Dr Mike Butler
FRCP FRACP FFPMANZCA
Retired Rheumatologist and Pain Medicine Specialist, formally at
Auckland DHB, NZ
Dr Mike Butler qualified from Otago University Medical School in 1968. His initial interests were in Anaesthesia and Intensive Care, then General Medicine and General Practice, with overseas experience in Vancouver, Edinburgh, and London.
In 1977 he specialised in Rheumatology in Auckland, followed by overseas training in Edmonton, Alberta, and London, Ontario, Canada.
In 1980 he was a part-time Rheumatologist at Auckland Hospital and from 1982 became a full-time Rheumatologist, developing a special interest in the diagnosis and management of nonspecific/atypical musculoskeletal/visceral pain. He was the only physician in TARPS (The Auckland Regional Pain Service) Multidisciplinary Pain Clinic at Auckland DHB, over many years focusing 50:50 on Rheumatology and TARPS. Dr Butler retired from Rheumatology in early 2012, and retired from TARPS in early 2014.
A Retired Senior Pain Physician’s Personal Choice of Top Pain Researchers (basic and clinical) in the Latter Half of the 20th Century.
The best overview of this topic is given in the International Association for the Study of Pain (IASP) Press 2005 book “The paths of pain:1975-2005”, (eds) Harold Merskey, John D Loeser, Ron Dubner.
I give personal profiles of pain pioneers John Bonica, Wilbert Fordyce, William Noordenbos, Ronald Melzack, Patrick Wall, Marshall Devor, Clifford Woolf, Ronald Dubner, Allan Basbaum, Han Ji-Sheng, Daniel Carr and Michael Cousins.
The conceptual flow is the 1960s clinical recognition of chronic non-malignant pain as an unaddressed issue in relation to diagnosis and management, the 1965 (actually 1962) proposal of the gate control theory, and the use of behavioural methods of management of chronic pain noting the IASP Press 2014 book “Fordyce’s behavioural methods for chronic pain and illness”, (eds) Chris Main, Francis Keefe, Mark Jensen, Johan Vlaeyen, Kevin Vowles. Professor Clifford Woolf’s rat based evidence published initially as a single author paper in “Nature” in 1983 was a seminal contribution documenting injury-induced central neural sensitisation disorder (CNSD), subsequently extended to human research explaining persistent nonspecific pain such as the controversial fibromyalgia syndrome for which criteria of diagnosis were validated initially in 1990 by Professor Fred Wolfe. Previously inexplicable nonspecific craniofacial, chest, abdominal and pelvic pain were also explained by CNSD. Professor Fabrizio Benedetti elucidated the nature of the placebo effect by using highly sophisticated clinical research.
The future of pain research includes advances in epidemiology, genetics, glial involvement in chronic pain, allied with advanced neuroimaging.