Dr. James Eisenach: In Pursuit of Pain Relief
Dr. James Eisenach
In 1985, James C. Eisenach, MD, came to Wake Forest School of Medicine for a one-year fellowship in obstetric anesthesia. Thirty years later, he holds an endowed professorship named for the man who brought him, Francis M. James III, MD, Professor Emeritus of Anesthesiology and our former Chair of Anesthesiology.
Eisenach’s pain research has been translated to clinical practice; his mentorship has benefited more than four dozen trainees, and his contributions to anesthesiology have garnered many professional awards. The highest honor came this year with his election to the prestigious National Academy of Medicine (formerly the Institute of Medicine).
“It’s a great honor,” he said, “but I’ve been fortunate to work around some really brilliant people in my life—Nobel prize winners like physicist Richard Feynman, who advanced quantum mechanics, immunologist J. Michael Bishop, who discovered oncogenes, and members of the National Academy of Medicine. I don’t see myself as having contributed in the same way many others in that academy have.”
His peers feel otherwise. “New members are elected by current active members through a selective process that recognizes individuals who have made major contributions to the advancement of the medical sciences, health care, and public health,” stated the news release announcing inductees.
From Chemist to Physician
Eisenach was born in Omaha, Neb., but grew up in Shenandoah, Iowa, where his father had a medical practice. His mother, a nurse, worked in the practice prior to raising four children. In his senior year of high school, his parents returned to Omaha, and he chose the University of Nebraska—Lincoln, an hour away. He set his sights on a chemistry career.
“I admired what my father did, but I was fascinated with the pure sciences,” Eisenach recalled.
After earning his bachelor’s degree in 1976, he was accepted into the California Institute of Technology’s doctoral chemistry program. Two years in, he had a change of heart and completed a master’s thesis instead.
“I decided I really missed the human side of applied science and decided to go to medical school,” he explained.
Eisenach entered the University of California, San Francisco, School of Medicine, planning a career in clinical medicine. He completed his medical degree in 1982, and remained in San Francisco for his internship at Mt. Zion Hospital. It was during his residency at the Mayo Clinic in Rochester, Minn., that his career took another turn.
“Dr. Tony Yaksh, a pharmacologist, got me interested in how the spinal cord processes and sends peripheral nerve signals in a way that the brain perceives as pain,” he said. “I talked with him after a lecture, and we did a little work together while I was a resident. He became my mentor, and I’ve had a grant with him for 25 years now.”
From Clinic to Lab
With Yaksh as his mentor, Eisenach wrote a successful National Institutes of Health (NIH) grant and was already a funded investigator when he arrived for his fellowship here. He has maintained continuous NIH funding since 1985, and his career turned out to be about 80 percent science and 20 percent clinical medicine.
“I was attracted to Wake Forest Baptist because it was one of the top five fellowships in obstetric anesthesia and because of Frank James,” Eisenach noted. “I chose obstetric anesthesia for its variety. The labor and delivery unit can present life-threatening emergencies, where a physician can make a big difference at a crucial moment, but there is also a lot of routine, happy care.”
His early research focused on epidurals, injecting drugs into the spinal space, and how to maximize pain relief while minimizing side effects, such as numbing and leg weakness. He has investigated numerous spinal cord receptors and drugs, pursuing smaller doses that selectively block pain signals. In the case of one non-narcotic drug, 15 years of study led to FDA approval for its use not in obstetrics but for treating chronic cancer pain.
“I would point to that drug and to some of the refinement of epidural pain relief in labor as two things that I’m pleased about,” Eisenach reflected.
Currently, he is studying how to speed recovery from pain after trauma or surgery. One approach seeks to mimic brain signaling that naturally speeds recovery after childbirth. Another is investigating whether eye tests of pupil response to pain could be used to personalize the choice of pain medication for elderly surgical patients.
Eisenach has consulted with many pharmaceutical companies and has three patents and more than 300 peer-reviewed publications to his credit. Since 2007, he has been editor-in-chief of the journal Anesthesiology, a time-consuming job that also encroached on clinical practice but has placed him at the nexus of current thought in his field.
“The editorship ends next year, and I’m looking forward to getting back to part-time clinical work,” he noted.
Since 1985, his total NIH funding has exceeded $25 million. In 2011, he received an NIH MERIT Award, which provides recipients with up to 10 years of research funding. In 2013, the American Society of Anesthesiologists recognized him with its Excellence in Research Award, and the American Society for Regional Anesthesia and Pain Medicine bestowed him with its highest honor, the Distinguished Service Award.
With all that recognition, what accomplishment means the most to him? He points to the 52 physicians and post-docs he has trained.
“I’ve had a lot of fun doing the research, and I think we’ve made some important observations,” he said, “but what means the most to me are the people I’ve trained. That doesn’t stand out on a CV, but to me that’s the most important accomplishment.”