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The Anesthesiology Section of the newly reorganized Pain Branch was to be an expanded program in the evaluation of drugs for dental anesthesia and analgesia. Edward Driscoll had cut back on his experimental work as he took on new administrative responsibilities in the Dental Institute, but he continued to be an advocate for pain research at NIDR, and for effective alternatives to general anesthesia during oral surgery.

To staff the Anesthesiology Section, Dubner and Driscoll looked for people with expertise in psychology, pharmacology, and neurology, as well as dentistry, and with the skills and background to refine the complex methodologies of clinical trials to evaluate analgesics.

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Photograph of Rick Gracely at the computerImage Added
Rick Gracely at the computer


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Some Issues in Analgesic Clinical Trials

  • Differentiation of changes in sensory perception of pain from changes due to cognitive or affective factors
  • Relationship of activity of analgesic drugs to internal pain activation/modulation mechanisms
  • Variations in patient response to drugs

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Clinical trials of analgesics presented special problems both because so little was understood about pain mechanisms and because evaluators had to rely on the subjective report of patients, whose sensory perceptions were often affected by their cognitive and affective, or emotional, responses. [This is the reason why many analgesic trials use the crossover method, so that the test drugs are evaluated in the same patient, each serving "as his own control".]

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