Cousins, Michael J

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Michael Cousins is a world leader in pain management. He was the Foundation Professor of Anaesthesia and Intensive Care at Flinders University of South Australia in 1975 and has been the Foundation Chair of Anaesthesia and Pain Management at the Royal North Shore Hospital and the University of Sydney since 1990. In 1979 he was the Founding President of the Australian Pain Society and in 1999, became the Founding Dean of the Faculty of Pain Medicine (ANZCA). He played the key role in the recognition by the Australian Government of Pain Medicine as an independent medical specialty in 2005.

Michael was born in Sydney in 1939 and studied Medicine at the University of Sydney. After graduating in 1963, he completed his Residency at the St George Hospital and undertook specialist training in Anaesthesia at the Royal North Shore Hospital. Michael was awarded a University of Sydney Post Graduate Fellowship to carry out research on Acute Pain Management which gave him the opportunity to work with one of the pioneers in the field, Professor Philip Bromage, at McGill University in Montreal, Canada. Michael says of this time:

Philip Bromage was pioneering the use of epidural pain relief for patients suffering from pain associated with major trauma. His concept was to achieve optimal pain relief without sedation so that patients could quickly regain normal function. This was a very early version of one of the major research themes today which is to favourably modify the injury response so that recovery can be facilitated Professor Bromage's ideas had a major influence on my future research. Bromage was also very interested in improving pain relief after major surgery and was most supportive of my very first piece of research which was to study pain relief and blood flow following major lower limb vascular surgical operations. In this first study, I demonstrated that effective pain relief was associated with an improvement in blood flow through the surgical graft. In retrospect, this was probably one of the first studies to document a parameter other than pain in association with a major method of pain relief.

From 1970 to 1974, he was Assistant Professor of Anaesthesia at Stanford University in California, there collaborating with Professor Richard Mazze in studies of the metabolism and kidney toxicity caused by the inhalation anaesthetic agents. He was awarded a Doctorate in Medicine from the University of Sydney for this work.

While at McGill and Stanford Universities, he interacted with three of the pioneers of the field of Pain Medicine, Ronald Melzack and Patrick Wall, who in 1965 proposed the revolutionary 'Gate Control Theory of Pain', and John J Bonica the Founding Father of the 'team approach' to pain management. According to Michael:

The 'Gate Control Theory' revolutionised the study of pain and continues to be a stimulus for much of the work that is currently performed. Previously, pain had been regarded purely as a sensation with nerve impulses travelling in a unidirectional manner from the body surface to the brain. Melzack and Wall proposed that modulation occurred in the spinal cord and at other levels of the central nervous system to modify the pain stimulus in a major way. In other words, there was a descending system that ran in the opposite direction to pain impulses ascending to the brain. Our current NHMRC Program Grant is supporting a series of interlocking studies which are providing a detailed map of the important targets on the body surface, the spinal cord and more central areas of the neuraxis, that form different components of the 'Gate Control System'. Patrick Wall visited our Centre shortly before he died. Melzack is still alive and I am in regular contact with him.

The 'Gate Control Theory' continues to be cited at a very high level.

These and other key interactions at Stanford University in the early 1970s, stimulated Michael's over 32 years of research, teaching, clinical innovation and development of the field of Pain Medicine in Australia and Internationally.

In 1975 Michael became Foundation Professor of the Department of Anaesthesia and Intensive Care at Flinders University of South Australia. This was the first Chair of Anaesthesia and Intensive Care in Australia and the first with a major focus on basic and clinical research. Whilst in Adelaide, Michael also established the first multidisciplinary centre for Pain Medicine at Flinders Medical Centre. He remained in Adelaide until 1990.

