CLOSE UP working for Dr. Ronald Melzack, Professor of Psychology and author, with Patrick Wall, of the now classic Gate Control Theory of Pain. This bold move took Katz into a field that he knew nothing about, yet it turned out to be the launching pad for a career in pain that culminated in the 2013 Distinguished Career Award from the Canadian Pain Society. Katz spent two formative years at the pain center where he was exposed to people with a variety of chronic pain problems. Among the people he saw were amputees with severe, intractable phantom limb pain and people with spinal cord injuries who suffered from intense phantom body pain. When the MGH Pain Centre was forced to close due to funding problems, Katz entered the doctoral program in clinical psychology under the supervision of Dr. Melzack, whose theory of pain has revolutionized our current understanding of what it means to feel pain. At the time, Katz walked into relatively uncharted territory because of his interest in pursuing phantom limb pain. The primary question that he was in search of an answer for was, “what is going on in the periphery and central nervous system to explain how someone who has had a limb amputated continues to feel that the cut-off part is still present and that it is still painful?” Among the various types of phantom limb pain, the one that captured Katz’s attention was a class of pain that he has since called “somatosensory pain memories.” These pain memories are described by the amputee as replicas of pains that were present at or near the time of amputation and are referred to the phantom limb after amputation with the same intensity, qualities of experience and location as the pre-amputation pain. If an enduring, sensory memory-like mechanism was responsible for these types of phantom pains, Katz wondered what the effect was of noxious intraoperative stimuli (such as the cutting of tissue, nerve and bone during surgery) on the subsequent development of acute and chronic postoperative pain. Was it possible that these noxious intraoperative events also set up a memory-like mechanism that contributed to increased pain (hyperalgesia) and increased analgesic consumption after surgery? He knew that general anesthesia did not block the transmission of nociceptive impulses from reaching the spinal cord and brain even though patients are unconscious during surgery. Would a pre-operative local anesthetic,
administered regionally or centrally, block the noxious afferent input associated with surgery from reaching the spinal cord and thereby prevent the establishment of a somatosensory pain memory? Katz’s curiosity and interest in better understanding the mechanisms underlying these pain memories brought him to Toronto in 1990, where he did postdoctoral work in the Departments of Psychology and Anesthesia & Pain Management at the Toronto General Hospital (TGH) and where he subsequently became a member of the Institute of Medical Science in 1996. At TGH Katz joined the Anesthesia Department’s Acute Pain Research Unit, then led by Dr. Alan Sandler. Supported by Fellowship awards from the Ontario Ministry of Health and the Medical Research Council of Canada (MRC, now CIHR) he and
The primary question that he was in search of an answer for was, “what is going on in the periphery and central nervous system to explain how someone who has had a limb amputated continues to feel that the cut-off part is still present and that it is still painful?” his colleagues began to translate some of the ideas generated from his doctoral research into clinical studies in patients undergoing surgery. This included the role of pre-emptive analgesia (i.e. analgesics given directly prior to surgery) in preventing the establishment of surgery-induced central sensitization and in reducing postoperative pain intensity and analgesic consumption. “This was a really exciting, productive time,” Katz recalled. “One of my closest collaborators at the time was a Fellow in Anesthesia, Dr. Brian Kavanagh, who has gone on to great things and who is now the Chair of Anesthesia at the U of T.”
main areas, including: (1) the minimization of acute post-operative pain through pharmacological and psychological measures; (2) working towards the prevention of chronic post-surgical pain; (3) identifying the biopsychosocial risk factors for chronic post-surgical pain in adults and children; (4) understanding placebo analgesia; and (5) improving the understanding and management of pain in infants. Future areas of research will target psychotherapeutic interventions for chronic pain patients. In 2002, Katz joined the Department of Psychology at York University as the Canada Research Chair in Health Psychology. Even with the move to York, he maintained an active research program in the Department of Anesthesia and Pain Management at TGH and he continues to supervise and mentor students at the IMS. Although the primary reason for my interview with Dr. Katz was to discuss his most recent career award and his singular contributions to the fields of pain, analgesia, and psychology, he repeatedly steered the conversation away from his many accomplishments and instead focused it on the research that his students and colleagues conduct. This was not surprising given what I know, and have heard, about his reputation for humility and his immense respect and appreciation for his collaborators (i.e. nurses, anesthesiologists, pharmacists and other psychologists) and students, past and present. And so I was not caught off guard by his response when I asked him what he considered to be his biggest accomplishment thus far. He laughed and said, “Does having three children count?”
After more than 20 years of research at TGH, highlighted by the prestigious Scholar and Scientist Awards from the MRC, Katz is now the Director of the Acute Pain Research Unit where, with his colleagues and students, he continues to investigate the mysteries of pain. His program of research broadened into a multipronged approach targeting five IMS MAGAZINE SPRING 2013 DRUG RESCUE AND REPURPOSING | 28