Publications
APS Bulletin • Volume 16, Number 3, Fall 2006
Past Presidents’ Perspectives
John L. Reeves II, PhD ABPP, Department Editor
An Interview with Kathleen M. Foley, MD, APS President, 1983–1984
How did you get into the field of pain medicine, and who or what has influenced you the most?
When I was completing my neurology residency at New York Hospital, I was offered a position at Memorial Sloan-Kettering Cancer Center to work in the field of cancer pain. Dr. Jerome Posner, who was Chairman of the Department of Neurology, had received a grant from the National Cancer Institute to focus on the rehabilitation of cancer patients, in which pain was an important component. I joined the department initially as a special fellow and then as an assistant attending, and my role was to develop a clinical pain service and clinical research program. I had the opportunity then to be mentored by Dr. Posner, whose interest was on the neurologic complications of cancer, and by Dr. Raymond Houde, whose focus was on methodology to assess analgesic drugs. Both influenced me enormously in helping both to provide an environment for clinical research, and a high standard of care and respect for patients with pain and cancer.
What are you doing now?
I direct an international palliative care initiative focused on developing and expanding programs in pain and palliative care in central and eastern Europe, the former Soviet Union, and Africa. I am also an attending neurologist at Memorial Sloan-Kettering Cancer Center and professor of neurology. This year I am the chair of the International Association of Hospice and Palliative Care. These efforts to address pain and palliative care come from my experience directing a World Health Organization (WHO) Collaborating Center at Memorial Sloan-Kettering Cancer Center, to advance cancer pain research and education. I continue to work closely with leaders in the pain field including Drs. David Joranson and Charles Cleeland, who themselves have directed WHO Programs; with Jan Stjernsward, the past Head of the Cancer Unit at the World Health Organization; and with Vittorio Ventafridda from Italy and numerous colleagues around the world, who are members of both the International Association for the Study of Pain as well as international palliative care organizations.
What do you think the most significant contribution to the field of pain has been?
I am hard pressed to choose only one contribution. However, from my own work with patients with pain and cancer, one significant contribution is the recognition that pain can be treated and managed. Through the discovery of the opioid receptor, and in the molecular correlates of pain modulation, we have a scientific basis for treatment approaches in patients. I could probably list three important contributions:
- the identification of the opioid receptor and the endogenous ligands that bind to these receptors
- the development of targeted opioid therapy with the use of epidural and intrathecal opioids, based on the work of Dr. Tony Yaksh
- the rapid and wide integration of patient controlled analgesic devices for patients in the management of post-operative pain.
How do you view current U.S. pain research and treatment?
I think that we are in the best of worlds and the worst of worlds. From the best of worlds’ perspective, we now have basic research defining the molecular mechanisms of pain, the molecular biology of receptors, genetic correlates, and mechanistically based hypotheses. Research into the behavioral aspects of pain is expanding and emphasis has focused on the development of better methods to assess neuropathic pain. Research and neuroimaging of pain has provided unique insights into the behavioral correlates associated with pain, as well as to some correlates with pain genetics. Yet the lack of an organized infrastructure to advance pain research continues to be a significant problem. There are no NIH-supported centers of excellence where clinical and basic researchers can work together to advance pain research. Although there are some centers that have tried to combine these efforts, there is no readily available national network to enable researchers in clinical trials to take new ideas and move them into practice. Lastly, prospective long-term studies on opioid use, both from the perspective of clinical effectiveness and risk, continue to thwart the field’s ability to appropriately place opioid therapy in the management of chronic pain. Sadly for patients with neuropathic pain, current treatments provide only 50% of patients with less than 50% relief. The National Institutes of Health spend less than 1% of their funds to support pain research. In short, there are spectacular advances but little translation into helping patients with pain.
What is your forecast for the future?
I am an optimist and think that the science will drive the field forward with the opportunity to support young investigators, clinical programs, and clinical centers. Effective pain treatment is a reality. The future I see is one in which clinical centers of excellence provide the intellectual framework for committed leaders to drive the field forward.
Kathleen Foley, MD, directs an international palliative care initiative and is an attending neurologist at Memorial Sloan-Kettering Cancer Center and a professor of neurology at Weill Medical College of Cornell University.
Please direct your comments or suggestions about this article or department to John L. Reeves II, Department Editor, at reeves@ucla.edu.