Researching Spinal Pain in Adolescence: Dr. Michael Swain

AECC University College recently received a visit from Senior Lecturer in Chiropractic and Director of Research Training in the Department of Chiropractic at Macquarie University in Sydney, Dr. Michael Swain.

Michael is currently working with Chiropractic colleagues at the University College on an international study into spinal pain in adolescents.

The UK arm of the project, led by Aurélie Marchand, Dr. Michelle Holmes and Dr. Amy Miller, is being funded through the Royal College of Chiropractors. Dr. Katie Pohlman, Director of Research at Parker University in Dallas, Texas, is leading on behalf of North America,

Michael tells us more about the study and his research interests:

“This project is called the COURSE Study, and that's short for the Clinical Course of Spinal Pain in Adolescents Study. It's a prognostic study, which means it's trying to understand the course of recovery for adolescents that have spinal pain who present to Chiropractors.”

Chiropractic education

“When I finished my Chiropractic degree, I went into clinical practice and then did a two-year Sports Chiropractic Diploma. The Diploma included educational modules and practical components. I was working with injured rugby players at the time.

“I went on to complete a Master of Philosophy, focusing on neck injuries in rugby players, and after that I felt the next step was to do a PhD. I spoke to a prospective supervisor, Prof. Chris Maher, who is a really prominent researcher in the back-pain world, and he linked me up with his postdoctoral research fellows. 

“That then formed my supervisory team and we decided to look at pain and injuries in adolescents and young adults as my doctoral thesis topic.”

Spinal pain in adolescents

“My area of research interest aims to understand spinal pain in adolescents: what causes it and what are the impacts.

“I was a kid with a sore back and I played lots of sport, and now I'm an adult with a sore back, so I was thinking about this experience. Maybe we can do something about it.

“Spinal pain in adolescence is a common and burdensome problem for kids, their families, the community, and for our health systems.

“Spinal pain is the leading cause of disability globally and it becomes the leading cause at the end of adolescence. Kids that have spinal pain typically become adults with spinal pain, and it can become a lifelong issue thereafter.

“Adolescence tends to be a time in life when a lot of chronic diseases first occur and develop, so it's a potentially important time to try and intervene. We want to prevent or minimise the burden across the lifespan. My current focus is looking at prognosis: once people have got pain, how does it change over time and what are potential target factors to intervene on?

“I think we can help tackle this problem in the Chiropractic setting; we are well positioned to offer appropriate treatments and models of care, or potentially we can develop new treatments that target factors that we weren't previously targeting to try and reduce that burden impact with the view of trying to help the back-pain problem across the lifespan.”

Research outcomes

“In terms of outcomes, we are of course looking at pain intensity and severity, but also psychological, social, and physical functioning, and health-related quality of life. We have to look at these things in the context of adolescence too; the experience of pain in adolescence is different to that of pain in adults.

“The impacts of pain are also different to that of adults, as we're thinking about things like peer relationships in school, absence from school, and the cognitive impacts of that across a lifetime.

“It'll be the first clinical course study of its type, the first prognostic study of spinal pain in adolescence in primary care.”

Plans for research

“At the moment we are still trying to understand the problem. I’m currently working with the team here at AECC University College with Amy, Michelle and Aurelie, Katie and the team in North America, and the group back in Australia, to understand the research methods. A big study might take two or three years, so just to get our teeth into understanding the clinical course is probably like two to five years realistically. 

“This line of work is probably going to become my career, so I'm approaching it with that in mind, and I've decided that I'll make this my research focus.

“The set-up of the study is very automated so that the researchers don't have to be constantly looking at it and monitoring. The computer system will actually do a lot of the corresponding for us and it will let us know when we're missing data points and when to chase. Most importantly, we will need the help of community chiropractors to identify adolescents with spinal pain who present for care.

“For us to do a big study, we're likely going to need sites in Australia, North America, Europe, and the UK. It's a matter of trying to develop teams and people with common interests.”

You can follow Dr. Michael Swain on Twitter here.

Dr. Michael Swain

Above: Dr. Michael Swain