By Sienna Shoup
The American Chiropractic Association’s (ACA) 2021 George B. McClelland Researcher of the Year Award was presented to Kenneth A. Weber, II, DC, PhD, of Palo Alto, Calif. The award, presented at ACA’s annual meeting and conference, ACA Engage, recognizes a deserving individual for developing, refining and/or expanding the body of knowledge in chiropractic.
As a postdoctoral researcher and instructor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University’s School of Medicine, Dr. Weber’s work is not only interesting, but significant in improving patient outcomes. Dr. Weber also teaches in the Department of Neuroscience and Clinical Neuroscience at Parker University.
Learn more about Dr. Weber (pictured) and his pioneering work in this ACA Blogs Q&A:
How did you first become interested in research?
I have always enjoyed math and science. During my undergraduate training, I had the opportunity to work at the Dow Chemical Company as a lab technician. Being part of a research team was very exciting, and I enjoyed the experience and research environment. When I started my chiropractic training, however, I was not planning on becoming a researcher. My goal was to start my own practice.
Shortly into the coursework, I began to see the gaps in our knowledge, and I started to get passionate about research. About halfway through my chiropractic training, I began to seriously consider a research career path, and at that time, I started reaching out to chiropractic researchers across the country and putting the plans in place to make my dream a reality.
What is spinal cord fMRI?
Functional magnetic resonance imaging (fMRI) allows us to use MRI to study neural function. A main benefit is that it’s noninvasive, which is terrific for clinical research. When a brain region becomes activated, your body sends more oxygenated hemoglobin to that region to support the local increase in metabolism. Oxygenated and deoxygenated hemoglobin have different magnetic properties, and the increase in oxygenated hemoglobin leads to an increase in the signal in the images with fMRI.
Spinal cord fMRI is similar to brain fMRI, but the spinal cord is technically a much more challenging region to image. The small size of the spinal cord and increased physiological noise due to the respiratory and cardiac cycles are two of the main difficulties. We are just starting to be able to reliably detect and study neural activity in the spinal cord with fMRI. My goal is to use spinal cord fMRI to study spinal cord neural activity related to sensorimotor function.
What types of changes are you looking for in the brain?
The major mystery for me is why certain patients recover from an injury while others with a seemingly similar injury continue to experience symptoms. With MRI, we can look at the brain structure and neural activity, which are known to be altered in chronic pain conditions. We still do not understand how these brain changes are exactly related to chronic pain.
The brain imaging I use in my research has largely outpaced any clinical applications for the conditions chiropractors commonly see, except for ruling out brain tumors or other red flags. I think brain imaging at some point may provide a measure of central nervous system health allowing us to predict who may respond to care. This will probably be useful first in those patients who have not responded to a course of conservative care, including chiropractic care, and are considering more invasive options.
For example, we may be able to use brain imaging in the future to predict who may or may not recover from spine surgery. Those not likely to respond to surgery may seek other options for care or postpone surgery to a later time.
What changes do you notice in the brain when someone is in pain?
Brain imaging has shown us that the processing of nociceptive and pain information in the brain is quite complicated. The pain experience is not encoded by any single brain region but distributed across the brain. Somehow across this network of brain regions, the different dimensions of pain come together and create the individual’s pain experience.
I feel there is strong evidence that pain-related brain activity in chronic pain differs from acute pain. The brain’s gray matter and white matter appear to be altered as well. We are still trying to understand why these changes occur and how and when they develop. Brain imaging, in my opinion, has had the greatest impact on how we communicate with patients. Pain processing is very complex and reflects the complexity of our patients and the uniqueness of their pain experience. This emphasizes that we need to treat the whole patient and support the use of the biopsychosocial framework as an example model for care.
What questions do you get asked by colleagues?
