At Cole Pain Therapy Group, our team of chiropractors are 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 import 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.
  • Transition of Care – Our office can schedule a new appointment same day or next day in most cases.  We will return a summary report to your office, and keep you informed about the status of your patient.  Simply call or fax to coordinate a referral.

 

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


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, 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

  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.

  1. 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

  1. 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
  1. 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

  1. Fornari M, Robertson SC, Pereira P, Zileli M, Anania CD, Ferreira A, Ferrari S, Gatti R, Costa F. Conservative Treatment and Percutaneous Pain Relief Techniques in Patients with Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurgery: X. 2020 Jul 1;7:100079.
  2. Bussières A, Cancelliere C, Ammendolia C, Comer CM, Al Zoubi F, Châtillon CE, Chernish G, Cox JM, Gliedt JA, Haskett D, Jensen RK. Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical practice guideline. The Journal of Pain. 2021 Apr 12.
  3. Ammendolia C, Stuber KJ, Rok E, Rampersaud R, Kennedy CA, Pennick V, Steenstra IA, de Bruin LK, Furlan AD. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database of Systematic Reviews. 2013(8)

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.

  1. Krøll LS, Callesen HE, Carlsen LN, Birkefoss K, Beier D, Christensen HW, Jensen M, Tómasdóttir H, Würtzen H, Høst CV, Hansen JM. Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta-analysis. The journal of headache and pain. 2021 Dec;22(1):1-2.
  2. Koes, BW, Bouter LM, et al.  “Randomised Clinical Trial of Manipulative Therapy and Physiotherapy for Persistent Back and Neck Complaints:  Results of One Year Follow Up.”  British Medical Journal, Volume 304, Number 6827, March 7, 1992, Pages 601-605. 
  3. Nilsson N., Christensen H.W., Hartvigsen J., The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther, 1997. 20(5): p. 326–30.
  4. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27:1835-1843.
  5. McCrory, Penzlen, Hasselblad, Gray.   Duke Evidence Report (2001) 
  6. Espí-López Gemma V., Gómez-Conesa Antonia. Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients With Tension-Type Headache: A Randomized, Controlled Clinical Trial. Journal of Chiropractic Medicine Volume 13, Issue 1, p1-80 March 2014
  7. Dunning JR, et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016 Feb 6;17(1):64
  8. Garcia JD, Arnold S, et al. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Front Neurol. 2016 Mar 21;7:40. 
  9. Varatharajan S, Ferguson B, Chrobak K, Shergill Y, Côté P, Wong JJ, Yu H, Shearer HM, Southerst D, Sutton D, Randhawa K, Jacobs C, Abdulla S, Woitzik E, Marchand AA, van der Velde G, et al.  Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario  Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. 2016  Jul;25(7):1971-99.
  10. Malo-Urriés, Miguel et al. Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. J Manipulative Physiol Ther. Volume 40, Issue 9, 649 – 658
  11. Haas M. et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018 Feb 23.  
  12. Corum M, Aydin T, Ceylan Cm, Kesiktas Fn. The comparative effects of spinal manipulation, myofascial release and exercise in tension-type headache patients with neck pain: A randomized controlled trial. Complementary Therapies in Clinical Practice. 2021 Jan 24:101319.

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

  1. Whedon JM, Kizhakkeveettil A, Toler AW, MacKenzie TA, Lurie JD, Hurwitz EL, Bezdjian S, Bangash M, Uptmor S, Rossi D, Haldeman S. Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries. Spine. 2021 Jun 21.
  2. Whedon, JM et al. Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain, Pain Medicine, March 6, 2020. 

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 nondrug 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 on the management of lower back pain. Study participants were evaluated by the primary care physician and also by the chiropractor, in the same office. Physicians and chiropractors partnered to discuss decision-making for: 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 chiropractors 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 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.