German Research Network on Neuropathic Pain (GNNP)
Link: http://www.neuropathischer-schmerz.de/
Project III.1.1
Idiopathic trigeminal neuralgia and trigeminal neuropathic pain: Pathophysiology, mechanism-based assessment and treatment
Supported by the Federal Ministry of Education and Research (BMBF)
(Link: http://www.bmbf.de/)
Duration: 01.04.2002 to 31.03.2005
Coordinator: Volker Tronnier, Department of Neurosurgery, University Hospital Heidelberg
Subprojects at the Central Institue of Mental Health:
C) Quantitative sensory testing, perioperative trigeminal potentials and psychophysiological evaluation
(Wolfgang Eich, Herta Flor, Dirk Rasche, Volker Tronnier)
D) Determination of cortical and subcortical reorganization and influences of learning factors in humans using EEG and fMRI
(Herta Flor, André Rupp, Christoph Stippich, Klaus Sartor)
E) Mechanism-based therapy (psychological, medical, surgery) in humans and animal models
(Justus Benrath, Wolfgang Eich, Herta Flor, Dirk Rasche, Volker Tronnier)
Research assistant Central Institue of Mental Health: Claudia Rolko
Research assistant Department of Neurosurgery Heidelberg: Dirk Rasche
Project description:
There is a special need of empirical research in the field of chronic facial pain including idiopathic trigeminal neuralgia, symptomatic trigeminal neuralgia, trigeminal neuropathy and atypical trigeminal neuralgia. The pathogenetic mechanisms are not very well understood and the common classification is not yet well supported empirically. Starting from the findings concerning the critical role of cortical reorganization in other chronic pain syndromes such as chronic back pain it seems to be very likely that cortical reorganization – in addition to other factors like vascular compression or demyelinization - may participate in the pathogenesis and maintenance of chronic facial pain either. In an animal model of trigeminal pain marked changes such as expanded receptive fields and map disorganization in the primary somatosensory cortex have already been observed, however, the significance of such processes in human facial pain in unclear. Additionally, subcortical reorganization processes may contribute to chronic facial pain. Further, the role of learning and other psychological mechanisms is not well understood until now.
Patients who undergo operation in the Neurosurgical University Hospitals of Mannheim and Heidelberg are examined prior to the operation (microvascular decompression according to Jannetta, thermocoagulation), 4 to 8 weeks, and 6 month after the operation. The examination includes psychophysical, psychophysiological and psychological measurements. It consists of an extensive quantitative sensory testing of the painful and contralateral facial area, different questionnaires and an electronic pain diary (in collaboration with the Clinical and Psychosomatic Medicine of the University Hospital of Heidelberg).
Some of the patients will be examined with fMRI and EEG, partly simultaneously, with either a pain-related sensitization procedure or a Pavlovian conditioning procedure.
Additionally, stress reactivity is tested by applying personally relevant stressors while peripheral psychophysiological measures are assessed. The results will be compared with that of matched healthy controls.
In addition, the comparison of a routine pharmacological treatment of chronic facial pain at the Neurosurgical Hospital of the University of Heidelberg and a specifically designed psychological intervention is planned. The intervention will consist of a stimulation of the painful facial area thought to influence cortical reorganization, biofeedback and elements of behaviour therapy.
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