2024 John J Bonica Award Lecture: Less is More.

Abstract

'Less is More' reflects the idea of Ludwig Mies van der Rohe, who only retained the essentials in his designs. This principle is also applicable in different areas of pain medicine.Several pioneers have worked hard to introduce the multidisciplinary approach to obtain the most appropriate treatment for the patient. Most of those pioneers received the Bonica Award before me, and I am happy that those persons mentored me and stimulated me in understanding pain management and developing my career. Pain management has known a great evolution, from accepting pain because of an underlying disease to recognizing pain as the fifth vital sign. The rise in interest in (interventional) pain management evolved parallel to the introduction of evidence-based medicine. Most physicians welcome reviews summarizing the available literature. There are many pitfalls of systematic reviews and meta-analyses, such as the interpretation of the information, which is predominantly done by epidemiologists, who have little clinical background to make a distinction between the effect of the treatment in different diagnoses. Guidelines are based on correct diagnosis, weighing the potential for complications against the anticipated benefits, are progressively introduced and should guide physicians in establishing a treatment plan. A group of physicians normally prepares these guidelines.The golden rule in the treatment selection is 'Less is More'.