Pain Management Doctor or Chiropractor? How They Work Together
Back or neck pain often leads people to ask: should I see a pain management doctor or a chiropractor? For many people, the answer is both. The two are care partners. Each brings different training and tools, and patients are often referred from one to the other. This guide explains what each one does, how they work together, and when patients see both.
Quick Answer: Pain Management Doctor or Chiropractor?
- A pain management doctor is a medical doctor (MD or DO) who can order tests, prescribe medicines and do image-guided injections.
- A chiropractor is a Doctor of Chiropractic (DC) who mainly uses hands-on care such as spinal manipulation, plus exercise and advice.
- They work together. Patients are referred both ways, and many people see both.
- Bladder or bowel changes, or weakness in both legs? That is an emergency. Call 911.
What Does a Pain Management Doctor Do?
A pain management doctor is a medical doctor. You may also hear the name pain medicine doctor. After medical school, they train for years in a residency. This is often in anesthesiology, physical medicine and rehabilitation, or neurology. Then they spend one more year in a pain medicine fellowship [Source].
A pain management doctor may:
- Ask about your pain and do a full exam, including a nerve exam
- Order tests such as X-rays or an MRI, or refer you for nerve testing
- Prescribe medicines and refer you to physical therapy
- Do image-guided procedures, such as an epidural steroid injection or a medial branch block, when they fit
- Work with your family doctor, chiropractor, therapists and surgeons
Learn more about why people see a pain management doctor and the role of an interventional spine specialist.
What Does a Chiropractor Do?
A chiropractor holds a Doctor of Chiropractic (DC) degree. The program usually takes 4 years, after at least 3 years of college. Chiropractors pass national board exams and hold a state license. They also take classes each year to keep learning [Source].
Chiropractic care is mostly hands-on. Spinal manipulation is a quick, controlled push to a joint. Mobilization is a slower, gentler move without the push. Chiropractors also give exercises and tips on posture and activity [Source]. In New York, chiropractors may take X-rays, but they do not prescribe medicines or do surgery [Source].
What Each One Does
| Pain management doctor | Chiropractor | |
|---|---|---|
| Degree | MD or DO | DC (Doctor of Chiropractic) |
| Training after college | Medical school, residency, then a pain fellowship | Doctor of Chiropractic program |
| Main tools | Exam, tests, medicines, physical therapy referral, image-guided injections | Spinal manipulation, mobilization, exercise, posture and activity advice |
| Imaging | Orders X-rays, MRI and CT | May take X-rays |
| Medicines | Can prescribe | Drug-free, hands-on care |
| Works with | Chiropractors, physical therapists, primary care doctors and surgeons | Pain management doctors, physical therapists and primary care doctors |
How the Two Work Together
Chiropractors are key referral partners for pain management doctors. Each focuses on a different part of care, so working together can give you more options. Patients are referred both ways:
- From a chiropractor to a pain management doctor, for a medical exam, an imaging review, a nerve check or an image-guided injection.
- From a pain management doctor to a chiropractor, for hands-on care, movement work and posture advice.
- Shared updates. With your OK, the two can share notes and imaging so your plan fits together.
Our Farmingdale office works side by side with a chiropractic practice, and the two staffs work closely together. For long-lasting back pain, team programs that help both body and mind worked better than usual care [Source].
When Patients See Both
Many people get the best fit by using both kinds of care. Common examples include:
- Pain that travels down an arm or leg. A pain management doctor checks the nerves and may suggest an injection for sciatica, while chiropractic care continues for movement and comfort.
- After a car accident. Get a medical exam first, then a care plan that may include both. See the first 30 days after a car accident.
- Pain that lasts for months. Tests can look for the cause, while hands-on care and exercise help you stay active.
- After a procedure. Your doctor will tell you when it is fine to go back to hands-on care and exercise.
Home exercise helps too: see lower back stretches and neck exercises. Tell each provider about all the care you get.
What the Research Says
US doctors’ guidelines list spinal manipulation as one of several drug-free choices for low back pain. Others include exercise and heat [Source]. For new low back pain, manipulation gave small to modest gains in pain and movement for up to 6 weeks [Source]. For long-lasting low back pain, it worked about as well as other advised treatments [Source]. For neck pain, manipulation and mobilization gave similar results [Source].
For pain medicine, guidelines say an epidural steroid shot may be considered for severe sciatica. But spine shots are not advised for low back pain alone [Source]. The FDA has not approved steroids for this use, so it is off-label. Talk through the risks and benefits first.
