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August 02, 2016


NASS Names Professor Chris J. Main an Honorary Member


The North American Spine Society is pleased to present its newest honorary member, Professor Chris J. Main MA(Hons), MPhil, PhD, CPsychol, FBPsS. Dr. Main was nominated for membership by Gregory L. Whitcomb, DC, Assistant Professor in the Department of Neurosurgery at the Medical College of Wisconsin and chair of the NASS Section on Allied Health.

For more than four decades, psychologist Chris Main has been a trailblazer in the field of spine research. His illustrious career began in the 1970s when he joined forces with his colleague and mentor, Gordon Waddell, MD, to develop the Glasgow Illness Model. This seminal work was the precursor of the biopsychosocial model of pain and disability. He has been a leader in the “Back Pain Revolution” ever since, effecting profound and international change in the way spine patients are evaluated and treated.

Dr. Main’s numerous accomplishments include the development of commonly used psychological assessment tools for patients with low back pain, including the MSPQ, the DRAM, the FABQ and most recently the STarT Back Screening Tool.

Inspired by his mentor, Wilbert Fordyce, PhD, he established the first interdisciplinary pain program in the United Kingdom specifically for low back pain at Hope Hospital in Salford, UK in the 1980’s, leading to a textbook for spinal clinicians. He and his colleagues were the first to identify the now universally acknowledged “yellow flags” or psychosocial predictors of disability in patients with spine pain, and in the mid 1990’s he co-authored the Yellow Flag Initiative (with Nicholas Kendall, PhD and Steven Linton, PhD) in New Zealand. This initiative represented a seismic shift in the focus of pain management from tertiary rehabilitation to secondary prevention in clinical and occupational settings

With co-researcher, Kim Burton, PhD, Dr. Main spearheaded the Decade of the Flags Think Tank and Conference in 2007 and coined the concept of Blue and Black Flags that refer to social factors that affect spine pain patients; this led to an occupational and disability focus, which he has continued with William Shaw, PhD and Michael Nicholas, PhD.

The STarT Back Trial (Hill et al, 2011), which provided the first evidence of improved clinical and economic outcomes for patients with spine pain based on a screening tool, was born out of Dr. Main’s idea to combine his DRAM screening tool with stratification of patients for optimal intervention, an idea supported and operationalized by Peter Croft MD and colleagues at Keele University.

Dr. Main co-edited (with Steven George, PhD) the influential Physical Therapy Journal special issue on Psychologically Informed Practice in 2011, in which it was argued that modifiable psychological factors could be identified and addressed within normal clinical management, triggering once again an important advancement in spine care.

Dr. Main remains engaged in the global spine community and continues to contribute through educational and research efforts that build on the biopsychosocial model in an era where high-value and patient-centered practice are defining the future of spine care.

NASS would like to congratulate Dr. Main and welcome him to the multidisciplinary membership of NASS!


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