Publications
APS Bulletin • Volume 14, Number 2, 2004
Past Presidents’ Perspectives
Wilbert E. Fordyce, PhD, Department Editor
An Interview with John L. Reeves II, PhD ABPP, APS President, 1991-1992
How did you get involved in pain?
It was a series of chance events. The first occurred when I was watching TV, avoiding the realities of writing my dissertation. A short news report was on; it featured Drs. Bill Fordyce and Richard Sternbach using operant principals to treat pain. The idea that pain was behavior and operant principals could be used to modify a medical condition was mind-boggling to me. I cannot express the immense impact this program had on me. At that moment, I knew exactly the path I wanted to take, especially given recent events. My favorite graduate school professor, with whom I had been very close and who had had a profound influence on my thinking, had recently committed suicide after having suffered for years with severe arthritic pain. To be able to apply my training in behavior modification to alleviate pain was the noblest thing I thought a psychologist could do.
I pursued a post-doctoral fellowship in psychophysiology and psychopharmacology at the UCLA Neuropsychiatric Institute with Dr. David Shapiro, one of the founders of the field of behavioral medicine and a real hero of mine. He was investigating the role of operant conditioning on autonomic responses in clinical populations. Together we studied the role of self-regulating autonomic processes using biofeedback on experimental pain perception. The next chance event happened at the very end of my three-year fellowship 1980. Dr. Shapiro and I were in his office pondering my future. I wanted to go sailboat racing for a year or so, and had been invited to participate in the round-the-world race. He, on the other hand, wanted me to jump in right a way and accept one of the several very good offers I had received to pursue a research career. I knew I did not want to continue to inflict experimental pain on helpless college freshmen as I had been doing for three years. I really wanted to pursue a career in clinical pain management and do what I had seen Drs. Fordyce and Sternbach doing on the TV program I had viewed years earlier, although I had no idea how to go about doing this.
During our meeting, the phone rang and it was Dr. Ronald Katz, chairman of the UCLA Department of Anesthesiology. He was calling Dr. Shapiro to see if he knew of a behavioral psychologist with a strong physiological/psychopharmacological background who could join in the formation of a new multidisciplinary academic pain management center. Dr. Shapiro said “I have the person you need sitting in front of me now.” Knowing very little about clinical pain management, I joined the UCLA Pain Management Center, but only after Dr. Katz gave me a couple of months to go sailing. Since ocean sailing can generally be described as long periods of silence interspersed with moments of terror, I read everything I could that Drs. Fordyce and Sternbach had written on pain during the periods of silence.
Upon my return, I was plunged into the infancy of one of the most exciting places to be during some of the most exciting and formative times in pain management. I had some of the very best colleagues one could ever have to mentor me and to collaborate with, and I am grateful to each of them. It was Dr. Richard Kroening, however, the director of the Pain Management Center, who gave me a solid foundation for everything I know about clinical pain management. He was a brilliant diagnostician, clinician, and teacher, and my gratitude for what I learned from him is immeasurable. Dr. John Liebeskind and I became close friends, and we taught many pain courses together during an 8-year period. He, too, was a great mentor. For 10 years at UCLA, we did exceptional and innovative work. Then, as chance would have it, the axe dropped in 1990 when a new dean of medicine decided that pain was not important because “pain did not kill.” With only a 10-week notice, the incredibly talented group of pain specialists was abruptly set out to pasture by a dean lacking in vision. This prompted me to go into full-time private practice.
What are you doing now?
I am in private practice. I see patients in The Pain Center and Institute for Spinal Disorders at Cedars-Sinai Medical Center. I mostly perform presurgical psychological evaluations and psychological preparation for spine surgery. I also conduct behavioral and psychopharmacological evaluations on chronic pain patients. I am an adjunct associate professor in the UCLA School of Dentistry and Orofacial Pain Clinic, where I supervise dental residents and teach pain psychopharmacology and psychological factors in pain. I also am involved in various research projects. Currently, I am engaged in collaborative research using linear growth modeling to construct causal models of the effects of depression and anxiety on treatment outcome in orofacial pain patients. I also am finishing a post-doctoral master’s degree in clinical psychopharmacology, which is really my passion.
How do you view U.S. pain research and treatment?
These are exciting times for research focusing on basic molecular and biological mechanisms and pharmacology of pain. With respect to the majority of psychological pain research, however, I believe things have been stagnant for quite some time. Behavioral research has been hampered by outdated statistical methodologies that have not allowed the construction of true causal models of psychological processes in pain. The introduction of newer statistical methods such as structural equation modeling and, especially, linear growth modeling, offer methods that will allow behavioral scientists to construct meaningful causal models of the role of psychological (and biological) processes in the pain experience.
What is your forecast for the future?
The state of affairs regarding training in pain management continues to be dismal. Medical schools continue down a narrow-minded traditional path that leaves large gaps in the training of physicians with regard to pain and psychosocial factors in illness. Even the majority of pain medicine fellowship programs are narrowly focused on interventional strategies, ignoring that people experience pain and that psychological factors are a critical determinant in maintaining the pain experience. I am concerned about the current retro-trend in pain treatment and reimbursement, which focuses solely on sexy interventional strategies in chronic pain just because practitioners can do so. They are fun and, most important, profitable, without much evidence to support their efficacy. The data still show that multidisciplinary treatments are the most efficacious for most chronic pain conditions, but multidisciplinary centers are rapidly becoming a thing of the past in favor of modality-based operations. On a positive side, I see that in the next few years, when prescription privileges are granted to properly-trained psychologists, this will result in major improvement in the delivery of psychological services to those with pain.
Please direct your comments or suggestions about this article or department to Wilbert E. Fordyce, PhD, Department Editor, at wfordyce@msn.com.