School of Medicine

Wayne State University School of Medicine

Welcome!

PAIN PROGRAM

 
A typical visit to the Headache and Pain clinic involves initial evaluation by a neurologist to establish the proper diagnosis and to provide the latest advanced management for headache and pain conditions.  Complicated cases may require a multidisciplinary approach with affiliated psychologists, physical therapists, and anesthesiologists to provide the best effective treatment for headache and pain.  The treatment options after establishing the diagnosis are medication adjustments, nerve block, botox injection, and occasionally surgical intervention.
 
Treatment of chronic pain remains a major weakness of modern medicine.  While great advances have been made in providing relief from acute traumatic and post-operative pain, treatment of chronic, unremitting pain, whether from injury or inflammation, has largely been a dismal failure.  In spite of expanding knowledge about neurotransmitters and neuro-modulators that convey nociceptive (painful) information and the existence of several animal models which mimic the characteristics of human chronic pain syndromes, the pathophysiology underlying development of chronic pain has yet to be elucidated.  M. Maher Fakhouri, MD is a clinical specialist in headache and pain management.
 

Dr Joshua Adler's laboratory has long been devoted to the study of neuropathic pain, its etiology and pathophysiology and potential ways of relieving it. We are currently comparing biologic characteristics of two related nerve injuries, only one of which reduces withdrawal threshold to light touch (allodynia). While neurotransmitter expression in sensory ganglia and dorsal spinal cord are identical after both injuries, there are marked increases in expression of specific growth factors in spinal cords from allodynic rats. Further, they increase in the thalamus on the side contralateral to the injury only in those rats with abnormal sensation. These factors have never before been associated with pain or pain behaviors, nor has an increase in any factor been found in the brain in these behaviors. Blocking the action of these factors restores normal responsiveness to sensitive limb. We are investigating potential mechanisms by which the factors can induce allodynia and why only one of two seemingly identical injuries increases expression of the factor. At the same time, we are investigating novel methods for preventing pain after nerve injury. By binding specific trophic factors, which have analgesic properties, to synthetic reservoirs that can slowly release them to the area of injury, we can prevent the development of neuropathic pain. Moreover, it can reverse the pain after it has developed. This work has major implications with regard to treatment and may help prevent the late occurrence of pain after injury.  Dr Adler also serves as director of the pain service of the VA Medical Center.