Pain refractory to routine diagnosis and treatment disables millions of people in the United States, with an estimated annual cost of 70 billion dollars. One of the largest groups disabled by pain consists of people suffering from orofacial and head pains. While this special subgroup remains inadequately studied and treated, recent scientific and technological advances now mandate an investigation focused on the distinctive clinical features of orofacial and head pain and their unique underlying basic mechanisms. We believe our large academic clinical and research hospital is presently particularly well-positioned to provide such an investigation focused on orofacial and head pain. Accordingly, different disciplines within our institution - Neurology, Neurological Surgery, Oral Surgery, Psychiatry, and Anesthesia - are now joined together to propose this integrated multidisciplinary basic and clinical science Program Project. This Program Project proposes four basic scientific animal models focused on the mechanisms subserving intractable orofacial pain. These four models have been designed to study overlapping links of the trigeminal system extending from the peripheral receptors and nerves to the brainstem, thalamus, and somatosensory cortex. Modern extra and intracellular electrophysiology techniques are proposed, along with immunohistochemistry and electron microscopy, to be applied in animal models and postmortem human tissue. These basic studies are aimed at providing fundamental biological clues to the disabling clinical syndromes. The complementing clinical investigation focuses on three syndromes of orofacial pain in adults: trigeminal neuralgia, myofascial orofacial pain, and atypical facial pain. Our hope is that by completing this comprehensive, integrated, and balanced Program Project our multidisciplinary pain group will reach our common goals which are to understand further the mechanisms subserving intractable pain, and thereby to improve health care, especially for people suffering from orofacial pain and headaches.
