Professor Michael Cousins AO Retires

Professor Michael J Cousins AO has devoted his entire career and much of his personal life to improving the lives of people living with pain. His selfless commitment to this goal over the past four decades has led to a new understanding of chronic pain as a disease in its own right. Professor Cousin’s advocacy has prompted governments in Australia and internationally to recognise pain as a health care priority.

After completing his medical and specialist training in Anaesthesia, he undertook further studies at McGill and Stanford Universities. There he interacted with three of the pioneers in the field of Pain Medicine: Ronald Melzack, Patrick Wall and John J. Bonica. These key interactions, and others at Stanford University stimulated more than 46 years of research, teaching, clinical innovation and development of Pain Medicine in Australia and internationally.

In Australia, Professor Cousins was the Founding President of the Australian Pain Society, Chairman of the Joint Advisory Committee on Pain Medicine of several specialist colleges, which led to the formation of the Faculty of Pain Medicine (FPMANZCA) in 1999. He served as the Founding Dean of the Faculty of Pain Medicine, which is currently unique worldwide in bringing together five speciality bodies to oversee a single training program and examination leading to a specialist qualification in Pain Medicine. He also played the leading role with Faculty of Pain Medicine colleagues, in gaining recognition of Pain Medicine as a medical speciality by the Australian Government in 2005.

Professor Cousins developed two large multidisciplinary centres in Pain Medicine, at Flinders Medical Centre, Adelaide and at Royal North Shore Hospital. Both of these centres became internationally recognised for clinical care, teaching and research. Professor Cousins fostered the development of a University of Sydney Graduate Diploma and Masters postgraduate degree in Pain Management, which now enrols students from across Australia and around the world in a web-based education program for all health professionals.

Professor Cousins chaired an NHMRC Working Party, which developed Australia’s first “evidence-based medicine” guideline on the Management of Acute Pain – now used throughout Australia and Internationally.

Internationally, Professor Cousins is the only Australian and the first Anaesthetist after the founder John J. Bonica to serve as President of the International Association for the Study of Pain (IASP). He played a major role in stimulating IASP to form an official relationship with the World Health Organisation (WHO) and to place more emphasis on cancer pain and acute pain, in addition to pre-existing emphasis on chronic pain.

In the Australian & New Zealand College of Anaesthetists (ANZCA), Professor Cousins served as the Councillor, Vice President and President. Previously he served as Chairman of the Primary Examination Committee, Chairman of the Research Committee and Member of the Education Committee. He re-organised the ANZCA Foundation and served as its Chair. Major initiatives during his Presidency were: overhauling the governance of ANZCA Council to meet ASIC requirements; appointment of a new CEO; appointment of ten taskforces, which harnessed over 100 ANZCA Fellows, leading to important ANZCA initiatives such as: a new focus on Perioperative Medicine; a major new emphasis on Quality and Safety – a joint initiative with the Australian Society of Anaethetists and development of a detailed strategic plan to respond in a positive proactive way to the evolution of Nurse Practitioners.

Professor Cousins’ research has produced over 330 original papers, reviews, book chapters and editorials. Studies have been at basic, clinical and epidemiological levels. Arising from the spinal opioid research, an invited review with colleague Laurie Mather was published in Anesthesiology in 1984. This became the most cited reference over the past 60 years in the Anesthesiology literature and fifth most cited over the last 20 years in the Pain Medicine literature. Highlighting the impact of inhalation anaesthetic metabolism and toxicity in the era 1970-1990, his key paper with Richard Mazze on methoxyflurane nephrotoxicity was also in the top 100 most cited papers over the past 60 years.

In the 1990s Professor Cousins set up the Pain Management Research Institute (PMRI) Ltd which is a not for profit, community based organisation which raises funds for the research and education activities of PMRI. Over the years PMRI Ltd has raised of the order of $0.5 to $1 M per annum.

Government, health professional and community awareness of societal, humanitarian, financial and health resource implications of the “hidden epidemic” of chronic pain, in terms of human suffering and financial costs, has been pursued nationally and internationally by Professor Cousins over the last 34 years. He has been the driving force in Australia and internationally in drawing attention to evidence that severe persistent pain becomes a “disease entity”.

Professor Cousins was instrumental in the development of Australia’s first National Pain Summit at Parliament House, Canberra in 2010. He spearheaded the formation of a new organisation, Painaustralia, which acts as an advocacy body to facilitate the implementation of the Pain Strategy. He continues to serve on the Board of Painaustralia.

In August 2010, Professor Cousins chaired the Steering Committee which developed the first International Pain Summit in conjunction with the World Congress on Pain in Montreal, Canada. An important outcome of this Summit was the: “Declaration of Montreal” which called for “Access to Pain Management as a Fundamental Human Right”. The Australian Pain Strategy has been adopted as a guide for National Pain Strategies in the USA, Canada, UK and other European countries.

In 2012 Professor Cousins became the first head of the new Academic Discipline of Pain Medicine at the University of Sydney, leading to the Inaugural Symposium on Pain for all health care students in April, 2012. In 2016 he was elected as a Fellow of the Australian Academy of Health and Medical Sciences (FAAHMS). The mission is to be an advice, support, advocacy and expert committee for health and medical sciences and an advisory group for all Government bodies.

His retirement was celebrated with a Festschrift on 19 May 2016 held at the Royal North Shore Hospital and attended by local, national and international leaders in pain management, all celebrating Professor Cousins’ many and significant lifetime achievements.