the wounded of World War II. When his own wife almost died in childbirth, he took up a pioneering effort against the pain of childbirth, and was instrumental in developing epidural anesthesia…. Working at Tacoma General Hospital from 1947 to 1963, he established the first residency training program in anesthesiology in Washington State. He founded the University of Washington's Department of Anesthesiology in 1960 and headed it for 18 years. He retired as its chairman in 1978 to promote advanced treatments of acute and chronic pain worldwide. The recipient of many honors at home and abroad, he was a founder and past president of the International Association for the Study of Pain, which now has 6,000 members in 80 countries.1

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Before his death, his wife, Emma, noted that one of the first things Dr. Bonica did at the University of Washington, in collaboration with a nurse, Dorothy Crowley, and a neurosurgeon, Lowell E. White, Jr., was to establish a multidisciplinary pain clinic. Dr. Bonica brought in research scientists; young anesthesiologists interested in pain management also were drawn to the clinic, which provided the first formalized training program in pain management. “This group of academic health care providers and researchers met regularly to discuss problem patients with chronic pain and to devise effective treatment strategies…. The University established the Multidisciplinary Pain Center in 1978, recognizing John's accomplishments and wishing to provide a broad base for its support beyond a single department. Health care providers of all types collaborated in this Pain Center.”2 Dr. Bonica clearly recognized the need for a group of physicians who dedicated their professional lives to the treatment of pain, and we must thank him for moving us so far toward that goal. This chapter looks back over how pain medicine came to be where it is today and sets out the next steps in further maturing this new young medical discipline, with a focus on training and certification of physicians.

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ON MEDICAL SPECIALIZATION

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It has become impossible for any physician to become an expert in every field. As knowledge expands and the need for detailed skills arises, the natural progression is for specialization to ensue. Yet there has long been a discomfort with specialization. The urge to both specialize and remain unspecialized dates back to the earliest recorded history of medicine. The first specializations were between the barber-surgeons and the internists, and a rivalry of sorts remains to this day. Writing about Ambroise Paré, the 16th-century physician who elevated the role ...

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