Trigeminal Neuralgia: Opportunities for Research and Treatment

Workshop Summary

Held: September 14, 1999

Organizer: Cheryl A. Kitt, Ph.D., NINDS

Sponsors: NINDS, NIDCR, NIH Office on Rare Diseases, NIH Pain Research Consortium

Background

Trigeminal neuralgia is a condition that affects the trigeminal nerve; it is characterized by a sudden, severe, electric shock-like or stabbing pain typically felt on one side of the jaw or cheek. The disorder is more common in women than in men and rarely affects anyone younger than 50. The attacks of pain, which generally last several seconds and may be repeated one after the other, may be triggered by talking, brushing teeth, touching the face, chewing, or swallowing. The attacks may come and go throughout the day and last for days, weeks, or months at a time, and then disappear for months or years.

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Summary

This small workshop focused on understanding the current status of research on this condition, and to identify new avenues of research and collaborations that would have an impact on this disorder as well as on other painful conditions that may be due to injury or disease.

The workshop brought together basic scientists (both extramural and intramural), neurologists, neurosurgeons, NIH program directors from the NIH Pain Consortium, and representatives from the patient advocacy group The Trigeminal Neuralgia Association, to identify priority areas for future directions in basic and clinical research in Trigeminal Neuralgia, specifically, and neuropathic pain in general.

Following an overview of the clinical picture of Trigeminal Neuralgia and a patient presentation, the talks covered the following topical areas: status of clinical trials/medications for Trigeminal Neuralgia; epidemiology; diagnostic criteria; role of gender; mechanisms of pain and plasticity; translational research; treatment strategies; and genetics.

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Recommendations

Several key areas were identified as priorities for setting a research agenda on Trigeminal Neuralgia:

• Epidemiology
• Pilot Clinical Trials of Medications (i.e., new anticonvulsants; transmitter receptor- or ion channel-specific drugs)
• New Model Systems for Pain (including in vitro and in vivo models)
• Research Opportunities in Humans (including imaging; electrophysiology; anatomy, circuitry, and systems approaches)
• Mechanistic Studies of Pain (i.e., neural plasticity)
• Identification of Non-Neuronal Mechanisms (i.e., vasculature; immune system; myelin)
• Diagnostic Criteria
• Evaluation of the Efficacy of Medical versus Surgical Treatments
• Infrastructure Mechanisms for Collaborations, Education, Patient Registry, etc.

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Follow-up:

• A referenced summary report has been prepared for publication in the journal Pain. (see Referenced Summary Report)
• A Request for Applications to stimulate research in Trigeminal Neuralgia and other painful neuropathies is also being considered.

Invited Participants

Gerald D. Fischbach, MD
Director
NINDS

Harold C. Slavkin, D.D.S.
Director
NIDCR

Clifford J. Woolf, MD, Ph.D.
Anesthesia-Neural Plasticity Res. Group
Massachusetts Gen. Hosp.

Jeffrey S Mogil, Ph.D.
Dept Psychol.
Univ. Illinois At Urbana-

W. Crawford Clark, Ph.D.
Research Foundation for Mental Hygiene
New York State Psychiatric Institute

Linda LeResche, Sc.D.
Dept. of Oral Biology
University of Washington

Christian Stohler, DDS
Depart. of Biologic and Materials Science
School of Dentistry
University of Michigan

Jon D. Levine, MD, Ph.D.
Div Neurosci/NIH Pain Ctr
Univ. California San Francisco

Peter J Jannetta, MD
Dept Neurological Surgery
Univ. Pittsburgh Sch Med

MA Ruda, PHD
Pain & Neurosensory Mechanisms Branch
NIH-NIDCR

Ian Gilron, MD
Pain & Neurosensory Mechanisms Branch
NIH-NIDCR

Thomas K Baumann, Ph.D.
Div Neurosurgery L-472
Oregon Hlth Sci Univ.
Dept Neurological Surgery

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Conference Organizers

Cheryl A. Kitt, Ph.D.
Program Director for Pain
NINDS

Kenneth Gruber, Ph.D.
Chief, Chronic Diseases Branch
NIDCR

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Conference Attendees

David Borsook, MD
MGH NMR Ctr.

Marian Emr
NINDS

Paul Girolami
NINDS

Paul Scott, Ph.D.
NINDS

Claudette Varricchio, RN, Ph.D.
NCI

Judy Finkelstein, Ph.D.
NIA

Michael Iadarola, Ph.D.
NIDCR

Mitchell Max, MD
NIDCR

Richard Gracely, Ph.D.
NIDCR

Raymond Dionne, D.D.S.
NIDCR

Margaret Jacobs
NINDS

Ursula Wesselmann, MD
Johns Hopkins Hosp.

Daniel R. Kenshalo, Ph.D.
NIH
CSR

Claire Patterson
President
Trigeminal Neuralgia Association

Plus 6 Board Members of the Trigeminal Neuralgia Association