During her clinical rotations at Logan University, Kristin Miller, DC (’22) encountered a patient with chronic neck pain who challenged her to think beyond physical symptoms.
“I wondered, ‘Could this pain be more than just tissue damage? Could psychological and social factors also play a role in shaping the patient’s pain experience and recovery?’” Dr. Miller said.
Dr. Miller’s curiosity led her to reconsider not only her approach to care but also how chiropractic students are trained to understand chronic pain. While her education emphasized the biomedical model—addressing the physical causes of pain—she wished she were also learning more about the psychological and social aspects of pain. This spurred a question: Are future chiropractors being prepared to treat pain from a biopsychosocial perspective?
With guidance from her clinical instructor Patrick Boylan, DC (’17), Ed.D. (’24), Dr. Miller launched a study on how pain neuroscience education and patient-centered care influence chiropractic students’ understanding of chronic pain.
Bridging the Gap in Chiropractic Training
The study, “Evaluation of chiropractic students’ knowledge and attitudes following pain interventions: A randomized educational trial at 2 institutions” was co-authored by Dr. Boylan; Logan alumni Casey Mullen, DC (’21) and Macy Randolph, DC (’22); Norman W. Kettner, DC (’80), DACBR, FICC, dean of research and professor emeritus of Logan’s Department of Radiology; and Katherine Pohlman, DC, MS, PhD, director of research at Parker University.
The study examined how incorporating the biopsychosocial model of pain into chiropractic education could enhance both student understanding and patient care. Participants received targeted 50-minute lectures on pain neuroscience, chronic pain or patient-centered care. Although students showed immediate improvements in their understanding, sustained progress required ongoing education.
“The results showed that immediate improvements in knowledge were possible, but without sustained focus, those improvements weren’t maintained,” Dr. Miller said. “That tells me the purposeful, ongoing education on these approaches may shift how we understand and treat pain.”
The research was presented at the 29th Annual Association of Chiropractic Colleges Educational and Research Agenda Conference (ACCRAC) in 2023 and published in the Journal of Chiropractic Education in 2024.
Applying Research in Practice
Now practicing in New Orleans, Dr. Miller applies the insights she gleaned from her research every day, treating patients with chronic pain across a variety of populations, including veterans and underserved communities.
“Being in private practice doesn’t mean my interest in research stops,” Dr. Miller said. “It’s important for practitioners to continue asking questions and looking at the latest research to improve patient care.”
Dr. Miller hopes to inspire the next generation of chiropractors to adopt the biopsychosocial model early in their training. She envisions these approaches becoming standard practice, fostering more comprehensive care for patients with chronic pain.
“My goal has always been to spark a conversation and inspire change; that’s why I chose the chiropractic profession in the first place,” she said. “I’d love to see chiropractors trained to not just treat the tissue but understand the entire experience of the patient.”