Where to Start
Many people start with their primary care doctor. See what doctor to see for back or neck pain. Either a pain management doctor or a chiropractor can be a good first stop, and each can refer you to the other.
- New back or neck stiffness without warning signs: either one is a reasonable start. Choose the type of care you prefer.
- Nerve pain down an arm or leg, numbness, weakness, or pain lasting months: a medical exam early on is a good idea.
Dr. Amit Sharma & our minimally invasive pain & spine team.
Warning Signs That Need Urgent Care
Call 911 or go to the emergency room now for numbness in the groin, buttocks or inner thighs; new trouble peeing, or loss of bladder or bowel control; or weakness in both legs. These can be signs of cauda equina syndrome. Also get emergency care for back or neck pain after a serious accident, or for sudden severe neck pain or headache with dizziness, vision changes, trouble speaking or weakness.
See a doctor soon for back pain with fever, a history of cancer, weight loss you cannot explain, or weakness that keeps getting worse [Source]. Learn more about when back pain is an emergency.
Working With SpinePain Solutions
At SpinePain Solutions, Dr. Amit Sharma, Chief, Division of Pain Medicine at Good Samaritan University Hospital, evaluates back and neck pain at our Bay Shore, Commack and Farmingdale offices (see office locations). He works with chiropractors, physical therapists and primary care doctors, and referrals go both ways. Care starts with simple, conservative steps, and options are based on your exam and goals. Call 631-310-0000.
Frequently Asked Questions
Should I see a pain management doctor or a chiropractor first?
It depends on your symptoms. For new, mild back or neck pain without warning signs, either can be a reasonable first step, and many people start with their primary care doctor. If you have nerve pain down an arm or leg, numbness, weakness, or pain that has lasted for months, a medical exam early on is a good idea. Either one can refer you to the other.
When should I go to the ER instead?
Call 911 or go to the ER for numbness in the groin or inner thighs, new trouble peeing, loss of bladder or bowel control, or weakness in both legs. These can be signs of cauda equina syndrome. Also get emergency care for back or neck pain after a serious accident, or sudden severe neck pain or headache with dizziness, vision changes, trouble speaking or weakness.
What does a pain management doctor do?
A pain management doctor is a medical doctor (MD or DO). They look for the cause of pain and make a plan. The plan may include tests such as an MRI, medicines, physical therapy, and image-guided shots or nerve blocks when they fit.
What does a chiropractor do?
A chiropractor is a Doctor of Chiropractic (DC) who mainly uses hands-on care, such as spinal manipulation and mobilization, along with exercise and advice on posture and activity. In New York, chiropractors do not prescribe medicines or do surgery.
Do chiropractors and pain management doctors refer patients to each other?
Yes. Chiropractors are key referral partners, and patients are referred both ways. A chiropractor may send a patient for a medical exam, an imaging review or an injection. A pain management doctor may send a patient for hands-on care and movement work.
Can I see a chiropractor and a pain management doctor at the same time?
Yes, many people do, and the two often work as a team. Tell each provider about the other care you are getting, and share any imaging or test results so your care fits together.
Do I need a referral?
Some offices ask for a referral from your primary care doctor and some do not. Check with the office before your visit.
Where does physical therapy fit in?
Physical therapy is a core part of care for most back and neck pain. Both pain management doctors and chiropractors often work with physical therapists, and exercise is a first-line treatment in guidelines.
Dr. Amit Sharma & our minimally invasive pain & spine team.
Medical References
- National Center for Complementary and Integrative Health (NCCIH). Chiropractic: in depth. NCCIH.
- National Center for Complementary and Integrative Health (NCCIH). Spinal manipulation: what you need to know. NCCIH.
- New York State Education Department, Office of the Professions. Education Law Article 132, Chiropractic, Section 6551. NYSED.
- Accreditation Council for Graduate Medical Education (ACGME). Program requirements for graduate medical education in pain medicine (2025). ACGME.
- Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367. PubMed.
- Paige NM, Miake-Lye IM, Booth MS, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA. 2017;317(14):1451-1460. doi:10.1001/jama.2017.3086. PubMed.
- Rubinstein SM, de Zoete A, van Middelkoop M, et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. doi:10.1136/bmj.l689. PubMed.
- Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev. 2015;(9):CD004249. doi:10.1002/14651858.CD004249.pub4. PubMed.
- Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444. doi:10.1136/bmj.h444. PubMed.
- National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management (NG59). NICE.
- Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. J Orthop Sports Phys Ther. 2020;50(7):350-372. doi:10.2519/jospt.2020.9971. PubMed.
