By Dr. Antti Rintanen, MD, MSc
Chronic pain affects over 20% of adults globally and remains one of the most difficult conditions to treat effectively with conventional medicine alone1. Despite major advancements in diagnostics, pharmacology, and rehabilitation, many patients continue to suffer from persistent musculoskeletal pain—often with minimal structural findings on imaging.
As a medical doctor, I’ve seen firsthand how frustrating chronic pain can be for both patients and providers. Yet, one approach that is increasingly gaining recognition—and results—is chiropractic care. By addressing the neuromuscular and biomechanical root causes of pain, chiropractic treatment offers a low-risk, evidence-based pathway that complements conventional medical care and improves patient outcomes.
Chronic pain is multifactorial. Beyond structural degeneration, it may involve peripheral and central sensitization, muscular imbalances, altered movement patterns, psychological distress, and inflammatory dysregulation2. In many cases, these patients are told there is "nothing wrong" based on imaging, but they continue to experience debilitating pain.
Pharmacological management—NSAIDs, antidepressants, anticonvulsants, and even opioids—may offer temporary relief but often comes with side effects and diminishing returns over time3.
This highlights the need for a broader, more functional model of care, where non-pharmacologic interventions like chiropractic treatment take center stage.
Chiropractors specialize in assessing and treating biomechanical dysfunctions—joint restrictions, spinal misalignments, soft tissue tension, and abnormal neuromuscular control. Manual adjustments and mobilizations are used to restore joint mobility and improve spinal alignment, which can reduce nociceptive input and promote normal movement patterns4.
Rather than chasing symptoms, chiropractic care focuses on correcting the functional disturbances that perpetuate chronic pain. This includes not only spinal adjustments but also soft tissue work, rehabilitative exercises, ergonomic counseling, and postural correction.
From a medical perspective, this hands-on, patient-centered model offers several key advantages:
The integration of chiropractic care into chronic pain management is increasingly supported by peer-reviewed literature.
A 2017 systematic review and meta-analysis in JAMA examined spinal manipulative therapy for acute and chronic low back pain. The authors concluded that spinal manipulation resulted in modest improvements in pain and function at jp to six weeks, with no serious adverse events reported5.
Another 2020 study published in Pain Medicine found that patients who included chiropractic care in their treatment plans had significantly reduced use of opioid medications, compared to those who received medical care alone6. Given the global concern over opioid overuse, this is a powerful finding.
Furthermore, the American College of Physicians (ACP) updated its guidelines in 2017 to recommend spinal manipulation and other non-pharmacologic therapies as first-line treatment for chronic low back pain7.
While chiropractic care is most widely known for back and neck pain, it has also shown efficacy in several other chronic pain presentations:
Many of these conditions respond well to consistent, conservative care with a functional focus. Chiropractic treatment also empowers patients by giving them strategies to manage their condition long-term—through exercises, posture training, and lifestyle adjustments.
From a systems-level perspective, integrating chiropractic care into chronic pain pathways can reduce healthcare costs, enhance patient satisfaction, and improve functional outcomes13. But collaboration between chiropractors and medical doctors is still evolving in many regions.
Some physicians remain uncertain about the evidence base or scope of chiropractic care. However, today’s chiropractors are increasingly research-informed, safety-conscious, and collaborative in their approach. They bring value to a medical team in the same way a physiotherapist or pain specialist does—through domain-specific expertise.
Here’s how effective integration might look:
This synergy avoids fragmented care and keeps the patient at the center of the process.
Chiropractic care is especially useful in the following chronic pain scenarios:
It is not a panacea—but it is an essential tool in the chronic pain toolbox.
Ultimately, chronic pain care must evolve beyond a reactive, symptom-suppressing model. It requires an integrative approach, where various disciplines bring their strengths to the table. Chiropractic care, with its emphasis on structure, function, and movement, fills a critical gap left by traditional medicine.
As physicians, we have a responsibility to explore safe, effective, and sustainable options for our patients. Chiropractic care checks all three boxes. And for patients navigating the complexity of chronic pain, that’s a step in the right direction.
Dr. Antti Rintanen, MD, MSc is a licensed medical doctor from Finland with a Master’s degree in Industrial Engineering and Management. He is the founder of The Internet Doctor, a platform that translates medical knowledge into accessible insights for public and professional audiences. His clinical focus includes integrative musculoskeletal care and chronic pain management.
Haas, M., Sharma, R., & Stano, M. (2005). Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain. Journal of Manipulative and Physiological Therapeutics, 28(8), 555–563. https://pubmed.ncbi.nlm.nih.gov/16226622/
Goldberg, D. S., & McGee, S. J. (2011). Pain as a global public health priority. BMC Public Health, 11, 770. https://doi.org/10.1186/1471-2458-11-770
Mrozikiewicz-Rakowska, B., et al. (2023). Whole body cryostimulation: A new adjuvant treatment in central sensitisation and chronic pain syndromes? Healthcare, 11(5), 546. https://www.mdpi.com/2227-9032/12/5/546
Mayo Clinic Staff. (n.d.). Chronic pain: Medication decisions. Mayo Clinic. Retrieved April 19, 2025, from https://www.mayoclinic.org/chronic-pain-medication-decisions/art-20360371
Bialosky, J. E., Bishop, M. D., & George, S. Z. (2009). What effect can manual therapy have on a patient's pain experience? Manual Therapy, 14(3), 231–238. https://pmc.ncbi.nlm.nih.gov/articles/PMC4976880/
Paige, N. M., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., Mardian, A. S., Dougherty, P., ... & Shekelle, P. G. (2017). Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: Systematic review and meta-analysis. JAMA, 317(14), 1451–1460. https://jamanetwork.com/journals/jama/fullarticle/2616395
Whedon, J. M., Toler, A. W. J., Kazal, L. A., Bezdjian, S., & Greene, L. (2020). Impact of chiropractic care on use of prescription opioids in patients with spinal pain. Pain Medicine, 21(12), 3567–3573. https://doi.org/10.1093/pm/pnaa014
Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367
Bronfort, G., Assendelft, W. J. J., Evans, R., Haas, M., & Bouter, L. (2001). Efficacy of spinal manipulation for chronic headache: A systematic review. Journal of Manipulative and Physiological Therapeutics, 24(7), 457–466. https://pubmed.ncbi.nlm.nih.gov/11562654/
Pain Physician Editorial Board. (2019). Sacroiliac joint dysfunction diagnosis and management. Pain Physician, 22, 53–61. https://www.painphysicianjournal.com/current/pdf?article=NjAwNQ%3D%3D&journal=116
Shaw, L., & Descarreaux, M. (2009). A systematic review of chiropractic management of adults with whiplash-associated disorders: Recommendations for advancing evidence-based practice and research. https://www.researchgate.net/publication/42975906
Schneider, M., Vernon, H., & Ko, G. (2009). Chiropractic management of fibromyalgia syndrome: A systematic review of the literature. Journal of Manipulative and Physiological Therapeutics, 32(1), 25–40. https://www.sciencedirect.com/science/article/abs/pii/S0161475408002935
Kruse, R. A., Imbarlina, F., & De Bono, V. F. (2001). Treatment of cervical radiculopathy with flexion distraction. Journal of Manipulative and Physiological Therapeutics, 24(3), 206–209. https://pubmed.ncbi.nlm.nih.gov/11313617/
