John Joseph Bonica (February 16, 1917 – August 15, 1994) was a Sicilian American anesthesiologist and professional wrestler known as the founding father of the discipline of pain medicine.

Pain is a multidimensional experience with an affective component: the unpleasantness.

Pain is the most common reason patients seek medical care. Pain has sensory and emotional components.

Major types of pain:

Nociceptive pain

a) somatic: well localized. Described as sharp, stabbing, aching or cramping. Results from tissue injury or inflammation, or from nerve or plexus compression. Responds to treating the underlying pathology or by interrupting the nociceptive pathway.

b) visceral: poorly localized. Poor response to primary pain medications.


Poorly localized. Described as crushing, tearing, tingling or numbness. Also causes burning dysesthesia numbness often with lancinating pain, and hyperpathia. Unaffected by ablative procedures.

“Sympathetically maintained” pain and the likes, e.g. causalgia

Often classified as acute or chronic.

Acute pain is frequently associated with anxiety and hyperactivity of the sympathetic nervous system (eg, tachycardia, increased respiratory rate and BP, diaphoresis, dilated pupils).

Chronic pain

Musculoskeletal pain

see Neuropathic pain

see Back pain

see Leg pain

Abdominal pain

Lancinating pain

Severe pain

Intractable pain

Many patients with a traumatic brain injury (TBI) are unable to self-report their pain in the intensive care unit (ICU) because of altered levels of consciousness (LOC), mechanical ventilation, and/or aphasia 1).

In nonverbal populations, use of behaviors suggestive of pain (a.k.a pain behaviors) such as grimacing, increased muscle tension, protective movements, and noncompliance with the ventilator is recommended for pain assessment 2) 3).

Integrating Pain Treatment into Your Spine Practice

This book fills the gap in knowledge and patient care by showing spine surgeons how to integrate pain management techniques into their practice. The first of its kind, Integrating Pain Treatment into Your Spine Practice is in tune with current efforts by major neurosurgical and neuromodulation societies and leading manufacturers of neuromodulation equipment to educate spine surgeons on the management of their patients’ post-surgical pain.

Designed as an all-in-one volume, this book explains how to identify candidates for pain treatment and when to refer them to specialists. It also presents “how-to” clinical information on approaches to managing pain, from the medical to the interventional and provides practical business guidance on coding and reinforcement.

J. A. Young, “Pain and traumatic brain injury,” Physical Medicine & Rehabilitation Clinics of North America, vol. 17, no. 2, pp. 145–163, 2006.
J. Barr, G. L. Fraser, K. A. Puntillo, et al., “Clinical practice guidelines for the management of pain, agitation, and delirium in adult ICU patients,” Critical Care Medicine, vol. 41, no. 1, pp. 263–306, 2013.
Herr, P. J. Coyne, M. McCaffery, R. Manworren, and S. Merkel, “Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations,” Pain Management Nursing, vol. 12, no. 4, pp. 230–250, 2011.
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