What inspired you to do what you do?
I was always interested in the complexity of the human brain. To me it is the most fascinating and mysterious organ in the body. It controls so much! After doing some undergraduate work in the neurochemistry of memory, I was drawn into both medicine and research. I started an MD/PhD program at Northwestern University in Chicago, and then realized that I could do all the research I wanted with just the MD. Since I was putting myself through school, saving a couple of years was nice! I was always enamored with the central nervous system, and the more I learned the more I realized that, in neurology, while we could treat symptoms, there were really minimal things that could be done to truly help deal with major issues. That’s when I “discovered” headache and pain and the fact that I could significantly help those patients. I was hooked into pain medicine in the 1970s, way before it was a subspecialty.
Why did you focus on pain management?
As noted above, I was sort of disappointed in the ability of neurologists in the 1970s to “fix” anything. That hasn’t really changed, but what we can do now for multiple sclerosis and Parkinson’s disease, as well as other neurological disorders, is incredible. When I was an intern, one of my students introduced me to her father, who was a well-known headache specialist. I got involved with the American Association for the Study of Headache, and I realized there was far more to neurology than was taught in medical school, which didn’t really deal with headache or pain. I made that a focus for myself and even as a resident dug into what I could in both areas. I studied everything I could and when I finished my residency my first job was with one of the two top headache gurus in the country. Then I got more into pain. I was one of the 30 founders of the American Academy of Pain Medicine (formerly Algology) in 1983. Five years later, I was one of 8 folks who helped form the American Academy of Pain Management. What was different? The American Academy of Pain Medicine didn’t think nonphysicians mattered, which of course was total bologna (to put it nicely). The bottom line is that I became a pain medicine specialist as well as a headache specialist, which now just isn’t done. Doctors are either one or the other. I still do both.
Who were your mentors?
My mentors were some of the absolute headache greats: John Edmeads, Arnold Friedman, Lee Kudrow, Neil Raskin, John Graham, Jim Dexter, and more. Probably one of my most incredible pain mentors was Joan “Rocky” Graziano, pt, who started the first interdisciplinary pain center at Walter Reed Hospital before I started my first interdisciplinary neuro-rehab center. Another incredible physician and mentor was Dr. Janet Travell.
If you weren’t a healthcare provider, what would you be?
If I wasn’t helping patients as a physician, I’d only be working in drug development. On the other hand, I could have become a full-time author, if there weren’t more important things to do— like feed my family.
What is your most marked characteristic?
Probably it would be my stubbornness (see my motto). I will always look for ways to do something clinically to help patients who have failed “book determined” pain treatment. I will do whatever I have to do, including utilizing medications off label as needed, to help patients. I am nothing if not inventive. I was also one of the first pain docs who didn’t use opioids as the primary types of medications, like helpful anticonvulsants, were around. Dilantin was there when I was starting out. So were other similar medications. It was just that the majority of physicians used ACMS for seizures. Period. I didn’t.
What do you consider your greatest achievement?
For me, to quote Frank Sinatra, “I did it my way.” I left home when I was 15 and put myself through college and then my medical training. I was one of the first to start a privately owned interdisciplinary neuro-rehab headache and pain center west of the Mississippi in 1980. After 26 years of running this center, in 3 states, I spent 12 years in pharma. As Chief Medical Officer of one company, I helped bring a formulation of intranasal fentanyl through the FDA ; the medication was used for breakthrough pain in cancer. I will never forget the feeling the first time I prescribed this medication for a cancer patient. I really had helped not a single patient, but hundreds of thousands, if not more.
I’ve also had the honor to be politically active. I was president of a state pain organization (the Florida Academy of Pain Medicine); a regional organization (the Eastern Pain Association, which was, per its bylaws, encompassing the Eastern Seaboard) and a national organization (the American Academy of Pain Management).
I think it is wonderful that I have been able to teach many folks, by lecturing, with 5 published textbooks, and over 170 mostly peer-reviewed journal articles.
What is your favorite language?
By default, English. Guess that’s my fault! I also know a bit of Yiddish and a bit of Chinese.
If you had to choose one book, one film, and one piece of music or art to take into space for an undetermined amount of time, what would they be?
Book: The Lord of the Rings trilogy (OK, maybe I cheated)
Film: Possibly Rudy (1993)
Music: A Genesis anthology or an Alan Parson’s anthology; possibly Dark Side of the Moon (Pink Floyd) or an Andrew Lloyd Webber anthology. I’ve never fallen in love with just one music group—then again, maybe Within Temptation or Nightwish (I love symphonic metal)
What would you like your legacy to be?
That I helped a bunch of people with a life-changing effect and, equally important, taught more physicians to do the same.
Plans for the future?
I will remain as a Clinical Professor at the University of North Carolina Department of Neurology at least part time. I will also work to achieve the one thing I have never done: start my own pharmaceutical company
What is your motto?
There is always more than one way to skin a rat!