CF 224: The Complexity & Treatment of Chronic Pain Today we’re going to talk about manual therapy for chronic pain the complexities within.  But first, here’s that sweet sweet bumper music  

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way a  round.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
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You have found yourself smack dab in the middle of Episode #224 Now if you missed last week’s episode , we talked about Kids’ Mental Status & Zero Calorie Drinks. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Still no real results on trying out the lead generation marketing that I’ve spoken about recently. We’ve tweaked it and will continue seeing if we can make a go of it. Polls have shown it and I forget. Every now and then I recall; people aren’t nearly as interested in wellness and talk about maintenance or preventative. They want RELIEF from pain points. 

As chiropractors, we want them to care about wellness and maintenance, and prevention. But they don’t. Pain is a hell of a motivator. In fact, it’s unmatched as the main motivator. Does that mean there aren’t amazing wellness clinics? Of course not. There are but they’re more the unicorn than the run-of-the-mill horse trotting around. 

Also, more recently, I have a new competitor in town that is copying everything I am doing. Copying my providers and copying my services. But, severely discounting everything. To the point of embarrassment. The Joint is one thing. They serve a specific gap. ‘I feel great. No issues. Just wanna be popped.” They serve that demographic and I can make sense of their discounted rate. They aren’t solving problems there.  But this place that’s copying me now, they are solving problems. Or at least trying to. And charging $29 for that first visit with the exam and all of the rigamarole. That’s rubbish, garbage, clown stuff right there.

I hope the type of chiropractor that listens to this podcast knows better than that. Knows what that does to our industry.  Have you noticed that when a chiropractor owns the clinic, charges are pretty appropriate? When someone that is not a chiro owns it, services are devalued to an embarrassing point. Either that or the chiro is desperate.  All of it equals devaluing what we do. It’s poor form.

My least expensive adjustment is $45 US American Greenback Benjamins. It took me some years to start valuing my service. Now, thanks to research and guidelines and colleagues and mentors, I understand the value, the time, the education, the work, the responsibility, and the effort.  

Hell with anyone that wants to sell an exam, x-rays, report of findings, and adjustment for $29. That’s the way I see it. Pick up your game and be better.   as well.

You’ll be hearing more about it in upcoming episodes.  We all know that the number one type of case that we want is a personal injury case.

Remember, I just said pain is the motivator and if you don’t know why personal injury patients are so valuable, you haven’t been paying attention.  They are gold because the clients are more compliant, and we get paid at rates far above insurance or Medicare or Medicaid. The patient’s attorney tells them to go for treatment because it enhances their legal case and gets them more money.

But we know that if they aren’t moving from the start, recovery from pain and getting back to normal might not happen at all. We can help these patients so much and medical practices in most markets are turning them away now.  The problem is, how do we get PI cases?  Attorneys don’t generally respond to your invitation for lunch. And let’s face it, they’re a tough bunch. I have the answer.

An attorney I recently connected with has put together a system, that is both in written and video form, that shares how to approach attorneys and get them to send their PI clients to you. I checked it out personally and I like it. Attorney Paul Samakow is an attorney teaching how to speak to attorneys. His system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment. Just one of my PI cases averages $3000-$3500 for example. It’s a win-win. 

Go to ‘C’ as in cat and ’S’ as in sweet. 


One more time so you get it right:

Alright, let’s get on with the research, shall we?

Item #1

This one is called “Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts” by Coronado et. al.  (Rogelio A. Coronado & Joel E. Bialosky 2017)and published in the Journal of Manual and Manipulative Therapy in June 12 of 2017 and that is not hot. It’s not in the freezer. But it’s not hot. 

Why They Did It

They start by saying that chronic pain affects nearly one-third of the American population. That’s pretty stout, yeah? And sitting here 5 years later, we know that it’s only gotten worse.  Then they pop out with something fairly powerful. They say, “For manual physical therapists to play a key role in the management of individuals with chronic pain conditions, simply being a safer option is not good enough. Instead, we must practice in an effective manner as well. Manual physical therapists can effectively treat patients with chronic pain and other musculoskeletal disorders; however, the field is at a crossroads.

The traditional approach to manual therapy assumes that proper technique selection and precise implementation is the primary driver of a successful outcome [10,11]. In this view, the resultant outcomes are directly attributed to the applied intervention. A similar perspective on intervention may be witnessed in traditional medicine when, for example, a pharmaceutical agent is prescribed to manage cholesterol or blood pressure, or a surgical approach is elected based on abnormal imaging findings. We propose manual physical therapists will only be recognized as ideal providers for individuals with chronic pain if we accept an updated paradigm acknowledging the complexity of the manual physical therapy experience and accept the robustness of varying contextual elements inherent in our interactions.  For some clinicians, this will require a revolutionary shift in their perception of the development, maintenance, and modulation of pain [12].

Pain is an experience orchestrated by dynamic sensory, cognitive, and affective processes and is strongly influenced by patient’s expectations, mood, desires, and past experiences. Limiting pain perception to a peripheral impairment is outdated and a more comprehensive, albeit complex, approach to manual therapy accounts for a myriad of interacting factors impacting chronic pain outcomes.”

What did the five fingers say to the face? Slap!!

That was like Will Smith Rocking Chris Rock…..

“Maladaptive neuroplastic changes are evident in patients presenting with chronic pain conditions, suggesting intriguing targets for effective treatments. “Pain sensitivity can serve as a proxy measure for central sensitization – a phenomenon that may impact prognosis and treatment response – and perhaps provide a more effective therapeutic target for treating patients with chronic pain” How many times have you heard me talk about upregulation and pain sensitization?? This is it, right here.  Patients with chronic musculoskeletal pain often report co-existing psychosocial complaints known to worsen their prognosis and limit the effectiveness of interventions.

Manual therapists are in need of clinical strategies to minimize the influence of negative psychosocial factors and boost positive thinking and outlook. Just a diagnosis with zero treatment has been shown to be helpful. How many times have you heard that words matter?? With our words alone, we can push someone into chronic pain or bring them more toward the surface. 

“Manual therapy is often a component of a comprehensive treatment package and multiple interventions may interact to influence clinical response.” – exactly – a broad management approach and not one single intervention solve the puzzle.  “Patient education is an important component of a manual physical therapy interaction and the manner and content of education, specifically related to pain, can greatly influence treatment effectiveness. “ – If you’re not properly educating and explaining without the catastrophization and doctor dependency garbage we see in our profession, then you’re missing the boat and doing more damage than good.  “Manual physical therapists should recognize the multidimensional nature of chronic pain as well as the complex interactions of contributing factors accounting for manual therapy-related treatment effects.

Continuing to attribute an effective manual physical therapy intervention to the correction of a peripheral impairment is too simplistic and prevents conscious attempts to augment contributing factors known to enhance outcomes in patients with chronic pain. While perhaps a safer avenue than opioids, we believe the continuation of an outdated approach to manual physical therapy will result in suboptimal provision of care.” While this is geared to PTs it’s speaking to us chiros equally and we better pay attention because, in my learning and in my experience, it’s hitting every nail right on the head. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.


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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    


Rogelio A. Coronado & Joel E. Bialosky (2017). “Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts.” J Man Manip Ther 25(3): 115-117.        

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