I work in a multidisciplinary team with anesthesiologists, pain medicine specialists, nurses, psychologists, physical therapists, physicists, neuroscientists and epidemiologists. I am seen as another member of the team with my own unique training, experiences and skillset. Our lab focuses on clinical pain research, and we have all have the common goal of predicting, preventing and alleviating pain.
I am frequently asked about the diagnosis and nonsurgical management of back and neck conditions. Most of our discussions tend to be focused on the technical aspects of the research regarding image processing, automating analyses, and organizing and navigating large datasets. My background as a chiropractor has been well-received and respected by all of my team members, and I definitely bring a unique and valuable perspective to the team.
What helped prepare you for your position at Stanford?
I started at Stanford as a postdoctoral research fellow. A research fellowship is like a residency for researchers. Typically, they are full-time and last between one and three years. During the fellowship, you receive hands-on training in research. Having a PhD helped me get my foot in the door, although a PhD is not a requirement to complete a research fellowship. Chiropractors are eligible for most National Institutes of Health-funded postdoctoral fellowships. You can perform a search for fellowships on the NIH website, and most departments with funding list their fellowships and application information on their websites.
If you find a postdoctoral research fellowship that feels like a good fit, I would reach out to the director of the program. While a PhD is not required to be a successful chiropractic researcher, the training and degree certainly help. I really enjoy mentoring early career researchers. Please reach out to me if you are interested in learning more about the process of getting a PhD or postdoctoral research training, and we can find a time to chat.
How would you explain your work to a person on the street?
I work with magnetic resonance imaging, which I am using to better understand how your nervous system influences your pain. We want to identify which treatments are best for you and develop more effective treatments for pain.
What are the takeaways from your success?
An academic research career is a long game. If you are passionate about becoming a researcher, you can make it happen. The rewards are great. I love my job, my team and the opportunity to improve the lives of our patients through research. I come to work each day with so much enthusiasm for the work we are doing, and I feel very fortunate to have chosen chiropractic research as my career path.
What can you teach others?
If you want to learn neuroimaging, I can certainly help teach you. I try to only use open-source software, and many open neuroimaging databases exist. You could learn these techniques on your Mac or PC, and I am happy to point you in the direction to get started.
That aside, I want chiropractic research to flourish. I am here as a resource to the profession. If you are even just considering a research career, feel free to reach out to me. I will share my experiences. The NIH wants more clinicians, including chiropractors, to be trained as scientists. There are many opportunities available for chiropractors to receive research training – from PhD programs to postdoctoral fellowships and even student loan repayment programs. The best part is that these are funded opportunities. You get paid to receive research training.
Who has inspired you?
The list is quite long, and I know I am leaving some out. The first are my professors during chiropractic college that challenged us to think independently and support our claims with evidence. They really inspired me. These include Drs. Shawn He, David Seaman, and Donald Dishman. Through them, I was introduced to Drs. Partap Khalsa, Michael Schneider, Geoffrey Bove, Joel Pickar, John Triano, Norman Kettner, Christine Goertz, and Scott Haldeman.
The textbooks of Drs. Craig Liebenson, Craig Morris, and Donald Murphy provided a strong evidence-based foundation for my clinical practice. Dr. James Stinear was a major mentor, and I trained with him for a year in neurophysiological techniques at the Rehabilitation Institute of Chicago before starting my PhD. I am also a member of the Chiropractic Academy of Research Leadership, which has been a tremendous opportunity to receive further mentorship from chiropractic researchers across the globe. These are my chiropractic research heroes.
What advice do you have for others interested in a research career?
First, reach out to chiropractic researchers and find a mentor. Then I would start getting research experience. My first research project was an educational survey, and now I am a neuroscientist. You just need to get started. If research is the career path for you, your passion for science will take over, and you will want to continue learning and discovering. Again, please reach out to me. I am here to help. The chiropractic research community is growing quickly, and we would love to have you join us.
If you’re interested in reaching out to Dr. Weber, you can send him a message through ACA’s member-only online community and discussion forum, MyACA.