Raymond F. Sekula, Jr., MD, MBA

Professor of Neurological Surgery

Columbia University Department of Neurological Surgery

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Each week, my team and I evaluate patients who have often traveled great distances for help with various forms of facial pain. Over seven years of training and the past thirteen years (that figure is particularly difficult for me to believe) of practice, I’ve learned a great deal about facial pain from these patients. I became interested in patients with facial pain when I was a firstyear medical student, during my first semester, assigned to study one afternoon each week with a general internist. In those days, ride services such as Uber and Lyft did not exist, and to get to his office in time for afternoon clinic after a morning of classes, I would hail a jitney to take me into the heart of South Philadelphia where this internist’s office existed. Over the course of that semester, one patient’s story stayed with me more than any other. An elderly African American man with chronic high blood pressure, cared for by this internist for years, presented early in the semester with a new complaint. He reported that “for the past few weeks, Doc, I feel like fire is shooting through my face when I eat or talk”. Looking at me, he said, “The pain can bring me to my knees, son.” Until that day, I had never heard of trigeminal neuralgia. This gifted (i.e., many patients with trigeminal neuralgia struggle to receive a proper diagnosis and treatment) and kind internist diagnosed him with trigeminal neuralgia and prescribed a course of carbamazepine, which he deftly titrated for the man each month in subsequent appointments. I still remember the first follow-up appointment, when the patient reported to the internist, “It’s gone, Doc…it’s a miracle.”

Unfortunately, for many patients, the story is more complex, more nuanced. While that first patient I witnessed was likely suffering from the so-called classical trigeminal neuralgia, many patients suffer from trigeminal neuralgia of various forms, which we do not understand as well as we would like. Over the past six years and with the financial help of many grateful patients, my scientific partner, Michael Gold, PhD. and I have been investigating the fundamental mechanisms of trigeminal neuralgia. Most of our work is directed at understanding differences between pain which occurs in the face as compared to pain in other parts of the body. Recently, our proposal “Mechanisms of Pain Associated with Trigeminal Nerve Injury” was awarded, from the National Institutes of Health, five years of funding totaling nearly $3 million to study this devastating disease. Essentially, this is a drug discovery grant, and we hope that the results of our work will form the basis for viable medications soon to help those who currently cannot be helped with available medications like carbamazepine and the others most of you know so well. Michael and I are grateful to our financial supporters, including my patients, the University of Pittsburgh, and the National Institutes of Health. For me, it all started with that first patient in South Philadelphia in 1996 (wow!). Something about his admonition, “The pain can bring me to my knees, son.” inspired me to want to learn more. And there is so much more to learn. I hope to report back to this group with encouraging findings in the next few years!