During my training in neurology, it became clear that although most patients seen by neurologists have chronic pain, by a strange cognitive process most neurologists found a way to ignore this and simply regard the patient as a diagnostic puzzle rather than a person in need of reduction in suffering. I believed that in order to be a competent neurologist I needed more advanced training in pain management. Once I got hooked, I never went back to general neurology.
My patients. I have always reacted to the patterns of difficulty they brought to me in the office. In addition, I have been inspired by the works of John Bonica and Russell Portenoy.
When I began, not so long ago in 1990, there was a severe shortage of pain management practitioners, even in the Boston area, which forced me to spend a great deal of time seeing patients. Even 5 years later, there were enough practitioners that I could transition to my original interest, clinical trials. Unfortunately, what has not changed much since I became involved is the lack of evidence relevant to nearly all the treatments we offer our patients, and even less evidence about how to diagnose their painful afflictions.
The use (and misuse) of opioids for chronic pain, cancer pain, neuropathic pain, and clinical trials methods.
In general, grateful patients have been most rewarding. I also enjoy helping pharmaceutical and device companies bring their treatments to market, to put more powerful tools into the hands of those who treat our patients.
Balancing the seduction of my exciting professional opportunities with spending time with my wife, four kids, and dog.
Pick one problem that you find compelling and go after it with all your energy and perseverance. Listen to your heart even if the field is not where you are. Be alert to the roles of the private sector, academia, and the regulatory agencies in helping you achieve your goals of solving clinical problems.
Nathaniel Katz, MD MS, is director of the Center for Opioid Research, Massachusetts General Hospital, Boston, and director of the Pain Research Division, Inflexxion, Inc., Newton, MA.