Successful Reporting: Successful reporting would include a validated QVAS or similarly validated tool showing for pain and functionality show either: a. A two (2) point pain improvement since last clinical encounter with the treating provider or maintenance of a functional improvement greater than or equal to a six (>6). b. If functionality 5 or less and/or pain 7 or more, medical record documentation of treatment change or diagnostic work up is present. c. Failure to document these changes with continued treatment despite lessening functionality and/or increasing pain would result in measure failure. Measure explanation: a. Utilizes Quadruple Visual Analogue Scale (QVAS) or similarly validated tool for pain related patient encounters to assess and document efficacy, functional, clinical and/or pain improvement of at least two points (a two-point reduction to show improvement) or a functionality > 6 to show functional improvement is maintained with current treatment. Pain scale maintained between 4-6 for good control with current treatment regimen and/or a two-point improvement in pain since last visit for treatment with or without treatment adjustments. If this fails to occur provider changes technique or considers other intervention (i.e.: further diagnostics, referral, injections, prescription medication). b. If provider changes manipulative technique at the previous visit he/she uses QVAS at the subsequent visit to assess impact of change in technique or intervention on current pain state where patient’s pain is above a 6 on a 0-10 scale with 0 being no pain and 10 greatest pain and/or functionality is < 6 on a 0- 10 scale with 10 most and 0 least functional. Pain scale maintained between 4-6 for good control with current treatment regimen and/or a two-point improvement in pain since last visit for treatment with or without treatment adjustments. If this fails to occur provider changes technique or considers other intervention (i.e.: further diagnostics, referral, injections, prescription medication). Rate 1: Percentage of patients receiving manipulative medicine with a QVAS score and treatment adjustment/maintenance for low back pain. Rate 2: Percentage of patients receiving manipulative medicine with a QVAS score and treatment adjustment/maintenance for neck pain.