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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?. 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

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  1. Needed Research to Improve Care for People with Trigeminal Neuropathic Pains Donald Nixdorf, DDS MS Assistant Professor University of Minnesota nixdorf@umn.edu

  2. 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

  3. 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

  4. 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

  5. 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

  6. Wynder EL. Am J Epidemiol 1994; 547-549

  7. What we are looking for… Epidemiologist Scientist Care Provider

  8. What am I going to do… • Functional Magnetic Resonance Imaging fMRI

  9. 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

  10. Vessel Classification 3D Vessel Reconstruction blue = vein red = artery Bolan, Yacoub, Garwood, Ugurbil, Harel NeuroImage 2006

  11. Maximum Intensity Projections (MIP) MIP of the 3D subtraction (Pre/Post MION) Bolan, Yacoub, Garwood, Ugurbil, Harel NeuroImage 2006

  12. First human images at 9.4 Tesla Vaughan et al., MRM 2006

  13. 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)

  14. 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)

  15. 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)

  16. Kehlet et al, 2006 in Lancet Take Home • 30% get persistent pain • 10% are severely affected

  17. SUMMARYDental Procedures

  18. 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)

  19. 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

  20. Why participate in practice-based research networks? • Generalizability • Sample size Laboratory Clinical Practice-based Community- research trials research based in academic research settings

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