Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-09-22, 20:18:13 | version 1.38.0
News Wednesday, 23 September 2015 C hronic pain is a complex health problem that affects millions of people worldwide but is still not wellunderstood.Prof.WilliamMaixner, fromtheSchoolofDentistryoftheUni- versityofNorthCarolinaatChapelHill, is analysing the underlying causes of persistentpainconditions,suchastem- poromandibular disorder (TMD), in or- dertoimprovetheirdiagnosisandther- apy. At the FDI 2015 AWDC, Worldental Dailyhadtheopportunitytospeakwith theFDIpresenteraboutrecentdiscover- ies regarding the risk factors and causes of TMD and the importance of chronicpainasafieldofresearch. Worldental Daily: Prof. Maixner, one of your main research areas is chronic pain. Currently, what are the most pressing issues in the field of chronicpainresearchandtherapy,es- pecially regarding orofacial pain and conditionssuchasTMD? Prof. Maixner: I think one of the most important issues is public aware- ness of chronic pain and of the magni- tude of the problem. Chronic pain con- ditions are a hidden epidemic. A US studyfrom2011thatwasconductedby the Institute of Medicine and commis- sioned by the US congress found that oneinsevenAmericanswillsufferfrom a chronic pain condition in their life- time. This represents over 116 million adults who will experience chronic pain. The economic burden for the US health care system is calculated to be US$635 billion a year, which is more than the costs of diabetes, cancer and heart disease combined.Thus, there is ahugecosttosocietyandtoindividuals that is not well known. Therefore, I am callingitahiddenepidemic. Within the chronic pain domain, one of the most common types of pain conditions are musculoskeletal con- ditions, and TMD is highly prevalent withinthese.About15percentoftheUS population will experience TMD and worldwide about 10–15 per cent will experience it at some point in their life- time. Often, the condition will diminish with age, but frequently it is persistent in about 20–30 per cent of that group, causingseveredisruption.Chronicpain conditions, including TMD and other orofacial pain conditions, are highly prevalentandrepresentahugeburden tosociety. On the research front, one of the unmet needs is understanding the pathophysiological mechanisms that lead to the onset and progression of chronic pain conditions. Just like any otherdiseasecondition,suchashyper- tension, diabetes and cancer, we now recognise that chronic pain conditions have a true biology and our challenge today is to begin to understand the biologythatunderlieschronicpaincon- ditions. The good news is that over the last 50 years, we have developed tools on the preclinical and clinical levels to begin to dissect and understand the underlying pathophysiological proces- ses that lead to the onset of a chronic painconditionandriskfactorsthatlead to the chronicity of a variety of these conditions. The tools that we use are neurolo- gicaltools,psychologicalassessments and autonomic assessments, a variety of assessment procedures to better diagnose and classify these patients into groups with different mechanisms that lead to these conditions. In order to better understand these groups, we canthenbegintolookatthemolecular substructures using genetics and ge- nomictechniquestoidentifytheunder- lying molecular pathways that con- tribute to a variety of chronic pain con- ditions.Thegoalofallthisistodevelop new therapeutic targets and new ther- apies for chronic pain conditions, and Ithinkwearenowthere.Wehavemade significantadvancesinthefieldandwe arenotfarbehindcardiovascularmedi- cineandoncology,forexample,inbeing able to essentially type a chronic pain patient and begin to personalise his or her treatment based on his or her phenotypic signature—that is, how he orshepresentsclinicallybutalsohisor hermolecularsubstructure.Obviously, thereneedstobemuchmoreworkdone totranslatetheseresearchfindingsinto the clinical setting. A real need in this area is for pharmaceutical companies and governments to step up to help realise this. Another important need is in the area of education: one reason thatsomanypatientsaresufferingfrom chronicpainisbecauseourhealthcare systems globally have really been un- abletodevelopacurriculumaroundthe area of pain mechanisms and manage- ment. Most of our graduates in both dentistry and medicine are minimally exposedtothisfield,sowhenadifficult patientpresentstheyoftendonotknow how to handle that patient. Thus, the patient ends up as part of the hid- den epidemic, a silent group that has nowheretogo.Theareaofchronicpain requires great augmentation in educa- tionandthusacurriculumrevisionand reform that will honour the chief com- plaint of most patients, which drives them to the dentist and drives them to seeaphysician,thatis,pain. In 2006, you started the OPPERA project (Orofacial Pain: Prospective Evaluation and Risk Assessment), the first prospective cohort study of TMD. Whatwastheaimofthestudy? I think one of the premises that un- derlie OPPERA and the understanding of most chronic pain conditions, such as fibromyalgia, headache conditions likemigraine,andosteoarthritis,isthat pain is part of a larger mosaic of com- plications that patients experience. Pain is not just something that origi- nates in the brain. One of our goals is to understand the biology that leads to conditions like TMD and many co- related conditions. We took a biopsy- chosocial approach, which assumes thattheconditionsareassociatedwith risk factors that are biologically and psychologically based. We can meas- ure different domains. In the biological domain, there are pain sensitivity and pain amplification, for example. In the psychologicaldomain,wecanmeasure factors, such as anxiety, depression, and somatic awareness, which is how well we perceive different sensory events in our environment, like smell and visual stimuli. So when we talk about the biopsychosocial domain, we are talking about different domains that show disturbances, and most dis- turbances can lead to signs and symp- tomsinthepatientwhoreportstousin the clinic with TMD. These signs and symptoms, including anxiety, depres- sion and increased pain sensitivity, re- allyresultfromtheexpressionofdiffer- ent biochemical pathways in the body that are influenced by genetic variants and the interaction of proteins. The resulting intrinsic genetic codes that everyone has are impacted by certain environmental events, such as injury, andpsychologicalorphysicalstress,and in return influence behaviours and af- fectmoods,suchasanxiety,depression and pain processing. We have been in- volvedinOPPERAinseekingtoidentify those biopsychosocial variables that predictthedevelopmentofTMD. What was your approach to iden- tifyingthesevariables? AninterviewwithProf.WilliamMaixner,US 2 www.fdiworldental.org www.fdiworldental.org/oral-health-atlas The Oral Health Atlas SECOND EDITION A CALL FOR GLOBAL ACTION CHALLENGE ORAL DISEASE The of Oral health is essential to general health and quality of life. WHO fact sheet on oral health, 2012 AD page 4 IProf.WilliamMaixner “Chronicpainconditionsareahiddenepidemic”