Pain
Mission: The primary mission
of the Pain Focus Group is to stimulate the study and management
of chronic or persistent pain conditions of cutaneous and deep
tissue origin. The program is diverse and spans the basic and
clinicial sciences from molecular studies to clinical trial studies.
A secondary mission is to transfer the research findings to health
professionals and the public via outreach and demonstration projects
in the community.
| 
Imaging pain in the brain: an fMRI image
of the response to an experimental heat pain stimulus.
|
Our working model is that research
on pain has reached a level of understanding that facilitates the
transfer of basic knowledge to the study of persistent pain in humans,
and ultimately to new methods of diagnosing and treating these conditions
in the general population. Further advances will require multidisciplinary
collaborations among basic and clinical scientists and clinicians.
A multidisciplinary University of Maryland Organized Research Center
in the thematic area of persistent pain has been formed to facilitate
the mission of the Group.
Research
Major advances have been made in our
understanding of some of the basic mechanisms of persistent pain
including the identification and cloning of peripheral receptors
and their changes in excitability associated with injury, the central
nervous system changes that result from the persistent neuronal barrage
arising from sites of injury, and the role of descending modulatory
mechanisms in engaging the attentional, motivational and cognitive
substrates that influence how we perceive pain. Nevertheless, important
gaps in our knowledge remain. Research programs at the University
of Maryland have utilized the latest advances in biomedical technology
to extend our knowledge about the functional properties of peripheral
nociceptors located in the skin, muscle and viscera, and their biophysical
properties. Nociceptors in the skin have a special class of sodium
channels in their membrane which appears to enhance their ability
to respond to tissue-damaging stimulation. We know much less about
the peripheral and central nervous system characteristics of visceral
nociceptive pathways in the nervous system and researchers are learning
about sodium channels in visceral nociceptors, how the spinal cord
processes visceral information, and how this information is modulated
by descending pathways in the brain. Other studies have shown that
tissue damage and inflammation leads to dynamic changes in descending
pain modulatory circuitry that has important implications for our understanding of diffuse pain conditions
arising from deep tissues such as fibromyalgia, irritable bowel
syndrome and low back pain. Tissue injury leads to increases
in neuronal excitability at the spinal cord level and in descending
pain modulatory circuits originating from the brain stem. These
changes involve alterations in the phosphorylation of glutamate
receptor subunits, changes in their gene expression, as well
as changes in the functional properties of the neurons.
Another important finding being investigated
is the new knowledge that neonatal tissue injury in animals and children
can lead to changes in the development of pain circuitry in peripheral
and ascending and descending pain pathways in the brain. These changes
often increase our response to painful stimulation as adults. New
research is investigating noninvasive approaches that will provide
protection against these developmental changes in newborn infants
and preterm neonates. Other important research is examining how higher
centers in the brain process information about pain using modern
imaging techniques in patients and human subjects. These techniques
are helping research scientists at the University of Maryland better
understand how the sensory, attentional, cognitive and emotional
components of the pain experience are encoded and how they can be
modified. Related studies examine gender related differences in higher
center pain processing and changes associated with chronic and debilitating
pain conditions. Researchers are also interested in the etiology
and treatment of temporomandibular disorders, low back pain and fibromyalgia.
Acupuncture studies are underway to determine their usefulness in
the management of various pain conditions. In summary, this group
of scientists brings multidisciplinary expertise to study all aspects
of pain and its management and the University of Maryland Organized
Research Center on Persistent Pain is recognized for its leadership
role in this field.
Investigators and Extramural Support
There are over 20 faculty and an
equal number of postdoctoral fellows and graduate students with
a major interest in pain research. These investigators work in
the Dental School, School of Medicine, School of Pharmacy and the
Baltimore VA Medical Center. As mentioned above, their research
ranges from molecular biology of receptors to integrative processing
in the spinal cord and higher centers, to neuroimaging of the brain,
to clinical trial studies of analgesia. The multidisciplinary group
includes neuroscientists, neurologists, anesthesiologists, psychiatrists,
psychologists, dentists and nurses, among others. Investigators
are funded through a number of mechanisms including federal government
support from the NIH and NSF, state funding, and industry. Total
dollars of external support are approximately $7.5 million anually.
Challenges for the Future
Pain research is a multidisciplinary
field in which basic science findings are readily transferable
to the clinical setting. Research flows from the bench to the clinical
arena although knowledge gained in clinical research and in patient
management also leads to new basic science approaches and models.
Our future research goals include:
Developing our program in fundamental
research related to pain to further our understanding of the underlying
mechanisms of pain and analgesia including studies of the neurochemical
and anatomical basis of pain, the interactions of cutaneous and
visceral pain, and new imaging approaches for assessing the pain
experience in patients and subjects.
Furthering the study of persistent pain conditions by developing animal
models that mimic them and then exploring the molecular, biochemical, physiological,
pharmacological and anatomical bases of these conditions.
Organizing seminars to help the local scientific community learn more
about the mechanisms and management of pain.
Continuing to develop training programs for dental, medical, graduate
and postgraduate students, postdoctoral fellows, junior faculty interested
in the study of pain, and mid-career faculty interested in retooling in the
pain research area.
Developing approaches for providing better education about pain management
to health professionals and the public.
Developing community outreach programs that maximize the care and education
of patients in the community served by the university.
For additional information
top
|
 |