Frances is a consultant rheumatologist, combining the study of chronic pain and chronic pain syndromes with the practice of musculoskeletal medicine at Guy’s and St Thomas’ Trust. In particular, she holds clinics in General Rheumatology and Metabolic bone disease. Also, having interest in occupational conditions and she additionally holds an NHS clinic for Musicians and Performing Artists with musculoskeletal complaints, which is unique and takes referrals from across the UK.

Modern medicine is ill equipped at present to deal with the highly prevalent symptoms of chronic pain. Seen in all medical specialties and affecting all organ systems, chronic pain syndromes are poorly understood and low back pain is no exception. These phenotypes have been shown to have a heritable basis and that basis is shared between them pointing to similar pathways of pathogenesis. The use of omic data derived from identical and non-identical same sex twins allows a greater understanding of the role of genetic and environmental factors in low back pain. Genetic results of large scale studies lend further support the biopsychosocial model of chronic pain. Mendelian randomisation has provided further evidence in support of risk factors showing that raised body mass index, smoking and alcohol all increase risk of persistent back pain. These modifiable risk factors provide an important opportunity for intervention.