SCU Researchers Launch NIH-Funded Study Examining First-Line Care for Back and Neck Pain

Southern California University of Health Sciences researchers are undertaking a $545,000 study funded by the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health. The study examines an important question in back and neck pain care: What happens when patients begin treatment with medication compared with nonpharmacological approaches?

Led by researchers in SCU’s Division of Whole Health Research, the interdisciplinary project will use Medicare claims data to compare three first-line approaches: nonpharmacological care, pharmacological care, and a combination of both. Researchers will examine differences in patient safety, healthcare costs, and escalation to more invasive forms of care, building on previous research comparing integrative approaches such as chiropractic and acupuncture and pharmacological treatment.

Examining the Gap Between Guidelines and Real-World Care

Clinical guidelines have increasingly recommended nonpharmacological approaches as first-line care for back and neck pain, particularly in the context of concerns surrounding opioid use. Yet patients do not always begin treatment with those approaches, raising questions about how initial treatment choices may influence subsequent care and outcomes. According to Steffany Moonaz, PhD, Director of Research at SCU, the study offers an opportunity to explore those questions across a large population of Medicare beneficiaries. By analyzing Medicare claims, researchers can examine treatment patterns, adverse events, healthcare utilization, and costs in everyday clinical settings rather than under the controlled conditions of a traditional clinical trial.

Of course, while claims data provide valuable insight into real-world care, they also have limitations. For example, they cannot reveal whether an individual patient’s pain improved, and variations in diagnostic and procedure coding can complicate comparisons. “Every study contributes a different slice of the evidence pie,” Moonaz said.

Bringing Together Expertise Across SCU and Beyond

The project brings together SCU researchers and clinicians from multiple disciplines with external collaborators whose expertise spans pain management, biostatistics, mental health, and other fields.

SCU’s core research team includes Moonaz, James Whedon, Leah Grout, Cynthia Chapman, and Barbara Gibson from the Division of Whole Health Research. The project also includes Heather Hayes from Physical Therapy, Sivarama “Prasad” Vinjamury from Eastern Medicine, and biostatistician Harrison Ndetan. External collaborators are connected to institutions including UCSF, UC San Diego, the University of Iowa, the University of Hawaii, RAND, Dartmouth, and McGill University.

That breadth is particularly relevant because the research will consider both physical and psychological approaches to pain management. Chronic pain is often understood as biopsychosocial, meaning that biological, psychological, and social factors can all influence a person’s experience with pain.

“We don’t know what these data will tell us,” Moonaz said. Previous research has suggested potential benefits from beginning with nonpharmacological care, but the SCU team will evaluate what the Medicare data show across the groups being studied.

Creating Research Opportunities for SCU Students

Beyond its potential contributions to pain management research, the project will create new opportunities for SCU students to participate in federally funded research alongside experienced investigators.

Beginning in spring 2027, SCU plans to broaden its Introduction to Spine Care Research elective, which was previously available only to chiropractic students. Four students from the course will then be selected for a one-year research fellowship working alongside the research team. The fellows are expected to contribute to research that leads to conference presentations and a peer-reviewed journal publication. SCU will also provide some tuition support for the four student research fellows.

For Moonaz, those opportunities can help future clinicians understand how research informs patient care while introducing students to the possibility of becoming clinician-scholars who contribute to emerging evidence in their professions.

The project also builds on a larger body of Medicare claims research led by SCU researcher Dr. James Whedon. Moonaz described the new study as a natural progression of that work and an opportunity to continue Whedon’s longstanding scholarly contributions to the field.

With findings still more than a year away, the study is now entering the work of answering its central questions. Its results could ultimately provide new insight into how initial treatment choices for back and neck pain affect patients, healthcare spending, and the course of care that follows.