ProfessorPaulo Ferreira

Research Profile

Low back pain (LBP) is the highest contributor to disability in the world and affects 4 million Australians. Professor Ferreira’s PARADIGM-SHIFTING research on the CAUSES and MANAGEMENT of LBP has revealed that the burden of LBP is largely due to people receiving ineffective treatments – such as pain medication and spinal injections – rather than effective treatments – such as lifestyle-based physical activity.

The program includes 69 systematic reviews; 30 RCTs; 73 cohorts; 46 twin studies; 2 Global Burden of Disease studies enabled by my >$28M in NHMRC/MRFF funding. I am senior author on 183 (~60%) of the program’s 306 publications which have been cited >37,000 times¹ across 113 countries and 27 disciplines², resulting in an FWCI of 9.34³.

The program has influenced LBP POLICY globally and reached BEYOND THE FIELD. It has been cited in 243 policy documents in 6 subject areas (health, economy, education, environment, science, and society), covering 467 knowledge topics, in 20 countries, 5 continents, 16 languages⁴. The program has also been recognised as achieving social sustainable development goals by promoting ‘well-being’ (167 studies), ‘reduced inequality’ (7 studies), and ‘peace and justice’ (3 studies)^{2, 3}.

PHARMACOLOGICAL TREATMENT

Professor Ferreira’s research program started by revealing that most PHARMACOLOGICAL treatments for LBP are INEFFECTIVE and has changed how LBP is managed globally through GUIDELINE CHANGES. His research on ineffective pain medication (eg. paracetamol) for LBP and osteoarthritis (BMJ 2015 award paper)⁵, has informed 30+ clinical practice guidelines (eg.⁶) in 9 countries⁴, where they have rejected paracetamol as a treatment for LBP and osteoarthritis. Half of the international guidelines for LBP have now removed paracetamol as a recommended LBP treatment (eg.⁷). Challenging the view that drugs such as anti-inflammatories are effective for LBP, his research (Annals Rheum Dis, 280 citations)⁸ showed that they offer only small clinical benefits, possibly no better than placebo.

This program of research demonstrating the inefficacy of painkillers culminated in demonstrating in a LANCET paper that opioid use is the main reason LBP sufferers develop depression⁹. His research on spinal injections led to major changes globally in policies and regulations. For example, his meta-analysis on spinal injection (Annals Int Med, 362 citations)¹⁰ has informed 26 clinical practice guidelines in 5 countries⁴. Since its publication, epidural injections have been removed as a Medicare reimbursement item in the USA¹¹ and from the UK National Institute for Health & Care Excellence (NICE) guidelines for LBP¹². He is the senior author or supervisor of a PhD student in ALL the pharmacological program’s publications [eg.^{5, 8, 10}].

TWIN RESEARCH PROGRAM

Driven by the need to discover effective solutions for LBP Professor Ferreira PROACTIVELY established a world-leading (most published) research program¹³ to unravel the CAUSES OF LBP by involving twins to control (ie. eliminate) the confounding effects of genetics. The program includes the discovery of poor sleep as a cause for LBP¹⁴, which has resulted in the award of a collaborative NHMRC CRE in twin research¹⁵, an editorial in the most prestigious physiotherapy journal¹⁶, and a $3.5M MRFF grant to evaluate, for the first time in Australia, sleep management in LBP¹⁷. His twin research program has informed policy BEYOND the LBP field with my global twin consortium (Australia lead) of 193,518 twins from 16 countries¹⁸ informing the 2022 UNESCO International Science and Evidence-based Education report¹⁹. He is the senior author on ALL 46 publications¹³.

NON-PHARMACOLOGICAL TREATMENT

Seeking a NON-PHARMACOLOGICAL solution, Professor Ferreira demonstrated the effectiveness of exercises for LBP. He ran 30 RCTs and 69 meta-analyses of exercises for LBP, and the work was the basis of a shift in the status quo, with exercises now recommended as the first line of care for chronic LBP management internationally (eg. UK NICE guidelines 2020)^{6, 12, 20}. He is senior author on ALL non-pharmacological, exercise publications of the program [eg.^21-23]. 

His research on EFFECTIVE CARE through exercises has REVOLUTIONISED how LBP is managed globally. The research published in the Lancet (2,569 citations)²⁴ has informed government recommendations on best practice worldwide, including the 2020 WHO guidelines for LBP²⁵. It has garnered significant media attention in over 212 news outlets (Altmetric, 2025). Worldwide, his research on the benefits of exercises over pain medications^{21, 26}, and ascertaining which exercise programs are most effective²³, informed the 2023 WHO guidelines for LBP²⁷ and the 2021 UK NICE guidelines for chronic pain²⁰. 

