Publications
APS Bulletin • Volume 17, Number 1, 2007
Past Presidents’ Perspectives
John L. Reeves II, PhD MS ABPP, Department Editor
An Interview with James N. Campbell, MD, APS President, 1994–1995
How did you get into the field of pain? Who or what most influenced you?
As a medical student at Yale I had decided on philosophical grounds that I was more interested in quality-of-life issues than longevity issues. My passion was to do work in the neurosciences though I felt the tug of patient care. Parallel to these considerations, I fell in love with surgery. On top of this, I came under the influence of Arthur Taub who then headed the neurosurgery research laboratories. This was 1970, not long after Wall and Melzack published their famous paper on gate control theory. We reasoned that if this hypothesis was on target we should be able to demonstrate hypalgesia with A-beta electrical stimulation in normal subjects. To me it was extraordinary that no one had yet done this obvious experiment. I worked on developing a reliable painful mechanical stimulus and used averaging techniques to record from compound action potentials in normal subjects after electrical stimulation of the median nerve with percutaneous electrodes. A-beta stimulation had no analgesic effects, to my disappointment. I demonstrated that with stimuli of sufficient frequency that stimulation induced a conduction block of at least the A-delta fibers. It was only when the A-delta fibers were blocked that I saw any hint of analgesia. I decided then that normal pain and pathological pain had to be served by different mechanisms. My career in pain was launched, therefore, as a medical student. I headed to Johns Hopkins to do training in neurosurgery. Donlin Long had just been recruited to be chair of neurosurgery there and he was the only departmental chair in neurosurgery that declared pain to be his major area of interest. Long encouraged me to work under the influence of Vernon Mountcastle, who served as another draw to Hopkins. Mountcastle put me under the tutelage of Robert LaMotte doing a 2-year fellowship in neurophysiology. I mastered the techniques for recording from C-fiber and A-fiber nociceptors and had access to the most sophisticated device to deliver heat stimuli to the skin. Richard Meyer, who had developed the device, became intrigued with my experiments and we worked together from that point forward. After my neurosurgery training was finished at Hopkins I was recruited to the faculty and my career in academic neurosurgery was launched.
What are you doing now?
I continue to see patients, operate, and do research. My credo is that all pain problems should be able to be solved. Today we still have many failures, but I earnestly feel that we do a better job now than we did 10 years ago. Progress is being made but I feel we should make progress faster. My research is in neural mechanisms of neuropathic pain and PET imaging of mu opioid receptors. I recently finished a sabbatical doing biotechnology venture capital. I am intent on research translation and I am intrigued by the many possibilities we have with modern day biotech. I founded the American Pain Foundation and continue to serve as board chair of this wonderful organization.
What is the most significant contribution to the field of pain?
I have always fought the stigma, which I have felt has held back progress in pain medicine. Just prior to the annual meeting of the American Pain Society over which I presided as president, I thought we should declare pain, “The Fifth Vital Sign.” Three days before the meeting I asked the executive director, Dick Muir, to manufacture 5,000 buttons that referred to pain as the fifth vital sign. I made this the theme of my presidential address. I have felt that our prejudice against opioid therapy for pain was next to barbaric and I have done what I could to influence clinicians to assume a more flexible view of what can be achieved with opioid therapy in patients with severe pain. I have stated that the war on drugs has turned into a war on patients. We need tamper-resistant opioids. When we get this we will have made some progress. Our research team has come up with many findings. We uncovered basic mechanisms of hyperalgesia and established the role of nociceptor sensitization in primates. We determined that tactile pain (allodynia) is served by A-beta tactile fibers not nociceptors, though nociceptor input plays an ongoing role in maintaining the central sensitization that underlies this phenomenon. Our work has played a role in elucidating the mechanisms of sympathetically maintained pain and has supported the role of the “intact nociceptor” in neuropathic pain.
What is your forecast for the future?
In the next decade we will uncover a basis for complex regional pain syndrome. As I peck away on my computer today, I would bet that this problem is due to a channel disorder. I believe that we will develop techniques of controlling the activity of nociceptors with highly targeted therapies. Surgery will advance and we will come up with better ways of dealing with axial spine pain. Percutaneous techniques will almost certainly advance. Current iterations of the artificial disk are not very satisfactory but progress will come. Neuropathic pain will continue to be a problem to the extent that it is due to irreversible injuries to the nervous system. Here biopharma will need to come to the fore to help target the villain-nociceptive pathways. Electrical stimulation of the nervous system will advance as one way of controlling pain. We will hopefully figure out better ways to target key structures in the central nervous system. Everyone is beginning to talk about individualized medicine. These concepts will hit the pain world and we will be able to test for polymorphisms, for example, to determine the cocktail of best therapy. What we do know will seem primitive in years to come. The exciting prospects for the future make the pain field a terrific place to be right now.
James N. Campbell, MD, is professor of neurosurgery, department of neurology, Johns Hopkins Hospital.
Send comments about this article or department to John L. Reeves, II, PhD ABPP, Department Editor, at reeves@ucla.edu.