Ask the experts: What has the establishment of multidisciplinary pain centers done to improve the management of chronic pain conditions?

Howard Fields received his MD and PhD in Neuroscience at Stanford University (CA, USA) in 1965-1966. After Internal Medicine training at Bellevue Hospital in New York, he spent 3 years as a research neurologist at Walter Reed Army Institute of Research (MD, USA). Following clinical training in neurology at the Boston City Hospital Service of Harvard Medical School in 1972, he joined the faculty of the University of California, San Francisco (USA) where he is currently Professor of Neurology, Director of the Wheeler Center for the Neurobiology of Addiction and Principal Investigator at the Ernest Gallo Clinic and Research Center. Fields' major interests are in nervous system mechanisms of pain and substance abuse, with a focus on how endogenous opioids contribute to these mechanisms. He was a founder of the UCSF Pain Management Center and has made major contributions to understanding and treating neuropathic pain. His group was the first to demonstrate the clinical effectiveness of opioids for neuropathic pain and of topical lidocaine for postherpetic neuralgia. In laboratory studies he discovered and elucidated a pain-modulating neural circuit that is required for opioids to produce analgesia. He also discovered that placebo analgesia is blocked by an opioid antagonist. Recently, his laboratory has discovered nerve cells in the striatum that selectively encode the magnitude of a reward. They have also shown how the neurotransmitter dopamine contributes to motivation and reward-based choice. Fields has received numerous research awards and has given many named lectureships including a Merit Award from the NIH, the Kerr Award of the American Pain Society, the Cotzias Award of the American Academy of Neurology and the RD Adams lecture of the American Neurological Association. He also gave the Beecher Lecture (in anesthesiology) and the Adams Lecture (in neurology) at Harvard. In 1997, he was elected to membership in the Institute of Medicine and in 2010, he was elected to the American Academy of Arts and Sciences.