Group Medical Visits and Chiropractic Care for Older Adults With Chronic Spine Pain

Inclusion Criteria: * 65+ years of age * Chronic neck, thoracic, and/or low back pain at least 5 days a week for at least 3 consecutive months * Neck, thoracic, and/or low back pain averaged over past week of 3 or more on numerical rating scale ranging from 0 to 10, with 10 described as 'worst pain imaginable' * Oswestry Disability Index score of 10% or greater * Access to and ability to use a smartphone, tablet, or computer and broadband internet * Access to reliable mode of transportation for study visits and chiropractic treatments * Agreeable to participate in all study procedures * Fluent in English Exclusion Criteria: * Currently, or having received chiropractic care in past 12 months (for any spine pain condition) * Any disability precluding safe exercise practice * Any prior spinal surgery within previous year * Persons currently involved in a disability/accident claim * Currently living in a nursing home and/or enrolled in hospice * Need for additional diagnostic imaging at the eligibility exam * Signs/symptoms of major systemic illness that may impair the participant's ability to effectively attend intervention sessions, or present risk factors to the care protocol: Participants with signs or symptoms suggesting the need for evaluation and/or management by other providers (e.g., Parkinson's disease, cancer, psychosis, substance use addiction) * Non-neuromusculoskeletal source: Participants with neck or back pain suspected or confirmed non-neuromusculoskeletal source (e.g., vasculitis, referred pain of cardiopulmonary origin, neoplasm, or infection) * Inflammatory arthritis: Participants suspected or confirmed diagnosis of rheumatoid arthritis, ankylosing spondylitis or other systemic inflammatory arthritis condition * Health conditions influencing compliance: Participants with health conditions that lead to difficulty complying with study protocol, such as renal dialysis, untreated psychiatric symptoms, or cognitive impairment * Vascular risk: Participants at increased risk for adverse cerebrovascular events are ineligible. Examples include a history of stroke, carotid artery dissection, or vertebral artery dissection, and those scheduled for endarterectomy procedures due to arterial stenosis. The presence of carotid artery bruit is exclusionary due to a presumed increased vascular risk and the likely need for referral and diagnostic testing * Neurological disorder: Participants exhibiting a clinical picture of serious or potentially serious neur…