Anesthesiology, Perioperative and Pain Medicine

Martin Angst, MD

Freedom of Choice

Dr. Martin Angst
            Although he’s a devoted wine enthusiast, Dr. Martin Angst can’t tell you his favorite kind of wine. “It really depends on the time of the year, my mood, the food,” he explains. Founder and director of the Human Pain Laboratory and an associate professor of anesthesia, Dr. Angst approaches his research with a similarly open-minded attitude. Founded in 1995, the Pain Lab partners with members of industry and researchers in genomics, molecular biology and bioinformatics to explore a wide array of biological aspects relevant to the relief of human pain.

Dr. Angst’s research interests include the accurate pharmacological characterization of novel analgesic compounds with a focus on early proof of effectiveness, the link between the genome and individual responsiveness to analgesics, and identification of specific biomarkers useful for the diagnosis and treatment of pain.

            Currently, the lab is conducting a clinical experimental study in 125 pairs of twins investigating the relative contributions of the genome and the environment in determining individual responsiveness to opioid pain therapy. “We have hints that inheritance may actually be quite significant,” says Dr. Angst. “If that is so, then you can start to dissect the genome and ask what aspects of the genome are relevant.”

            After completing his medical training in Switzerland and working for six months as a rescue medic, Dr. Angst came to Stanford in 1994to pursue a fellowship in clinical pharmacology. Along with his faculty advisor Dr. Barry Dick, Dr. Angst began conducting studies using small numbers of human volunteers in a lab setting to develop methods for reliably quantifying pain and pain relief in response to analgesics. The pair was able to demonstrate that their methods produced quantitative, well-controlled and reliable data. “The idea was to take some of the rigor of bench-side research and apply it to human biology,” explains Dr. Angst.         

In the laboratory

Since then, Dr. Angst has pushed the envelope on developing more sophisticated experimental pain paradigms for the comprehensive pharmacological characterization of analgesic drugs. He is fascinated by the complexity of the body’s response to pain and medications. According to Dr. Angst, when he started as a student, the medical community largely assumed that a drug could do one of two things: block or stimulate a receptor. “Now we understand that when we intervene at the level of a receptor, we have to take into account that the system may respond beyond the events at a particular receptor system,” he explains.

            In other words, sometimes the body does not behave as one would expect it to. “The nervous system is very plastic, and exerts changing and dynamic response over time in ways that are quite poorly understood,” says Dr. Angst. A systems-based approach to understanding pain medication is crucial to optimizing pain therapy in individual patients.

            Although Dr. Angst claims that it was “serendipity” that he ended up at Stanford instead of in Switzerland, he asserts that the environment here has proven ideal for his free-spirited approach to research. “Stanford allows you to have visions and research fantasies and to pursue them and there will be hardly anybody who will tell you it’s too crazy,” he says. “The intellectual freedom is probably my favorite thing about Stanford.”

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