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Needed Research to Improve Care for People with Trigeminal Neuropathic Pains. Donald Nixdorf, DDS MS Assistant Professor University of Minnesota nixdorf@umn.edu. What do YOU think?. Education More Awareness in Primary Care (DDS & MD) Better medications & treatments More effective

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needed research to improve care for people with trigeminal neuropathic pains

Needed Research to Improve Care for People with Trigeminal Neuropathic Pains

Donald Nixdorf, DDS MS

Assistant Professor

University of Minnesota

nixdorf@umn.edu

what do you think
What do YOU think?
  • Education
    • More Awareness in Primary Care (DDS & MD)
  • Better medications & treatments
    • More effective
    • Less side-effects
  • Improved Diagnostic Criteria
    • Based on WHAT?

Knowledge of the Mechanisms

slide4
H.M.S. Salisbury

James Lind (1716-1794)

“The number of seaman in time of war who died of shipwreck, capture, famine, fire or sword, are but of inconsiderable in respect of such as are destroyed by the ship diseases, and by the usual maladies of intemperate climates.” – Dr. Lind, 1753

symptoms of scurvy
Symptoms of Scurvy
  • lethargy
  • irritability
  • weight loss
  • aching of the joints
  • bleeding under the skin and nails
  • swollen and bleeding gums
  • spontaneous bruising
  • wounds slow to heal
scurvy timeline
Scurvy: Timeline

1601 - James Lancaster (sea captain) records lemon juice as protective against scurvy

1744 - British Admiral George Anson completes trip around the world in the Centurion . Over half of the 2,000 sailors die from scurvy

1747 - Lind’s experiment on the HMS Salisbury

1754 - Lind publishes “A Treatise of the Scurvy”

1775 - Captain James Cook completes historic voyages Sailors remained free from scurvy

1795 - British Navy supplies daily ration of lime or lemon juice

1932 - Waugh and King (U of Pittsburgh) and Szent Gyorgyi (Hungary) isolate and synthesize vitamin C

what we are looking for
What we are looking for…

Epidemiologist

Scientist

Care Provider

what am i going to do
What am I going to do…
  • Functional Magnetic Resonance Imaging

fMRI

slide10

High Resolution (post-MION) acquisition

Acquisition parameters:

TR/TE = 50/3.5 ms, readout bandwidth 20 kHz,

FOV 20 x 11.2 x 2.5 mm, matrix 384 x 216 x 16, 16 averages,

Acquisition time 2:53 min/scan, total time 46:08 min.

The image was reconstructed 2x zero-filling, producing a reconstructed resolution of 26 x 26 x 78 mm.

Bolan, Yacoub, Garwood, Ugurbil, Harel NeuroImage 2006

slide11

Vessel Classification

3D Vessel Reconstruction

blue = vein

red = artery

Bolan, Yacoub, Garwood, Ugurbil, Harel NeuroImage 2006

slide12

Maximum Intensity Projections (MIP)

MIP of the 3D subtraction (Pre/Post MION)

Bolan, Yacoub, Garwood, Ugurbil, Harel NeuroImage 2006

slide13

First human images at 9.4 Tesla

Vaughan et al., MRM 2006

definitions
Definitions

Neuropathic Pain needs to fulfill the following criteria:

  • Pain presents in a neuranatomically defined area
  • History of a relevant disease or lesion in the nervous system (dental procedures)
  • Partial or complete sensory loss in all or part of the painful area
  • Confirmation of the lesion or disease by a specific test (i.e. surgical evidence, imaging, neurophys., biopsy)
slide15
Does persistent pain arise from surgery?
  • What are the factors that would put some patients at higher risk for developing persistent pain than others ?
  • What are the human neuroanatomical & functional mechanisms involved in this type of pain?

…multiple other research questions & steps…

  • What are viable interventions and when should they best be applied ? (pre-op, intra-op & post-op)
procedures performed within u s in 100 000 yr
Procedures performed within U.S. (in 100,000/yr)

All General Surgeries

45,023

309

Nose/Mouth/Pharynx

55,874

All Dental Surgeries

40,036

Tooth Extractions

15,838

Root Canal Therapies

0

15,000

30,000

45,000

60,000

Data from the CDC (2004) & American Dental Association (1999)

slide17

Kehlet et al, 2006

in Lancet

Take Home

  • 30% get persistent pain
  • 10% are severely affected
procedures performed within u s in 100 000 yr1
Procedures performed within U.S. (in 100,000/yr)

All General Surgeries

13,406 (30%)

93 (30%)

Nose/Mouth/Pharynx

1,676 (3%)

All Dental Surgeries

400 (1%)

Tooth Extractions

792 (5%)

Root Canal Therapies

0

15,000

30,000

45,000

60,000

Data from the CDC (2004) & American Dental Association (1999)

pain oral health quality of life measuring success of root canal therapy
Pain & OralHealth Quality of Life:Measuring Success of Root Canal Therapy

Prospective cohort evaluating non-surgical root canal therapy 1 year after treatment

Aims:

  • Determine incidence of persistent pain at 1 year
  • Assess the burden on the individual
  • Evaluate the risk factors associated with developing this type of pain
slide21

Why participate in practice-based research networks?

  • Generalizability
  • Sample size

Laboratory Clinical Practice-based Community-

research trials research based

in academic research

settings