Editors’ Note: The PRF put a few questions to the three young investigators honored with awards at the International Association for the Study of Pain’s 14th World Congress on Pain in Milan, Italy, 27-31 August 2012. Below is a Q&A with Steven George, winner of the Ulf Lindblom Young Investigator Award for Clinical Science. See also Q&As with David Seminowicz and Giandomenico Iannetti.
Steven George, PT, PhD, is an associate professor and an assistant department chair at the University of Florida, Department of Physical Therapy, Gainesville, US. He received his bachelor’s degree in physical therapy from West Virginia University in 1994 and worked clinically until 2001. He received a master’s degree in orthopedic physical therapy and a doctoral degree in rehabilitation science from the University of Pittsburgh in 1997 and 2002, respectively. George also completed a postdoctoral fellowship in the Center for Pain Research and Behavioral Health and Brooks Center for Rehabilitation Studies at the University of Florida in 2004.
George’s primary research interests involve the use of biopsychosocial models for the prevention and treatment of chronic musculoskeletal pain disorders. His current and past research projects include: 1) developing and testing behavioral interventions for patients with low back pain; 2) investigating the interaction between pain-related genetic and psychological factors in the development of post-operative chronic shoulder pain; 3) investigating pain sensitivity mechanisms and efficacy of manual therapy; and 4) developing and testing low back pain prevention programs for soldiers in the United States Army.
George answered five questions from PRF via email. See his responses below.
PRF: How did you first get interested in pain research?
SG: There are really two phases of my interest. The first was at the beginning of my career, when I worked clinically and a majority of my patient load was musculoskeletal pain. Day-to-day management of these patients led to many of the research questions I would later pursue. The second phase was after the completion of my doctoral work at the University of Pittsburgh, when I entered into a postdoctoral fellowship at the University of Florida with Michael Robinson. It was at the University of Florida that I was exposed to a wide array of pain researchers and their methods. I was able to learn from some of the very best in the field and combine my expertise in rehabilitation science with pain research.
What is the overall aim of your research?
The overall aim of my line of research is to provide information that leads to more effective ways to limit the development or maintenance of chronic musculoskeletal pain disorders.
What is the most exciting or intriguing result you’ve gotten so far?
I think it is up to others to answer this question. If forced to answer I would say that from the work in which I have been directly involved, the most exciting things are 1) identification of combinations of genes and psychological factors that may provide better identification of those who are likely to develop chronic post-operative pain and 2) that a single session of psychosocial education favorably changes the beliefs of the negative consequences of low back pain; this change in beliefs was later found to limit use of healthcare when individuals were actively experiencing low back pain.
What are you working on most intensely right now?
Like many researchers, I am working intensely on pursuing funding to continue lines of research started four to five years ago. I was lucky enough to receive word from the Orthopaedic Section of the American Physical Therapy Association that they have awarded our group (with myself as PI) a three-year grant to start a clinical research network for their members. One part of this project will be to develop more efficient ways to identify pain-associated distress in patients who are seeking physical therapy for common musculoskeletal conditions. Also, we are working on disseminating the primary analyses from a five-year NIH-sponsored study that will expand upon our earlier studies to investigate genetic and psychological factors that contribute to chronic shoulder pain. We are investigating this question in two different pain models, one involving exercise-induced shoulder pain and the other involving post-operative shoulder pain.
In your field, what do you hope we will know in five or 10 years that we don’t know now?
I hope we will become much better at identifying which patient factors indicate an optimal response to given pain treatments. Until there are major breakthroughs in discovery for analgesic agents, we are pretty much stuck with available treatment options. Furthermore, “new” discoveries often fail to translate from preclinical to clinical studies. I think the next five to 10 years will be an important time for clinical researchers to learn how to accurately identify “responders” and target treatment to those that will respond the best to a given treatment. This will require a slightly different mindset, and also different study methodologies, but could lead to pain relief options that are better than haphazard use of existing treatments.
I also think that, along those same lines, work in health services research will provide important information on the cost-effectiveness of pain relief. Expensive treatments for common pain conditions often have similar outcomes to less expensive treatment options. Given the current pressures in healthcare reform such cost-effectiveness data will be extremely influential so that patients, providers, and policymakers can make more informed decisions on the efficiency of pain relief.
