AECC University College Professor Contributes to Leading Musculoskeletal Research

As a science-based University College, collaborating and creating new knowledge is important to us.

Research Professor, Alan Breen joined an international group of back pain researchers in 2017 at a consensus conference in Orlando. Experts in Musculoskeletal research met together to discuss how health professionals can begin to cope with the complexity involved in treating people with back pain. We’re pleased to learn that findings of the study have now been published in the widely acclaimed medical publication, The Spine Journal

In light of this news, Alan discusses his role as Research Professor at AECC University College and his contribution to the insightful research, which he hopes will move the musculoskeletal professions forward in their knowledge and understanding of back pain.

Musculoskeletal Research

“My role as Research Professor means I have a track record of getting research grants, directing and participating in research, leading its dissemination in journals and conferences and supervising and mentoring PhD students and Early Career Researchers. I have been doing this for quite a few years and for me, Musculoskeletal Research has gone through a number of phases – but mainly to do with back and neck pain.

"It started with surveys and trials of chiropractic, then went on to developing national back pain guidelines, then to collaborative studies on patient and practitioner beliefs, expectations and outcome measures, then to research on getting the evidence into practice (implementation) and finally to the mechanisms behind back and neck pain problems.

“This has always been exciting because the novelty of each area at the time brought us in contact with many international research leaders from a range of disciplines and university centres and put me on some steep learning curves. Most recently we have found ourselves in the exciting position of investigating the mechanisms of back and neck pain. This has occupied us the most lately, but our efforts have already shown promise in improving the diagnosis of back and neck pain.”

The Complexity of Back Pain

“I was a member of an international group of back pain researchers for whom funding was obtained  from the North American Spine Society (NASS), to assess the current state of understanding of back pain . The group met in Chicago in 2015 and concluded that there was a need to better acknowledge how complex the condition is and to build a more comprehensive and multidisciplinary conceptual model of it.

"The leaders of the group, Jacek Cholewicki and Paul Hodges, obtained further funding from NASS to run a consensus conference to try to get experts to agree on a collaborative conceptual model of the factors that determine whether a person with chronic back pain will get better or not. 

“In Orlando in 2017, they gathered together 29 of the original group who they felt had made sustained contributions to back pain research and were considered experts and I was lucky enough to be asked to be in it. The group was diverse and represented 11 disciplines from eight different countries.

"Prior to the meeting in Orlando, we all individually undertook an exercise at home to build our own personal ‘mind maps’ of the important factors in back pain and their interactions. This was done using computer software designed for something called ‘fuzzy cognitive mapping’ (FCM). Owing to the diversity of the disciplines and the complexity of back pain, the first combined model (Fig 1) was very large.

"However, it went through a series of consultation and consensus sessions, followed by statistical clustering by researchers at Michigan State University. The result was published by Jacek and Paul’s research group last year in The Spine Journal.”

Fig 1 Initial model showing all the factors considered (with permission) 

Diagram of Back Pain Causes

Key Findings

“The most remarkable result was that such a diversity of disciplines could agree on what factors to include and exclude at all! The next most remarkable result was that each participant’s mental model included consideration of at least five factors – so no one-trick ponies here! Almost all of us were clinicians, so we were also considering how manageable such a model would be to use in a clinical practice.

“Current knowledge supporting evidence-based practice is based more on identifying the risks of not getting better than on what mechanisms to tackle to get the patient better. This research has identified factors that are thought to affect both the mechanisms and outcomes in back pain. Hopefully, it moves us forward by pointing towards a concise and insightful set of factors that still recognises the condition’s complexity for practitioners to consider. For it to benefit healthcare practitioners, they will need to be exposed to it and discuss it in their educational and professional networks." 

Further Research 

“This Collaborative Group’s next step is to refine the results into a more concise model called a ‘meta model’ that will hopefully be more digestible and implementable by a trained clinician in their practice. They will probably also seek feedback from practitioners on its value – and someday, a clinical trial might be done to see if its use improves patient outcomes.

“Meanwhile, our research group, which has included academics from both inside and outside AECC University College, has been working on ways to measure one component of the model - the mechanical factors. We want to discover what is normal and abnormal, what is related to having back pain and getting better (and why) and how clinical assessments can be speeded up and simplified for use in diagnosis and treatment.

"So far, we have gone some way towards establishing a database of normal intervertebral motion and are publishing studies that identify mechanical markers that occur only in people with nonspecific back pain. The next steps, which are currently in the hands of our two PhD students, are to see how these relate to the pain and its resolution.”

Alan is preparing a brief online tutorial based on the findings of the published report to introduce it to healthcare practitioners.