Alumnus focused research on Mindfulness-Oriented Recovery Enhancement as a treatment for sciatica pain.

Four years after the inception of the its clinical trial, National University of Natural Medicine (NUNM) alumnus Dr. Ryan Wexler ’23 has published the first set of results from his master’s thesis on the topic of mindfulness-based intervention.

Wexler’s paper, titled “Virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) reduces daily pain intensity in patients with lumbosacral radiculopathy: a randomized controlled trial,” was published in the journal PAIN Reports. It is a collaboration between researchers at NUNM and Oregon Health & Science University (OHSU).

Now a postdoctoral research fellow at OHSU’s Oregon Center for Complementary and Alternative Medicine in Neurological Disorders, Wexler’s research focuses on non-pharmacologic management for chronic pain via lifestyle interventions such as mindfulness meditation.

In 2023, Wexler earned his Doctor of Naturopathic Medicine and M.S. in Integrative Medicine Research from NUNM and was accepted into a postdoctoral position at the Cleveland Clinic’s Department of Wellness and Preventive Medicine.

Wexler answers key questions about his recently published paper:

NUNM: The results of your master’s thesis were just published, can you tell us about the thesis?

RW: For my master’s thesis, I conducted a randomized clinical trial of a mindfulness-based intervention (MBI) called Mindfulness-Oriented Recovery Enhancement (MORE). My goal was to evaluate this specifically for patients with a condition called lumbosacral radiculopathy. This is more commonly known as sciatica — pain that radiates down the leg from the back. I chose to study this condition because I lived with chronic radiculopathy for many years and often still experience flairs, so I feel very passionate about changing the treatment paradigm for patients with this condition

So many things came together to make this trial successful. A big one was our research recruitment partnership with Oregon Health & Science University. Through being connected with Angela Senders, I had the opportunity to pitch my project to the OHSU Spine Center and eventually the Comprehensive Pain Center. Having both of these sites as recruitment sources for my study made conducting the trial and recruiting participants feasible. In addition, I had a team of eight research assistants who were all NUNM graduate students who helped me conduct the trial. These RAs called participants and conducted baseline and follow-up study visits. It wouldn’t have been possible without them

I received the Anna MacIntosh Junior Investigator Research Fellowship in September 2020 to conduct this work. Although COVID posed many challenges academically, a large silver lining was that it allowed me to run this clinical trial. Because the school moved to virtual, I could be a clinical researcher by day and a naturopathic medical student by night. At the peak of my clinical trial, I often spent more time working on this project than I did studying for school.

NUNM: What initially got you interested in this topic? Why is it important?

RW: I initially got interested in this work because of my personal experiences with low back pain (LBP) and radiculopathy. In addition, I’ve been a meditator since I was 15 years old and with a large interest in research, combining my personal experiences led to the natural development of a research question. This work is important because radiculopathy is the most common sequelae of LBP and LBP is ranked the highest for conditions causing years lived with disability by the World Health Organization.

NUNM: What surprised you about the results?

RW: The most surprising thing about our findings was that patients daily pain intensity improved while their disability (ability to perform activities of daily living such as sitting, standing, lifting, walking, etc.) did not improve. This was surprising to us because we expected they would move together or not at all. As a more experienced clinical pain researcher, I now understand that this finding is not atypical in pain research. Because we studied patients with CHRONIC pain, and our participants had been in pain for an average of ~13 years, many of our patients likely still experience a fear of movement, otherwise called kinesiophobia. That is, even though they had less pain, they were likely still afraid to be physically active out of concern that it may cause harm to their body. Additionally, data collection was conducted during the height of the COVID pandemic (January 2021-January 2022) and therefore our participants were likely much less physically active than normal because of pandemic-related lockdowns.

NUNM: What role did your mentors play in your work?

RW: My mentors (NUNM alumna) Katie Pickworth, (NUNM faculty members) Heather Zwickey, and Ryan Bradley were of immense support in getting this clinical trial designed and completed. Heather put me in contact with key collaborators at OHSU. Ryan helped me consider major elements of the study design and pointed me toward the intervention that I used in the trial: Mindfulness-Oriented Recovery Enhancement. Katie, my primary mentor, met with me weekly to design the study and prepare the grant application, oversee the implementation of the intervention, help me organize and coordinate our team of researchers, and prepare our findings for publication.

NUNM: What is next for you and your research?

RW: My goal is to continue studying non-pharmacologic and integrative health interventions for patients with lumbosacral radiculopathy. Although chronic LBP has gotten much scientific attention, lumbosacral radiculopathy remains understudied. In addition to developing and evaluating multicomponent interventions (mindfulness plus exercise, mindfulness plus pain education, and exercise plus dietary modifications, etc.) for patients with radiculopathy, I would like to incorporate the use of objective assessments of pain such as Quantitative Sensory Testing that go beyond what we kind find out from patients by just asking them about their experience of pain.

NUNM: Why do you think NUNM is a good place to do research?

RW: NUNM’s size makes it an extremely nimble organization. NUNM and its scientists are HIGHLY networked with researchers from other institutions and it is able to attract a disproportionate amount of attention from the Complementary and Integrative Health (CIH) research community and is moving the needle on how research is done at CIH institutions generally.