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APS Bulletin • Volume 14, Number 6, 2004
Past Presidents’ Perspectives
John L. Reeves II, PhD ABPP, Department Editor
An Interview with Christine Miaskowski, PhD RN FAAN, APS President, 2002–2003
How did you get into the field of pain, and who has influenced you the most?
My interest in pain management came through personal experience with my father’s illness and suffering. In 1976 he was diagnosed with head and neck cancer and had radiation therapy, followed by radical head and neck surgery, and then more radiation therapy. All this left him in intractable pain. He was treated with opioid analgesics (i.e., morphine injections) for what pain professionals would now diagnose as neuropathic pain. Unfortunately, I did not have access to a pain specialist or a pain clinic at the time, and my father suffered a painful end.
During this period, I was working on a medical unit at the Hospital of the Albert Einstein College of Medicine, which became an oncology unit. I resolved to get the education and training to improve cancer pain management in our acute-care hospital, so I took a series of continuing education programs on what was then called hospice care (now palliative care). From clinicians at St. Christopher’s Hospice I learned about the use of the Brompton Cocktail and the need to give analgesics to patients with chronic cancer pain on an around-the-clock rather than on an as-needed basis. I introduced this approach to our oncology unit in the early 1980s. In 1982 Dr. Ronald Kanner, a neurologist, came to my hospital to establish a pain service. He had been trained by Kathy Foley at Memorial Sloan Kettering Cancer Center. Ron and I worked together to establish a multidisciplinary pain program at Albert Einstein Hospital in the Bronx. This work was one of the happiest times in my professional career.
What are you doing now?
Currently, I am a professor in the Department of Physiological Nursing at the University of California, San Francisco. I teach in the master’s and doctoral programs. In the master’s program I focus on preparing advanced practice nurses in the field of oncology. In addition, faculty colleagues and I in the School of Nursing teach a pain management course. At the doctoral level, I prepare nurse scientists primarily in the area of symptom-management research.
My research focuses on evaluating the deleterious effects of symptoms on patient outcomes and the development and testing of interventions to improve symptom management. Most of my large, federally funded studies have focused on patients with cancer diagnoses. Currently, colleagues and I are conducting a longitudinal study of women who are undergoing surgery for breast cancer. The major focus of this study is to determine the prevalence of pain after a mastectomy. In addition, we will test the effectiveness of the topical lidocaine patch in women who develop post-mastectomy pain. We will conduct the research for this neuropathic pain problem in a randomized, double-blind, placebo-controlled trial.
What do you think has been the most significant contribution to the field of pain?
That is a really interesting question. From my perspective, the ability to unravel the complex mechanisms that underlie the development of chronic pain is the most significant advance made in the field. The fact that one can now say that chronic pain is a medical condition and not just a symptom is an extraordinary achievement. The elucidation of the complex mechanisms that underlie the development of chronic pain provides explanations why some patients do not improve despite numerous efforts to achieve pain control and provides hope for the development of new therapies.
How do you view current U.S. pain research and treatment?
Patients with both acute and chronic pain continue to be undertreated for a variety of reasons. I anticipate that this problem of undertreatment will continue to grow because the population in the United States is aging. We definitely need more basic and clinical research to improve pain management in this country.
What is your forecast for the future of pain management?
I think that the future is bright indeed. Combination therapies—both pharmacologic and nonpharmacologic—hold the greatest promise for the future of pain management.
Please direct your coments or suggestions about this article or department to John L. Reeves II, Department Editor, at reeves@ucla.edu.
