November 22, 1963, President John F. Kennedy was assassinated in a motorcade in Dallas. 50 years later and the images and memories of this tragedy remain branded into the national psyche. Everyone alive then remembers where they were the moment they learned that Kennedy was shot. Television was in its infancy then, and his murder became the first news story to receive full time coverage by the networks. Every second of that weekend was covered: from the moment the shots rang out, to the announcement of his death shortly afterwards. Within two days his alleged assassin, Lee Harvey Oswald, also lay dead, his shooting also televised. A majority of Americans continue to believe that JFK’s death was the result of a conspiracy. Talk of conspiracy began almost immediately, and was made worse with the appearance of the “Zapruder film”. Private citizen Abraham Zapruder captured the JFK assassination on a home movie camera, and, although not seen on national television until 1975, this 8mm film has been the most watched 26.6 seconds of film in history. Much of what has has been analyzed and debated over the years has had to do with trying to confirm or disprove the theory of the existence of a second shooter. Less discussed has been the role that a back brace Jack Kennedy had been wearing that day, may have played in his untimely death.
President Kennedy dealt with debilitating back pain his entire life, including several surgeries, and multiple hospitalizations. On that fateful day in Dallas, he was wearing a supportive back brace, as he usually did, especially during longer trips such as this particular campaign trip to Texas. When the first bullet struck him in the back of the neck this brace prevented him from falling forward and potentially out of the way of further harm, allowing the second and fatal shot to strike him in the back of the head. An interesting article written by Robert S. Pinals, MD and Afton L. Hassett, PsyD, entitled “Reconceptualizing John F. Kennedy’s Low Back Pain”, which appeared in the September-October 2013 edition of Regional Anethesia and Pain Medicine, summarized JFK’s lifelong struggle with debilitating pain and other medical ailments. It asks the question, how would his low back pain be treated differently 50 years later?
Robert Kennedy, the President’s brother, said of him “at least half the days he spent on this earth were days of intense physical pain”. Jack Kennedy had been of generally poor health his entire life. He suffered gastrointestinal pain during his childhood and by 14 was diagnosed with colitis and later with Addison’s disease. He was later diagnosed with autoimmune polyendocrine syndrome, type 2, and likely suffered as well from celiac disease. JFK also suffered multiple urinary tract infections, prostatitis, allergies and upper reparatory infections. By age 21, JFK began having bouts of low back pain, which worsened two years later while playing tennis. During World War II, the PT boat he was in was sliced in half by an enemy destroyer. This incident only served to worsen his condition further. He underwent exploratory back surgery in 1944, when a disc herniation was suspected. Although no definite herniation was revealed some “degenerative” cartilage was removed.
His back pain continued through his successful 1946 run for Congress and 1952 run for the Senate. He managed his pain with corticosteroids and pain medications. Treatment at four different medical facilities between 1953 and 1954 did not improve his condition. In 1954, he underwent surgery at New York Hospital for lumbar fusion, using metal plate and screws. He suffered a postoperative infection, which eventually developed into sepsis and he fell briefly into a coma, at which time he received the last rites of the church. He finally recovered from complications, but experienced no relief from this surgery. He underwent another surgery in 1955 to remove this hardware and yet another for a more successful fusion using a bone graft, but his pain continued.
He was hospitalized another nine times over the following seventeen months for back and medical related concerns. In 1955, JFK met Dr. Janet Travell, a clinical researcher specializing in pain, who began treating him with trigger point injections, which did help his condition improve. He was later also treated by Dr. Max “Dr. Feelgood” Jacobson with still unidentified injections during his 1960 Presidential bid. Dr. Jacobson eventually lost his medical license for his flagrant abuse of controlled substances. Once in the White House, President Kennedy began to work with a physical therapist, performing various stretching and strengthening activities and swimming in a heated pool. By 1962, his pain had finally stabilized; however, he remained cautious and reluctant to discontinue the use of his back brace and his occasional use of crutches during flair ups.
The authors of this article ask, “can a structural basis for JFK’s back pain be identified?” The paper concludes by asserting that the causes of his pain were likely complex. If one particular structure were suspected, it would likely be the L5-S1 disc, but disc changes are often found in asymptomatic individuals (e.g., they experience no pain). A modern medical understanding of chronic pain has revealed that the experience of pain can trigger pain hypersensitivity. Specifically, the more one experiences pain, the better that individual becomes at experiencing pain. This pain becomes “centralized” into the brain and central nervous system, whereby the experience of pain is magnified and the ability to modulate or dampen this experience becomes impaired. This centralized pain syndrome is thought to underlie many chronic pain issues, including myofascial pain, chronic low back pain, and fibromyalgia. It is frequently associated with fatigue and sleep disturbances, memory loss, GI irritability, mood alteration and depression. Often, an adult suffering from centralized pain will have a history of childhood pain and experience worsening symptoms with stress, both of which were applicable to JFK.
Current medical literature has been demonstrating that the best way to avoid this more chronic experience of centralized pain is to address problems early. A study appearing in the November 2012 issue of the journal SPINE, reveals a nearly $2,700 per patient savings for patients who experience low back pain, but who seek physical therapy care within fourteen days of the onset of symptoms. This savings comes through helping the patient recover completely from pain early and thereby avoid unnecessary tests (i.e., MRI’s, EMG’s) , procedures, surgeries, and long term use of pain medications. Once chronic central pain manifests, the best evidence today recommends physical therapy, including aerobic exercise, but also includes medications which address the central nervous system as well as anticonvulsants.
How might the world have been changed had John Fitzgerald Kennedy’s back pain been treated more successfully and he not have been wearing that brace? The world will never know.