The Passing of Ron Melzack, PhD

A giant in the field of pain management passed away the other day. It was December 22, 2019, and, to be exact, he was the father of pain management. It is no overestimation to say that he brought pain management into modernity. Ron Melzack, PhD, was 90 years old.

A native of Montreal, Melzack earned his PhD in psychology at McGill University in 1954. While earning his degree, he became interested in pain and in so doing he began his life-long career of its study. He taught psychology at Massachusetts Institute of Technology (MIT), among other universities, but for most of his career he was back at McGill University.

While at MIT, however, Melzack met Patrick Wall, MD, (1925-2001), and together they published their novel ideas on what came to be known as the gate control theory of pain.¹ This ground-breaking work challenged centuries-long Cartesian notions that pain is highly correlated with, and indeed caused by, bodily pathologies, such as injuries or tumors. They dared to notice that pain isn’t as correlated with bodily pathology as the Cartesian notions have long had us expect. Just as often as people experience severe pain when having a severe injury, they noticed that people also experience mild or moderate pain to such injuries. Similarly, many people experience excruciating pain when having mild injuries or no injuries at all (think: tension headaches or fibromyalgia). In response to such commonplace observations, Melzack & Wall posited that the spinal cord and brain must play a role in the production of pain. Moreover, they further posited that the spinal cord and brain are not static entities from birth, but are modifiable by past and present learning and circumstances, all of which go on to influence how the spinal cord and brain produce pain. Thus, in their gate-control theory of pain, Melzack & Wall acknowledged the inherent subjectivity of pain as a product of multiple inputs, including from the body, and the spinal cord and brain, the latter of which exert their influence on the production of pain in accordance with the past and present life circumstances of the individual who experiences pain.

This non-Cartesian model of pain initiated an expansive body of clinical and basic science research into how and why self-management based therapies, such as cognitive-behavioral therapy, mindful meditation, therapeutic neuroscience education, and the like, are effective at reducing pain when they do not target bodily pathologies. In so doing, the gate control theory of pain provided an academic justification for the development and growth of interdisciplinary pain rehabilitation programs and other forms of interdisciplinary pain clinics that today routinely include pain physicians, pain psychologists, nurses, and physical therapists, among other disciplines.

Over the decades, Melzack expanded on the gate control theory of pain to develop what is now known as the neuromatrix model of pain. Basic pain science has now well-established that different parts of the brain, or neuromatrix, lend themselves to the production of the various aspects of pain – sensory, emotional, cognitive-evaluative, behavioral, and social affiliative.

Melzack was a prolific researcher and author who spawned others to follow suit. He also developed the McGill Pain Questionnaire, received a number of academic awards, and co-developed the first interdisciplinary pain clinic in Canada.

When, in 2009, Melzack was inducted into the Canadian Medical Hall of Fame, it was said of him, “What Einstein did for physics, [Melzack] has done for pain research and management.”²

While Melzack’s impressive legacy is well regarded by all in the field, a full appreciation of the extent of the consequences of his work remains unachieved. In many ways, the field of pain management and the general public remain swayed by the Cartesian model of pain and its emphasis on understanding pain as the direct, if not sole, result of bodily pathologies. It’s as if we are only part way through the paradigmatic scientific revolution that Melzack initiated.

On the one hand, the gate control theory and now the neuromatrix model of pain are established and required reading in medical and psychology schools. Basic science researchers and academics take his work as the assumed given, from which they now pursue their own work. Clinically, pain psychologists, physical therapists, relaxation practitioners (such as meditation, tai chi, and yoga) are all commonplace providers in pain clinics and no reputable pain clinic would be without them. Indeed, clinical practice guidelines developed by multiple professional organizations over the last decade call for these therapies to be first line treatments for common conditions, such as low back pain. There even seems to be a general trend towards increasing acceptance of these therapies for common pain complaints.

On the other hand, though, the field of pain management continues to have pockets of deep investment in therapies that target bodily pathologies despite the poor to non-existent correlation that bodily pathologies have to pain levels. Despite years of clinical guidelines advocating for their reduction, scans of orthopedic structures, and interventional and surgical procedures remain highly utilized – even over-utilized. The general public too remains largely influenced by the Cartesian model of pain, when, for instance, the default understanding of backache is that it must be the result of an injury and that the default understanding of conditions like fibromyalgia is that it ‘must be all in their heads’.

Thus, despite Melzack’s unparalleled achievements that have brought pain management into the modern era, more still needs to be achieved.

In light of his passing, we might honor the legacy of Dr. Ron Melzack by continuing his work and striving ourselves to complete the paradigmatic scientific revolution that he started.

References

1. Melzack, R. & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150, 971-979.

2. Canadian Medical Hall of Fame. (2019). Retrieved from: http://www.cdnmedhall.org/inductees/ronaldmelzack.

Date of publication: December 31, 2019

Date of last modification: December 31, 2019

About the author: Dr. Murray J. McAllister is the editor at the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Our mission is to lead the field in making pain management more empirically supported and to make that empirically-supported pain management more publicly acessible. To achieve these ends, the ICP provides scientifically accurate information on pain that is approachable to patients and their families.