Publications
APS Bulletin • Volume 15, Number 1, Winter 2005
Past Presidents’ Perspectives
John L. Reeves II, PhD MS ABPP, Department Editor
An Interview with Benjamin L. Crue, MD, APS President, 1980-1981
How did you get into the field of pain, and who has influenced you the most?
I received my MD at the University of Chicago in 1948 when I was 22 years old. I decided on neurosurgery rather than psychiatry in my junior year of medical school, largely due to Dr. Earl Walker. I interned in the U.S. Navy Hospital in Oakland, CA, where I also completed a year of general surgery residency as well as a year of neurosurgery residency. In 1953 the Navy sent me to Huntington Memorial Hospital in Pasadena, CA, where I did two more years of neurosurgery residency. There I was a resident with C. Hunter Shelden and Robert Pudenz, and I became interested in brain tumors in children. My first monograph, “Medulloblastoma,” was published in 1958. Since Dr. Shelden turned me on to trigeminal neuralgia, I have been interested in pain ever since. Between 1956 and 1957 I did a fellowship in neurophysiology and neuropathology at Yale University and in neurosurgery at Lahey Clinic in Boston. After leaving active duty in the Navy, I went to the University of Southern California, where I stayed until 1985. I founded the City of Hope Pain Center in 1960 in Duarte, CA, and in 1980 I founded the New Hope Pain Center in Alhambra and Pasadena, CA. After moving to Durango, CO in 1985, I founded the Durango Pain Rehabilitation Center. These were true multidisciplinary pain centers, based on what I term the “centralist” model of pain. My pain career and thinking regarding the issues of “centralist” versus “peripheralist” models of pain were most influenced by my long-time psychiatrist colleague, Jack Pinsky.
What are you doing now?
I retired in 1993 and am living in Durango, CO. Since retiring, I devoted much of my time to completing a two-volume book, The Myth of Chronic Pain. It is my fifth book.
What do you think the most significant contribution to the field of pain has been?
I would like to think that my recent two-volume book, The Myth of Chronic Pain, would be seen as one of them. In the book, I plug the centralist concept of chronic pain. I provide a historical account of my differences of opinion with John J. Bonica and others who were proponents of the peripheralist approach to chronic pain. (These differences date back to before the Issaquah conference in 1973.) The differences are huge. The peripheralists saw, and continue to see, chronic pain as a manifestation of peripheral nervous system input. With them, treatment focuses on disrupting this peripheral input via surgical interventions, nerve blocks, and other interventional strategies. By stark contrast, the centralist position, to which I have been committed my entire career, sees chronic pain as generated and perpetuated by the brain. The brain is responsible for turning bodily trauma into chronic pain after the original hurt is gone. Thus I believe that treatment must be directed to the brain using psychotherapeutic approaches. Only through depth psychotherapy and group psychotherapy can practitioners address the unconscious emotions of anger, fear, guilt, grief over loss, and sexual abuse that maintain most chronic pain experiences. I detail this model and the approach in The Myth of Chronic Pain. (See the review in this issue of APS Bulletin.)
How do you view current U.S. pain treatment?
Anesthesiologists have taken over recent treatment of chronic pain. While anesthesiologists are very good at dealing with acute and post-operative pain, I view their treatment of chronic pain as a catastrophe. This is based largely on their adherence to a peripheralist, nociceptive model. Fortunately, a few healthcare professionals in many different specialties are gradually accepting the central factors in chronic pain.
In your opinion, what is the current state of pain management?
Treating pain from the peripheralist perspective has gone on too long, longer than explainable except that insurance companies still pay better by “procedure.” Continuing this course is criminal. I am an optimist, however, and I think the centralists will gradually win out as they are at least near the truth—even if this goes against the tide of managed care and limited federal funds.
Dr. Crue is a founding member of the International Association for the Study of Pain, a founder and second president of the American Pain Society, and a founder and first president of the American Academy of Pain Medicine.
Please direct your comments or suggestions about this article or department to John L. Reeves II, Department Editor, at reeves@ucla.edu.