Returning to Sydney, Michael was appointed Foundation Professor and Head of Anaesthesia and Pain Management at the Royal North Shore Hospital, within the Faculty's Department of Anaesthesia. He remains in this position today. In this capacity, he again established a large multidisciplinary centre for the study and treatment of Pain Medicine, the Pain Management Research Institute (PMRI), of which he is Director. Like the Flinders Centre, this new Centre has become internationally recognised for clinical care, teaching and research. In 1998 the University of Sydney PMRI was recognised by the National Health and Medical Research Council (NHMRC) of Australia as one of only eight 'Centres of Clinical Excellence in Hospital Based Research' among all medical research disciplines across Australia. He also fostered the development of the Sydney Medical Simulation Centre, based at Royal North Shore Hospital.

Michael drove the development of the University of Sydney's diploma and master's course in Pain Management, which now enrols students from around the world in its unique web-based education program. He chaired the NHMRC Working Party (1995–1999) which developed Australia's first 'evidence-based medicine' guideline on the Management of Acute Pain, a document now used throughout Australia and internationally.

In Australia, Michael has been the Founding President of the Australian Pain Society (1979), Chairman of the Joint Advisory Committee on Pain Medicine of the specialist College of Anaesthesia (ANZCA), Medicine (RACP), Surgery (RACS), Psychiatry (RANZCP) and Rehabilitation Medicine (AFRM) which led to the formation of the Faculty of Pain Medicine (ANZCA) in 1999. He served as the Founding Dean of the Faculty (1999–2002), which is currently the only Faculty in the world bringing together five specialty bodies to oversee a single training program and examination leading to a specialist qualification in Pain Medicine. He has also served as a Councillor for the NHMRC.

Internationally, Michael is the only Australian, and sole Anaesthetist after the Founder, J J Bonica, to serve as President of the International Association for the Study of Pain (IASP) (1987–1990). He played a major role in stimulating IASP to form an official relationship with the WHO and to place more emphasis on the treatment of cancer pain and acute pain, in addition to its pre-existing emphasis on chronic pain. In recognition of these contributions, he was made Honorary Member of the IASP, and also of the Pain Society of Great Britain and Ireland. Michael is currently serving as President in the Australian and New Zealand College of Anaesthetists, and is Chairman of the Committee of Presidents of Medical Colleges. Previously, he has served as Chairman of the Primary Examination Committee, of the Research Committee, and as Councillor. He has also been President of the Association of Clinical Professors of Australia. He has served on numerous international editorial boards including the leading journals Pain and Anaesthesia and Analgesia, and was the Founding Section Editor for a new Pain Medicine section of the latter.

His research has produced over 200 original papers, reviews and book chapters in the fields of mechanisms and treatment of acute, chronic and cancer pain; pharmacology and toxicology of anaesthetic and analgesic drugs; development of novel routes of delivery of analgesic drugs; epidemiology of chronic pain; and impact of pain on the individual and society. Currently, his main research interest remains Epidemiology and factors associated with the development of persistent pain; mapping of the pain pathway to develop new targets for pain control; development of non-opioid drugs for use by the spinal intrathecal route for treatment of cancer pain and severe chronic non-cancer pain; and development of a societal and political framework for ‘pain relief as a universal human right'. He was awarded a DSc by the University of Sydney for this research in 2006.

His text Neural Blockade and Pain Management has become a key reference internationally, and is now in its fourth edition. A review with colleague L E Mather in 1984 on the spinal route of analgesia has become the third most frequently cited reference in the entire field of Pain Medicine over the last 20 years, and the most cited reference in Anaesthesiology literature over the last 60 years.

Throughout his career, Michael has been the recipient of numerous national and international awards in the fields of anaesthesiology and pain, and in 1995, he was made a Member of the Order of Australia “for service to medicine particularly in the fields of pain management and anaesthesia”.[1]

Citation: Mellor, Lise (2008) Cousins, Michael J. Faculty of Medicine Online Museum and Archive, University of Sydney.

An alternate version appears in: Mellor, L. 150 Years, 150 Firsts: The People of the Faculty of Medicine (2006) Sydney, Sydney University Press.