Orthopedics 208: Managing Chronic Pain | Chiropractic CE

Chronic pain is one of the most clinically complex presentations a chiropractor encounters, requiring a structured, evidence-informed approach that extends beyond standard musculoskeletal care. As acute pain transitions into a chronic state, neuroplastic brain changes and psychosocial barriers compound the challenge of recovery, demanding both diagnostic precision and collaborative management. Orthopedics 208 equips practicing chiropractors with the clinical tools, screening frameworks, and treatment algorithms needed to confidently manage the chronic pain patient.

What You Will Learn

• Outline pain management strategies and treatment protocols for the chronic pain patient, including the use of the Diagnosis-Based Clinical Decision Rule (DBCDR)
• Discuss brain changes associated with chronic pain and how manual therapy modulates neuroplastic cortical adaptations
• Review the Flag system for identifying red and yellow psychosocial barriers to recovery, including Waddell Non-organic Signs
• Diagram proper return-to-work strategies for chiropractic patients presenting with chronic pain conditions

Course Overview

Chronic pain is broadly defined as pain persisting beyond the expected healing time — typically three to six months — and represents a distinct clinical entity from acute musculoskeletal complaints. In this course, Dr. Steven Yeomans introduces the Flag system as a structured screening tool for identifying patients at risk for delayed recovery. Red flags indicate serious pathology requiring immediate referral, while yellow flags highlight psychosocial factors — such as fear-avoidance beliefs, catastrophizing, and workplace dissatisfaction — that predict chronicity and poor outcomes. Understanding these flags allows chiropractors to triage patients appropriately and initiate targeted interdisciplinary collaboration from the outset of care.

A cornerstone of this course is the Diagnosis-Based Clinical Decision Rule (DBCDR), a decision-making algorithm that guides chiropractors through assessment and treatment planning for the chronic pain patient. Outcome assessment tools — including standardized questionnaires that quantify functional status, pain intensity, and psychosocial risk — are reviewed in depth. Dr. Yeomans also addresses Waddell Non-organic Signs, a set of clinical findings that help distinguish organic pathology from behavioral pain responses, informing more accurate prognosis and care planning.

Among the most compelling topics in this course is the emerging science of central sensitization and neuroplastic brain changes that occur when acute pain becomes chronic. Research demonstrates measurable alterations in cortical gray matter and pain-processing pathways in patients with chronic pain. Critically, Dr. Yeomans reviews evidence suggesting that manual therapy can modulate these brain changes, reinforcing the unique value of chiropractic intervention in chronic pain management. The course closes with practical return-to-work strategies and self-help approaches, ensuring chiropractors can guide patients through the full continuum of care.

Course Outline

1. Definition of Chronic Pain
2. Red and Yellow Flags — the Flag System
3. Subjective/Objective Detection Methods
4. Outcome Assessment Tools
5. Assessment & Treatment Algorithms — Diagnosis-Based Clinical Decision Rule (DBCDR)
6. Waddell Non-organic Signs
7. Management Strategies and Self-Help Strategies
8. Brain Changes When Acute Pain Becomes Chronic
9. Modulating Brain Changes with Manual Therapy
10. Return-to-Work Strategies

About the Instructor

Steven G. Yeomans, DC, FACO is a board-certified chiropractic orthopedist (FACO) who completed a rigorous five-year residency program and has maintained that certification since 1985, bringing decades of orthopedic clinical expertise to every course he teaches. A graduate of National University of Health Sciences, Dr. Yeomans is the author of The Clinical Application of Outcomes Assessment (Appleton & Lange, 1999), has taught at seven chiropractic colleges, and serves as Lead Orthopedics Faculty at CCEDseminars — with additional service on the Medical Advisory Board of Spine-health.com and as a member of the North American Spine Society. Learn more about the full CCEDseminars faculty at ccedseminars.com/faculty.

Frequently Asked Questions

Is this course approved for chiropractic CE credit in my state?

Orthopedics 208 is PACE-approved and recognized by chiropractic licensing boards in the majority of U.S. states. CE requirements and board acceptance vary by jurisdiction, so chiropractors should verify their specific state's acceptance of PACE-approved online courses. CCEDseminars maintains a state-by-state CE guidelines page to help you confirm eligibility before registering.

How does this course address the clinical challenges chiropractors face with chronic pain patients?

The course provides a systematic clinical framework — including the Flag system, DBCDR algorithms, Waddell Non-organic Signs, and outcome assessment tools — that helps chiropractors differentiate chronic pain presentations, identify psychosocial barriers to recovery, and implement evidence-based management strategies. It also covers the neuroscience of central sensitization and how manual therapy can favorably influence brain neuroplasticity in chronic pain patients.

What format is this course, and how long do I have to complete it?

This is a 2-credit-hour online course available entirely on demand, so you can study at your own pace from any internet-connected device. Once enrolled, you will have extended access to all course materials. Upon successful completion of the post-course assessment, your CE certificate is generated immediately for your records.

Certification & Programs

Orthopedics 208 may count toward CCEDseminars' structured chiropractic certification programs — visit the Certification Programs page to explore available tracks and credit requirements.

State CE Requirements

CE hour requirements and course-type restrictions differ by state licensing board — review the Online Chiropractic Course Guidelines page to confirm this course meets your state's renewal requirements before enrolling.

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References

1. Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther. 2011;91(5):700–711. doi:10.2522/ptj.20100330. Available at: https://pubmed.ncbi.nlm.nih.gov/21451097/
2. Woolf CJ. Central sensitization: Implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–S15. doi:10.1016/j.pain.2010.09.030. Available at: https://pubmed.ncbi.nlm.nih.gov/20961685/
3. Apkarian AV, Sosa Y, Sonty S, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci. 2004;24(46):10410–10415. doi:10.1523/JNEUROSCI.2541-04.2004. Available at: https://pubmed.ncbi.nlm.nih.gov/15548656/
4. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009;14(5):531–538. doi:10.1016/j.math.2008.09.001. Available at: https://pubmed.ncbi.nlm.nih.gov/19027342/