The Australian Pain Society

2008Distinguished

MemberAwards

Awarded for services to the promotion,

treatment and science of pain management

and lifelong contribution to the

Australian Pain Society.

Professor Bogduk was theyoungest medical practitioneramongst the founding membersof the Australian Pain Society.

At the time, he was a PhD student in Jim Lance’s Dept ofNeurology at the University ofNSW. His career in Pain Medicinehowever, started earlier;between 1974 and 1975, as apostgraduate student at JohnsHopkins Hospital, he partici-pated in spinal cord stimula-tors and operant conditioning.He also worked with NormanShealy who developed both spinal cord stimulation and facet denervation.

Throughout his career, Professor Bogduk’s work, whilespearheading and underpinning, has at times refuted,the biomedical approach to spinal pain. His early workpursued the anatomical basis of spinal pain. Thesestudies demonstrated the innervation of the intervertebral discs and the zygapophysial joints,which established these structures as possiblesources of pain. These contributions to the study ofAnatomy have at last been recognized. Consequently,for the first in 200 years, in the forthcoming edition ofGray’s Anatomy, description of the spine, its musclesand innervation, has been totally overhauled.

Professor Bogduk’s later work addressed the way inwhich pain from the discs and joints of the vertebralcolumn could be diagnosed and then treated. As a lecturer, and subsequently Reader in Anatomy at theUniversity of Queensland, he served as an HonoraryMedical Officer in Leigh Atkinson’s Pain Clinic at thePrincess Alexandra Hospital in Brisbane. There heundertook the early studies of diagnostic blocks for

cervical and lumbarzygapophysial joint pain,and their treatment byradiofrequency neurotomy.Subsequently, at theUniversity of Newcastle,Professor Bogduk’s studentsundertook seminal studies intothe validation of diagnosticblocks and radiofrequencyneurotomy. Those studiesshowed that an anatomicaldiagnosis of chronic neckpain could be achieved insome 60% of patients. Hisstudents performed the only double-blind, placebo

controlled trial of spinal surgery for neck pain.

Radiofrequency neurotomy remains the only intervention for neck pain ever shown to be able toprovide complete relief of chronic pain, in some 70%of patients. This work has left Professor Bogduk at thecentre of continuing tensions over whether whiplashis an organic disorder or entirely a psychosocial one.With Australian and US colleagues, Professor Bogdukundertook studies into the sources of chronic lowback pain. This work superintended the rise and subsequent fall of lumbar facet pain.! Technical studies validated controlled, diagnostic

blocks of the lumbar Z joints! initial studies promoted these joints as possibly

common causes of pain;! but subsequent studies have reduced the

prevalence of lumbar Z joint pain to miniscule.Other studies showed that sacroiliac joint pain couldnot be diagnosed by clinical examination, but couldbe diagnosed by controlled, diagnostic blocks. If areused, the sacroiliac joint accounts for some 15-20% of

patients with chronic back pain. There is still not a validated treatment for this pain, but studies areemerging.

With respect to discogenic back pain, ProfessorBogduk’s anatomy studies promoted the disc as a possible source of pain; his clinical studies indicatedthat it accounts for some 40% of chronic low backpain. Professor Bogduk has contributed to studies tovalidate discography, and the diagnosis of discogenicpain by MRI. That field still remains contentious.Meanwhile, in the past and currently, he has beeninvolved in studies of minimally-invasive treatmentsfor discogenic back pain. In that regard, he providesclinical services only, and strictly, under the auspices ofethics approved clinical trials.

As an academic, Professor Bogduk has published nigh-on 200 refereed papers, and 120 chapters tobooks on spinal pain and headache. Of late, he haspublished chapters on neck pain and back pain in theHandbook of Clinical Neurology, and the definitivechapter on cervicogenic headache in Wolff’s Textbookof Headache. His books on Clinical Anatomy, on NeckPain, on Back Pain, and on Biomechanics of the LumbarSpine have variously been translated into German,Japanese, French, and Chinese. As Deputy Editor of theIASP Classification of Chronic Pain, he was responsiblefor revising the entire section on spinal pain. Thatmonograph has now been translated into Polish,Italian, and Chinese.

In his later career, Professor Bogduk has championedevidence-based practice. As Director of the NationalMusculoskeletal Medicine Initiative, he developed andtested evidence-based guidelines for the treatment ofAcute Musculoskeletal Pain. In his own Area HealthService, studies have shown that practice according toguidelines can virtually all but eliminate workers compensation claims. Otherwise, Professor Bogduk has

promoted evidence-based practice for needle proceduresfor spinal pain, and has edited the Practice Guidelinesof the International Spine Intervention Society.

Professor Bogduk’s work has not been popular, eitherwithin or outside the world of needle jockeys and surgeons. He has adhered to precepts instilled byProfessor Lance, which were to produce the evidence,and to follow the evidence. In Spine Science, the evidence that has emerged has not always favouredthe establishment, and has frequently challenged it.Manual Medicine practitioners have not liked beingtold that their physical examination and treatmentsdo not work. Anaesthesiologists have not liked beingtold that their blocks are not valid, or that their treatments do not work. Surgeons have not liked beingtold that fusion does not work. The truth, however, isnot designed to make practitioners feel good. Thetruth is to serve the patients. It is for the benefit ofpatients, not the satisfaction of peers, that ProfessorBogduk has published his work.

During his career, Professor Bogduk’s research hasbeen recognized with Prizes from the Cervical SpineResearch Society, the Spine Society of Australia, andthe North American Spine Society. His students havebeen honoured by the IASP, the AustralianRheumatology Association, and the Australian NewZealand College of Anaesthetists. Professor Bogdukcompleted an MD, and was awarded a DSc for hisresearch. Yet, as a Professor, he still made time to com-plete the Diploma in Pain Medicine, with other stu-dents, and later the Master of Medicine, in PainManagement. In the twilight of his career, he and hiswife are training to become rangers for wildlife sanc-tuaries in outback Australia.

When people speak of notable achievements inAustralian Pain Medicine, they often refer to “…andothers”. Professor Bogduk has been those “others”.

Nikolai BogdukBSc (Med), MB, BS, Dip Anat,

PhD, MD, DS, M Med (Pain Management),FAFRM, FFPM, (ANZCA), FAFMM