Impact Stories

What is your area of research? 

My research focuses on the treatment and prevention of chronic pain, particularly chronic low back pain. Chronic pain is characterized by pain lasting more than three months and occurring on a frequent basis. Chronic pain permeates every aspect of an individual’s life and can significantly compromise overall quality of life, both physically and psychologically, contributing to depression, anxiety and sleep disorders.

Chronic pain accounts for a significant portion of healthcare costs in the U.S. and chronic low back pain is the leading cause of disability worldwide. Chronic pain is also the primary reason patients seek out OMT, where osteopathic physicians use manual techniques to achieve and maintain patient health. My research related to OMT led me to focus on interventions aimed at mitigating the consequences of chronic pain, including disability and poor health-related quality of life.

How does your research contribute to a more comprehensive understanding of chronic pain management?

Initially, we conducted randomized controlled clinical trials, a form of research in which patients are assigned to receive an intervention – such as OMT – or not. In our initial studies, patients who received OMT reported a reduction of chronic pain intensity compared to patients who did not receive OMT. However, many factors and treatments other than OMT may influence pain outcomes.

To better understand which factors and treatments contribute to better chronic pain outcomes, we established PRECISION to collect patient-reported data and gather evidence in real-world settings to help impact healthcare delivery. This national patient registry collects self-reported data including demographic information, clinical characteristics, treatments and outcomes from patients experiencing chronic low back pain. Data on healthcare providers, including both osteopathic (DO) and allopathic (MD) physicians, are also reported by patients to PRECISION. Patients also complete questionnaires related to patient-physician communication, empathy and overall satisfaction.

PRECISION allows us to assess the effectiveness of treatments for chronic pain, including but not limited to OMT, and to gain insights into the nature and quality of the patient-physician relationship and its impact on patient outcomes. The data collected to date has enabled us to better understand risk factors for pain, evaluate common treatments and promote better approaches to pain management that may prevent disability.

How does your research benefit patient care?

Chronic pain is often measured by both the level of intensity and how much it limits a person’s ability to function and perform ordinary activities of daily living. To demonstrate a treatment approach is effective in improving chronic pain, a patient must show improvement in both intensity of pain and in function. Through PRECISION, we have found people who receive OMT report significant improvement in both intensity of pain and level of function. It has also shown patients receiving OMT are less likely to use prescription pain medication. These findings support OMT as an effective treatment for chronic pain without the significant side effects or downstream effects of other ways pain is currently managed, including the over-prescription of opioids.

The availability of patient-reported perceptions and outcomes in PRECISION contributes to our understanding of the patient-physician relationship and its impact on patient outcomes. It allows us to better evaluate the effectiveness of interventions from the patient’s point-of-view and make recommendations related to patient preferences in healthcare decision making. Our evaluation of these data indicates physician empathy is strongly associated with patient satisfaction and patients who report their care providers to be empathic were more satisfied with their care regardless of whether their chronic pain improved. Patients also report osteopathic physicians demonstrate more empathy than their allopathic counterparts.

PRECISION has also helped increase understanding of disparities experienced by Black patients in the treatment of chronic pain. While Black patients generally report less favorable chronic pain outcomes, they report experiencing similar levels of empathy from their healthcare providers and are equally satisfied with their care in our research. Findings such as these will help focus future research on systemic factors, such as access to high-quality medical care, including the availability of health insurance; where and how healthcare is provided; and access to specialized care to mitigate racial disparities in chronic pain treatment and outcomes.

How has the Osteopathic Heritage Foundation’s support helped you advance osteopathic medicine and patient care?

The Osteopathic Heritage Foundation Endowment and Distinguished Chair in honor of Benjamin L. Cohen, DO and David M. Richards, DO has two primary aims – conduct research and train osteopathic medical students in research practices. The financial support provided by the endowment for PRECISION has successfully achieved both objectives. Participants in PRECISION provide frequent and repeated updates over time, creating a valuable longitudinal dataset researchers like myself use to assess treatment options and outcomes, informing new and improved treatments for chronic pain. Access to PRECISION for students at TCOM and partner institutions supports student research experience and allows students to conduct comprehensive research studies within a relatively short timeframe and with minimal resources. Student researchers can work with faculty to derive meaningful insights in response to questions arising in contemporary medical literature with potential to inform clinical research guidelines. Twenty-six student research projects have been conducted since 2021, involving more than 100 TCOM students using PRECISION data.

How does conducting your research at a College of Osteopathic Medicine and the osteopathic profession’s focus on treating the whole person influence your work?

I have always been interested in how biopsychosocial factors, the combination of biological, psychological and social factors, influence a person’s health and well-being. The overall objective is to enhance quality of care through the patient-physician relationship. For instance, in researching chronic pain, we use validated scales which allow for the measurement of effects, such as how pain affects mindset. This enhances our understanding of how chronic pain is influenced by various interconnected factors, contributing to a holistic understanding of this condition and informs treatment methods.

What is next for your research?

We will continue to expand our work related to the patient-physician relationship, including empathy and shared decision making. In addition to our legacy research on osteopathic medicine, other emerging research interests involve the benefits and harms of opioid therapy for chronic pain and racial health disparities pertaining to chronic pain treatments and outcomes.

With nine years of registry data, we can now look more closely at which factors identify patients who recover from chronic low back pain compared with those who do not recover, improve or whose condition worsens. We will use these findings to develop a predictive model to identify patients with chronic low back pain who are most likely to recover and those at the greatest risk of worsening and developing disabilities. This type of assessment can inform treatment strategies to help people with chronic low back pain recover and stay well.

Longer-term, we have collected genetic material and blood samples from over 500 PRECISION participants to establish a biobank for future research. We will analyze and link these data to the information in the registry to identify biomarkers of chronic pain. This will be an exciting project with the potential for identifying genetic predisposition to chronic pain and clinical biomarkers for diagnosing and treating chronic pain.