Dr. Travell’s treatment was a comprehensive approach that included analgesics, physical measures, hormone replacement, and attempts to slow down his autoimmune disease (Table 4). Medical records kept by Dr. Travell over the course of her 8-year treatment reveal that JFK was prescribed the following medications: codeine, meperidine, methadone, methylphenidate, meprobamate, barbiturates, liothyronine, gamma globulin, cortisone, testosterone, and procaine injections.1-4
Within about 3 months after starting Dr. Travell’s treatment regimen, JFK’s pain was immensely better and he was back to work as a senator from Massachusetts and planning his run for the presidency….Even more telling that his pain was controlled is the fact that he took dozens of campaign trips between 1955 and 1960. What’s more, he served 1,000 days as president and only missed one day of work. Any pain management specialist today would be proud of this result in such a tragic case.
The 1950 Standards For Pain Treatment
When Dr. Travell’s treatment, and particularly the list of medications, were initially revealed in 2002, there was great angst as many of JFK’s medications are potentially abusable.3 Despite some controversy, his treatment regimen was, in actuality, the forerunner of today’s treatment for intractable centralized pain.3 His medication list is quite similar to the one used today….JFK’s treatment program was not particularly controversial when Dr. Travell initiated it in 1955.
For example, the 1956 Merck Manual33 stated relative to pain treatment: “More severe pain requires the oral or subcutaneous use of codeine, meperidine, methadone, dihydromorphone, metapon, or morphine. The effectiveness of these analgesics often may be enhanced by judicious use of antispasmatics or mild sedatives.”
One thing, however, is very clear to this author. In May 1955, JFK was “down for the count” and “gravesite ready” due to severe centralized intractable pain. When Dr. Travell took charge, the only hope to save him, given her therapeutic options, were methadone and meperidine.33,34
Unless the physician truly has an understanding and expertise in prescribing these opioids, particularly methadone, they are dangerous. In recent years inexperienced physicians have tried to prescribe methadone and are now responsible for an epidemic of overdoses.35 The synthetic opioid has a negative reputation in the minds of some persons because it is used to detoxify or maintain heroin addicts. This is unfortunate because first-class pain specialists often get first-class results with it just as Dr. Travell did with JFK.
John F. Kennedy’s Pain Story: From Autoimmune Disease To Centralized Pain. Forest Tennant, MD, DrPH. 8/31/12.
Kennedy did not have ankylosing spondylitis/AS or an inflammatory arthritis but regardless of the source, the pain was managed so that Kennedy could function. When function and quality of life for the patient are treatment goals, these kinds of things can happen. Maybe there aren’t enough doctors with the “understanding and expertise” to safely use opioids in pain management. What about training? What about allowing those who can and cautioning those who only think they can? Or not assuming all patients are the same, and that that “same” is borderline junkie out to ruin as many professional reputations as possible? There is a difference between use, dependence and abuse. Conflating them all [just like conflating chronic pain patient and criminal addict] doesn’t serve anyone.