TCOM students publish article on pain and function outcomes following lumbar spine surgery
Five students under the direction of John Licciardone, DO, MS, MBA, Regents Professor
in the Texas College of Osteopathic Medicine at UNT Health Fort Worth, published an
article in the June issue of the International Journal of Spine Surgery, along with
Subhash Aryal, PhD, professor at Johns Hopkins University.
Student Doctors Kenneth Harrington, Arya Anagol, Crystal Peraza, Saadia Shaikh, and
Shahryar Malik began working on the project as a research team when they entered the
Osteopathic Research Center’s Summer Program in Clinical Research in 2025. Thirty
students participated in the program that summer, and their team was the first to
publish its results.
The study involved a target trial emulation to measure pain and function outcomes
of patients undergoing lumbar spine surgery compared with those receiving standard
non-surgical care over a period of 36 months. Surgery patients reported less pain
intensity, but their functional outcomes were comparable to those of the control group.
“These results are incredibly valuable because chronic low back pain affects millions
of people and rarely has a simple fix,” Harrington said. “Patients need to be fully
informed of these tradeoffs when deciding whether or not to go under the knife.”
Students in the Summer Program are provided with intensive training in clinical research methodology during June and then work with Dr. Licciardone during the Fall and Spring semesters to complete their projects, including literature reviews, study design, data analysis, and preparing manuscripts for publication.
“One of the most rewarding aspects of the experience was collaborating with classmates
who shared a genuine enthusiasm for research while supporting one another through
the demands of medical school,” Anagol said. “Under Dr. Licciardone's mentorship,
I also grew more confident in critically evaluating scientific literature.”
The ORC’s research is largely based on data acquired from its Pain Registry for Epidemiological,
Clinical, and Interventional Studies and Innovation (PRECISION), which was established
in 2016 and has grown to become a national registry using a digital research platform
and electronic data capture.
“The PRECISION registry has become a vital resource not only in conducting ORC studies,
but also for training TCOM students in clinical research,” said Licciardone, who is
also executive director of the Osteopathic Research Center at UNT Health Fort Worth.
“This student research team published an original research article in an international
surgery journal less than a year after starting the program.”
“This study is highly meaningful because it is the first of its kind in this field to utilize a framework known as a target trial emulation,” Harrington said. “This approach mimics a randomized controlled trial—the gold standard—but significantly reduces the cost, time, and ethical concerns that come with a traditional trial.
"Having the opportunity to conduct this type of research as a medical student has
meant a lot to me,” Anagol said. “We spend so much of our first two years learning
about diseases and treatments in the classroom, and being able to investigate a real
clinical question made those concepts feel much more real.
“Conducting this type of research is also deeply important to me as a medical student,”
Harrington said. “Applicants nowadays are expected to have a solid research background
before entering residency. Publishing this study alongside Dr. Licciardone and my
peers demonstrates to program directors that we can practically apply the scientific
method to medicine, making us well-rounded candidates.”
The ORC has recently leveraged PRECISION to conduct similar target trial emulations
to answer research questions that cannot be addressed in clinical trials. Two such
emulation studies have looked at the roles of physician empathy and communication
in preventing suicidal ideation in patients with chronic pain. A third emulation has
examined the long-term outcomes of patients with chronic pain following initiation
of opioid therapy.
“The value of PRECISION as a research registry and for training medical students in
clinical research has increased tremendously over the years as more and more participants
were enrolled and followed for longer periods of time,” said Licciardone. “This enabled
us to publish our recent article in an international surgery journal despite not being
surgeons.”
The PRECISION registry has enrolled more than 2,400 research participants and collected
data during more than 15,000 encounters, including up to 54 months of follow-up in
some cases. Over 100 TCOM students have participated in clinical research training
using PRECISION data since 2022, when the ORC implemented its team-based model to
promote timely completion of student research projects and their publication.
The ORC conducts its legacy research in osteopathic medicine as well as emerging research in the areas of the patient-physician relationship, benefits and harms of long-term opioid therapy, and social determinants of health, as they all pertain to chronic pain treatment and outcomes.