The program’s contribution reached beyond effectiveness of exercise programs to discover ‘how’ and ‘for whom’ they work. His study (714 citations)²⁸ revealed that specific spinal core muscles are affected in LBP, with the 2019 UK National Health Service (NHS) LBP guidelines²⁹ recommending spinal core exercises as a result of my meta-analysis (516 citations)³⁰. The 2023 WHO guidelines for LBP²⁷ asserted exercises are safe and effective for older people because of his trial²⁶. As a result of his trial of exercises for LBP (1,207 citations)^{31, 32} the 2020 USA Agency for Healthcare Research & Quality guidelines³³ recommend exercises as first line of care for LBP.

He led the program through innovative approaches including the world’s first LBP trial that employs an adaptive platform design³⁴. The trial evaluates how different lifestyle programs (eg. physical activity, sleep) impact function in people with LBP³⁴. His Medibank funded (CIA) trial of remote delivered exercises is the first in the world to target LBP sufferers living in remote communities³⁵. His Network Meta Analysis published in BMJ was revolutionary, unravelling that psychological interventions for LBP are most effective when paired with exercises³⁶.

The program’s research has been TRANSFORMATIVE BEYOND THE LBP FIELD. For example, the highly cited LANCET study outlining the Global Burden of LBP (1075 citations in 2 years)³⁷ informed the 2023 UNESCO Report on Physical Activity Programs³⁸; the study on LBP patient-centred care (565 citations; #1 physiotherapy journal)³⁹ informed the 2025 UK NHS RACE and Health Observatory⁴⁰; and the study of barriers for physical activity for older people (921 citations, British Journal of Sports Medicine, #1 orthopaedic and sports journal)⁴¹ informed the 2021 WHO Policy action for age-friendly environments in Europe⁴². The program has helped educate the general public about LBP, reaching >1B people in the past 5 years, through invitations for interviews on national/international media (eg. NY Times)⁴³.

INDUSTRY & PATHWAY TO IMPACT

He leads the program through TARGETED successful engagement with INDUSTRY and CONSUMERS with living LBP experience. He partnered with NSW Health to conceive the most innovative LBP model of care in Australia – a new model linking hospitals and the community to ensure patients with LBP are physically active in the community and do not receive ineffective care (CIA; NHMRC partnership grant; $2.3M; 2020/25)⁴⁴. In 2024 He partnered with the Australian Physiotherapy Association to implement Australia’s first model of care of physiotherapists as the first contact point for LBP (CIA; NHMRC partnership grant; $3.3M; 2025/30)⁴⁵.

In 2023, He partnered with Musculoskeletal Health Australia (main LBP consumer organisation) to implement the first national Help Line for LBP (CIA; NHMRC partnership grant; $3.3M; 2024/29)⁴⁶. The Australian LBP Help Line will integrate: i) his unique knowledge from 100+ cohort/twin studies discovering LBP causes [eg.⁴⁷ published in PAIN, #1 anaesthesiology journal]; ii) extensive skills in conducting 60+ robust meta-analysis identifying ineffective treatments [eg.¹⁰]; and iii) worldwide expertise leading 30+ trials designing innovative (eg. technology-based exercises), personalised (eg. older people) effective LBP care [eg.³⁵].

References

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7.          [https://www.nhs.uk/conditions/back-pain/]

8.          Annals Rheum Dis. 2017;76:1269-78

9.          LANCET EClinicalMedicine. 2021;42:101202

10.        Annals Int Med. 2012;157:865-77

11.        [https://www.medpac.gov/document/march-2022-report-to-the-congress-medicare-payment-policy/]

12.        [https://www.nice.org.uk/guidance/ng59]

13.        Web of Science [twin studies 2025]

14.        Eur J Pain. 2021;25:1091-106

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21.        BMC Musc Dis. 2019;20:1-14

22.        Eur Spine J. 2016;25:3495-512

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27.        [https://iris.who.int/handle/10665/374422]

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36.        BMJ. 2022;376:e067718

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41.        Brit J Sports Med. 2025;49:1268-76

42.        [https://iris.who.int/handle/10665/349476]

43.        USYD Media 2021

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46.        APP2031038

47.        Pain. 2015;156:496-503