Referring Physicians

At Cole Pain Therapy Group, our team of chiropractors is honored to care for patients in partnership with the larger Memphis healthcare community. We are committed to evidence-informed, patient-centered chiropractic care and strive to excel in the following areas:

Quality Care – Our team follows the best evidence regarding spine pain and functional pain syndromes.
Patient-centered Practice – Evidence-based practice places equal importance on the best evidence, practitioner experience, and patient values. We take time to understand a patient’s perspective in accordance with the biopsychosocial model of physical rehabilitation.
Patient Satisfaction – Each patient receives a survey after the first visit and at 30 days. When asked about the likelihood of referring a friend or colleague, 90% of responses are 10/10, and 6% are 9/10. Patients often share their reviews on our website and Google.
The transition of Care – Our office can schedule a new appointment the same day or the next day in most cases. We will return a summary report to your office and keep you informed about your patient’s status. Call or fax to coordinate a referral.

Research and comments regarding chiropractic as a component of medical management of spine pain and headache:

A 2017 practice guideline in the Annals of Internal Medicine recommends the same conservative, non-pharmacological care that our practice provides for acute, subacute, and chronic back pain.

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).
For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation).

Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians, Denberg TD, Barry MJ, Boyd C, Chow RD, Fitterman N, Harris RP, Humphrey LL, Vijan S. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14. PMID: 28192789.

A 2017 practice guideline in the Annals of Internal Medicine recommends the same conservative, non-pharmacological care that our practice provides for acute, subacute, and chronic back pain.

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).
For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation).

Two new studies have re-affirmed earlier research showing that early chiropractic co-management of back pain reduces the need for additional care:

“For [80,025] episodes of back pain, initial spinal manipulative therapy was associated with an approximately 30% decrease in the risk of imaging studies, injection procedures, or back surgery compared with no spinal manipulative therapy.” ¹
“In this study [of 40,929 individuals] we found that receipt of chiropractic care, though not PT, may have disrupted the need for opioids and, in particular, long-term opioid use in newly diagnosed LBP.” ²

Spinal manipulation is safe and effective and decreases opioid use.

“Systemic reviews and meta-analysis of 26 randomized clinical trials of spinal manipulative therapy (SMT) for acute low back pain and 47 randomized clinical trials of SMT for chronic low back pain found SMT performed by chiropractors and other providers to be relatively safe and associated with modest improvement in pain and function. However, the most significant benefit of SMT may be its association with decreased opioid use among patients who receive it.” 1

Eovaldi BJ, McAlpine B. Increased Utilization of Spinal Manipulation by Chiropractors to Tackle the Opioid Epidemic. Medical Care. 2021 Aug 25

There is good support for non-surgical treatment of lumbar spine stenosis with leg symptoms. These non-surgical options, including manual therapy and exercise, have been validated by multiple authoritative sources.

World Federation of Neurosurgical Societies consensus paper:

“A conservative approach based on therapeutic exercise may be the first choice in patients with lumbar spine stenosis, except in the presence of significant neurologic deficits. Treatment with instrumental modalities or epidural injections is still debated.” 2

Journal of Pain clinical practice guideline:

Clinicians and patients may initially select multimodal care nonpharmacological therapies:

manual therapy
rehabilitation and home exercise
education, advice, and lifestyle changes ³

Cochrane Database Systematic Review of 23 clinical trials:

“Manual therapy and exercise, with or without education, is an effective treatment and epidural steroids are not effective for the management of lumbar spine stenosis with neurogenic claudication. All other nonoperative interventions provided insufficient quality evidence to make conclusions on their effectiveness.” ⁴

A December 2021 systematic review in The Journal of Headache and Pain identified the most effective non-pharmacological treatment approaches for tension-type headaches:¹

Manual joint mobilization
Supervised physical activity
Patient education
Acupuncture

This data concurs with several prior studies on spinal manipulation for neck tension headaches:^2-12

Spinal manipulation cuts the number of symptomatic days in half.¹¹
Spinal manipulation is more effective than physiotherapy mobilization or massage for a headache of cervical origin. ^7,11
“Manipulation and exercise, in addition to pharmacologic treatment in tension-type headache patients appear to be a promising approach. The manipulation group… showed statistically significant improvements in all outcome criteria.” ¹²

This new data bolsters the growing support for chiropractic and medical collaboration for treatment of neck-tension headaches.

A study in Spine identified an effective means to reduce secondary low back pain management costs. These higher-cost events included: hospitalizations, ED visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and follow-up visits for potential complications.

