Collaborating to Cure Trigeminal Neuralgia Pain

The Facial Pain Research Foundation, or FPRF, and researchers at the University of Florida are collaborating to combat a chronic facial pain disorder, trigeminal neuralgia, or TN, through translational research such as human imaging and magnetic resonance imaging, or MRI, studies to get a better understanding of the mechanisms involved in the debilitating disorder.

Dr. John K. Neubert
Dr. John K. Neubert

“Trigeminal neuralgia is probably the worst pain condition a person could ever have and we don’t know what causes it,” said John K. Neubert, D.D.S., Ph.D., an associate professor in the UF College of Dentistry Department of Orthodontics. “It’s lightning bolt pain going off in your face hundreds of times a day. TN is 10-out-of-10 pain, the most pain one can experience. We are thankful for the support of the Facial Pain Research Foundation. They do a lot to fund research for this horrible disease, enabling us to pursue research aimed at a cure.”

For Michael Pasternak, Ph.D., the mission of the Facial Pain Research Foundation is personal. After a long and illustrious career, Pasternak found himself suffering from trigeminal neuralgia. A founding trustee of the foundation, he was one of the lucky ones: surgery helped cure his searing pain. A majority of people are not so lucky. Considered a rare disease, TN occurs most often in people over age 50 and, according to the National Institute of Health’s Institute of Neurological Disorders and Stroke, the incidence of new cases is approximately 12 per 100,000 people per year.

The FPRF is the brainchild of seven professionals across the United States, including Pasternak, who created the first international consortium of scientists from 14 different U.S. universities and two international institutions to work together to cure the disease. The foundation funds the most innovative research projects aimed at finding a cure to end the electric shock-like pain caused by irritation of the trigeminal nerve, whose branches extend to the forehead, cheek and lower jaw.

The foundation has no employees; all monies raised through grassroots fundraising efforts coast-to-coast in the U.S. and overseas go straight toward trigeminal neuralgia research.

“The money we raise has character,” Pasternak said. “It has dignity and heart.”

The FPRF is currently funding two UFCD researchers, Neubert and Robert M. Caudle, Ph.D., for over $330,000 this year toward research projects to investigate TN. Neubert’s project, “Mapping Towards a Cure – Identification of Neurophysiologic Signatures of Trigeminal Neuralgia Pain,” and Caudle’s study, “Exploring Neuropeptide Guided Botulinum Light Chain for Use in Blocking Pain Transmission,” are two related ongoing studies.

“People overuse the word hero, but these guys are heroes. They are outstanding scientists,” Pasternak said.

Neubert and Fuchs
Dr. John Neubert, left, and Dr. Kent Fuchs

Neubert and colleagues at UF’s McKnight Brain Institute, including Todd Golde, M.D., Ph.D., from the UF Department of Neuroscience in the College of Medicine, Mingzhou Ding, Ph.D., from the UF Department of Biomedical Engineering and Marcelo Febo, Ph.D., from the UF Department of Psychology, have been looking at preclinical models with trigeminal nerve pain, then comparing those models with human imaging and MRI studies of people who have TN. The imaging studies are designed to help researchers determine where the pain originates.

“We have a couple of interesting and exciting findings from our neuroimaging studies that may give us some insight into what’s causing TN,” Neubert said. “We look forward to publishing those findings.”

Now, Caudle, Golde, Ding, Febo and Neubert are collaborating on testing novel treatments for TN.

The overall end goal? A cure for TN pain, and Neubert’s passion for the cause is palpable.

Translational research continues, incorporating integrated techniques with both human and preclinical models and cross-country partnerships like a new academic, private company partnership between Neubert and Cory Nicholas, Ph.D., founder and chief executive officer at Neurona Therapeutics.

“I like the fact that we can try different things to see how it works,” Neubert, the 2015-16 UFCD Basic Sciences Teacher of the Year, said. “I’ve been treating pain patients for over 20 years now, and so you learn a lot from talking to the patients that you just can’t get from a petri dish with cells on it, or from a preclinical model. I feel fortunate that I can do both the clinical care and research because I learn a lot from both sides. We typically think of translation going from an idea, to a molecule, to a cell model, to an animal model, to a person. There’s also reverse translation that is just as important for discovering new treatments for patients.”​