UB professor studies pain in all its forms
“I liked asking questions about pain—the problem solving and complexity.”
For Richard Ohrbach, academic life is pain—in fact, pain has informed his entire career.
It’s what he studies, what he treats people for and what he’s known for internationally. The bookcases in his office in Squire Hall, South Campus, are lined with numerous academic books, a good number of which have the word pain in their titles.
Ohrbach, an associate professor of oral and diagnostic sciences in UB’s School of Dental Medicine, is on a quest to understand pain—not just as a symptom of disease that can be reduced when the underlying illness is treated, but when pain itself becomes the clinical problem.
“When pain is chronic, it’s the dominant experience even after the pathology has been resolved,” says Ohrbach. “The majority of chronic pain is central, not peripheral.”
He and fellow researchers in the dental school recently published a comprehensive set of clinical characteristics to identify individuals who are at risk for developing the painful jaw problems known as TMD, or temporomandibular disorders. Named the Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA), it was the first large-scale clinical study of pain conditions and how they develop that has ever been done.
Ohrbach, who is originally from North Carolina, was a trumpeter in an adult swing band as a high school student and leaned toward becoming a musician or maybe an engineer.
“Two band members told me the life of a musician was a tough road. One of them, the trombonist, was a dentist and said that the practice of dentistry was a good life,” he says.
He got his BS in dentistry and early admission to dental school at UNC-Chapel Hill. After receiving the DDS, he entered the Air Force as a commissioned officer. He was sent to Tokyo, Japan, and began practicing dentistry, treating members of the Air Force, their spouses and embassy personnel.
Ohrbach grew to love Japan and considered living there permanently. But he had also begun to develop an interest in TMD and pain.
“I liked asking questions about pain—the problem solving and complexity,” he says.
He was transferred to the medical center at Lackland Air Force Base in San Antonio, where he directed a clinic and was responsible for resident education in what is now regarded as TMD. He came to realize how complex pain is and decided that further training was essential. He resigned his commission and completed a pain fellowship at UCLA.
Ohrbach’s desire to understand the complexity of pain and the human response to it brought him to UB in 1986, where he received his master’s degree from a program in the dental school and then a PhD in clinical psychology under an individual Physician Scientist Award from the National Institutes of Health. He then completed a psychology residency, as well as a postdoctoral fellowship in behavioral epidemiology at the University of Washington-Seattle.
In about 1997, Ohrbach found out about an opening for a pain researcher at the UB School of Dental Medicine; the position was created by Norman Mohl, SUNY Distinguished Service Professor, UB professor of oral and diagnostic sciences and Ohrbach’s prior program director.
It was a perfect academic fit.
“That’s why I came back to UB. The position perfectly addressed my background and I have found terrific colleagues and a great deal of academic freedom here,” he says.
Ohrbach’s love of questions becomes evident when he begins talking about pain.
“Is it acute or chronic? Is it related to an underlying disease or is it the dominant experience, even after the pathology has been resolved? What is it if we can’t see it? What is pain if there is no evidence of a signal? Is it ongoing, as in advanced cancer, or persistent, as in headaches?” he asks.
As director of UB’s Center for Orofacial Pain Research, founded in 2000, Ohrbach also works with colleagues from around the world through the International RDC/TMD Consortium, a network within the International Association for Dental Research to advance the scientific knowledge of TMD and related pain conditions by developing authenticated tools for international use and multi-site and cross-cultural research studies based on standardized assessment.
“If you are going to study anything, you’ve got to agree on what it is and how to investigate it. How we interpret a stimulus and what truth standard we apply can be very complex in terms of pain. Everything that comes into our belief systems learned in early childhood will inform what pain means to us. This becomes extremely important when we study other cultures and how they react to pain,” Ohrbach says.
The dental profession in the U.S. is far behind its colleagues in Europe in its relationship to understanding pain disorders, he notes. “Perhaps this is mirrored in the cultures as a whole. The Europeans get it. They understand that chronic pain can exist outside of an underlying disease, that it can be its own condition. As a culture, the U.S. still seems to be focused on pain as a symptom, and therefore on finding a straight-forward solution, as though there is a single cause—the classic search for the smoking gun,” Ohrbach explains. With chronic pain, such simple solutions seldom exist.
This is most evident in third-party payment for the chronic pain of TMD, notes Ohrbach, who also has a clinical practice. Many insurance companies do not provide the level of treatment reimbursement for chronic pain, and reimbursement for temporomandibular disorders in particular often is excluded.
“We are lucky in Western New York in that several of the major health care insurers have very good medical policies for their subscribers and treatment of problems in the masticatory system—the TMDs—is covered,” he said.
Ohrbach also works on the ontology of pain with Werner Ceusters, UB professor of psychiatry and director of the Ontology Research Group, and Barry Smith, SUNY Distinguished Professor in the UB Department of Philosophy. “Werner and Barry study the way in which we set up conceptual models; they take the definition of pain apart and see what we can do with it,” he says.
When asked how all his research on pain affects his personal relationship to it, he laughs and says, “Oh I hate having pain.”
Ohrbach still misses Japan and Seattle. But as far as Western New York, he likes the four seasons, skiing is affordable and accessible, and the lifestyle of the area is “paced nicely.”
He admits that the most challenging aspect of research is translating it into clinical practice and public policy, but that research is the best pathway to establishing a set of rules that we all can agree on.
And with that comes some certainty.
“At the end of the day, I like certainty—at least, a bit of it,” he says.