The five-year Medicare claims analysis concluded that initiating low back pain management with a chiropractor limits care escalation:

“Among older Medicare beneficiaries who initiated long-term care for chronic low back pain with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher [by 2.67 times] as compared to those who initiated care with spinal manipulative therapy.” ¹

And a recent Pain Medicine study concluded that early availability of conservative management is valuable:

“Among those who saw a chiropractor within 30 days of diagnosis, the reduction in [opioid use] risk was greater as compared with those with their first visit after the acute phase.” ²

The Journal of the American Medical Association published a synopsis of the American College of Physicians guidelines for managing low back pain. Among the recommendations:

For acute and subacute low back pain: “Patients should stay active as tolerated and begin with non-drug treatments, including spinal manipulation, superficial heat, massage, and acupuncture. If medicines are needed, they should be added at the lowest effective dose for the shortest period.”
For patients with chronic low back pain: “Priority should be given to nondrug treatments combined with exercise. [Recommendations include] spinal manipulation, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercises, progressive relaxation, electromyographic biofeedback, low-level laser therapy, and cognitive behavior therapy.”
For patients who do not respond to non-drug treatments: “Nonsteroidal anti-inflammatory drugs are the initial medication recommended to manage chronic low back pain. Second-line therapy includes tramadol or duloxetine. Opioids should be considered only for patients who do not improve with all other recommended treatments and for whom the potential benefit of opioids outweighs the known risks.”

Traeger AC, Qaseem A, McAuley JH. Low Back Pain. JAMA. 2021;326 (3):286.

A study of 750 active-duty US military personnel with acute LBP compared the effectiveness of standard care alone (medication, physical therapy, pain management) versus a collaborative care plan that included chiropractic manipulation. “Chiropractic care, when added as usual medical care, resulted in improvements in low back pain intensity and disability. This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines.”

Specifically, chiropractic co-manage patients reported:

significantly lower mean worst pain intensity
significantly less symptoms of “bothersomeness”
significantly better global perceived improvement
significant and greater mean satisfaction with care
significantly less pain medication use
no serious treatment-related adverse events

Goertz CM, et al. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain. A Comparative Clinical Trial. JAMA Netowork Open. 2018:(1):e180105.

The Ontario Ministry of Health has funded a study to determine the value of MD/DC collaboration in managing lower back pain. Study participants were evaluated by the primary care physician and the chiropractor in the same office. Physicians and chiropractors partnered to discuss decision-making for: the appropriateness of advanced imaging, specialist referral, patient education, self-management, and care plans.

High patient satisfaction (94% of patients said they were “very satisfied” or “satisfied”) with care.
High provider satisfaction. All physicians made reference to the value of referring back pain patients to the consulting chiropractor.
The majority of physicians perceived the consulting chiropractor’s assessment and management of back pain as being of higher quality than medical physicians.
Increase patient confidence in diagnosis and treatment options.
Decrease in referrals for imaging and specialist (71% of physicians reporting).

Endicott, A. Working with MD’s to Treat Back Pain, Dynamic Chiropractic, Sept 2012

The American Medical Association goes on record endorsing chiropractic care in a patient information synopsis: “Many treatments are available for low back pain… people benefit from chiropractic therapy.”

Denise M. Goodman, Allison E. Burke, Edward H. Livinston. Low Back Pain. JAMA 2013:309(16):1738.

There is a growing amount of interest in chiropractic care within the allopathic model of healthcare. Branson reports 74% of respondents to favor the addition of complementary medicine into a Minnesota hospital system.

Branson RA. Hospital-based chiropractic integration within a large private hospital system in Minnesota: a 10 year example. J Manipulative Physiol Ther. 2009 Nov-Dec;32(9):740-8.

Chiropractic co-management of Department of Defense recipients shows significant improvement and high patient satisfaction.

Green BN, et al. Integration of Chiropractic Services in Military and Veteran Health Care Facilities: A systematic Review of the Literature. Journal of Evidence-Based Complementary & Alternative Medicine. 2016 Apr;21(2):115-30.

The 2018 Joint Commission Guideline enhanced the pain assessment and management requirement for hospitals to include “non-pharmacologic pain treatment modalities” that were defined in 2015 to include “chiropractic therapy”.

The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7.
Joint Commission Online. Revision to Pain Management Standards. jconline_November_12_14pdf

In a measure to help control opioid use disorders, 37 state Attorneys General suggest that PCPs prescribe non-opioid alternatives, including chiropractic.

Attorney General Janet Mills Joins 37 States, Territories in Fight against Opioid Incentives.

Current research supports a multimodal approach to tendinopathy management.

Exercise-based rehabilitation remains the foundation of treatment. However, for patients whose recovery plateaus, adjunct treatments such as extracorporeal shockwave therapy may provide an additional pathway for improvement.

When integrated appropriately with progressive rehabilitation programs, shockwave therapy may help patients advance beyond recovery plateaus and return to activity with improved function.

References

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We are the Memphis area’s top-rated chiropractic group, providing you with gentle chiropractic care, dry needle therapy, exercise therapy, and therapeutic massage.

2845 Summer Oaks Dr, Memphis, TN 38134
(901) 377-2340

Life Shouldn't Hurt!

You Deserve To Feel Great. We Can Help!
Your go-to Chiropractor in Memphis, TN

Richard L. Cole, DC, DACNB, DAIPM, FIACN, FICC
Jeffrey D. Luebbe, DC, CCRD, CCSP
W. Steven Vollmer, DC, DAAPM
Bradford J. Cole, DC, MS, CSCS
J. Colby Poston, DC
Daniel H. Smith, DC
2845 Summer Oaks Dr., Memphis, TN 38134
(901) 377-2340

Monday – Friday:
8:00 AM – 6:00 PM
Saturday :
8:00 AM – 12:00 PM
Walk-ins are Welcome!