Intervention Review ArticleEvidence-informed management of chronic low back pain with medicine-assisted manipulation
Section snippets
Terminology
Medicine-assisted manipulation (MAM) is a broad term used to define manipulation of the spine after any type of anesthesia or analgesia, whether facilitated by injections or oral pharmaceuticals. It is often used interchangeably with the term manipulation under anesthesia (MUA), which is the most commonly used form of MAM.
History
Various forms of MAM have been used since the 1930s and several studies were published on MUA in the 1940s and 1950s when it was practiced by orthopedic surgeons and
Mechanism of action
The use of MUA grew from clinical observation and experience that the combined effects of anesthesia/analgesia and SMT were more beneficial than when each was administered separately [1]. The mechanism of action offered to explain these observations is that anesthesia/analgesia decreases regional pain, spasm, or muscle guarding that could interfere with effective delivery of manual therapies such as SMT, mobilization, traction, and stretching. The relaxation brought about by MUA is postulated
Review methods
A search of the electronic databases Medline, Embase, and CINAHL was conducted in May 2007 using a search strategy recommended by the Cochrane Back Review Group (CBRG) to identify clinical trials related to LBP [14]. The following terms related to MUA, MUJA, and MUESI were added to the (CBRG) strategy: MUJA.tw. or MUJA.mp., (MUA adj20 (spin$ or back$)).tw., (manipulati$ adj3 anesthe$).tw., (manipulati$ adj5 inject$).tw., or/1-4, exp Manipulation, Spinal/, exp Manipulation, Chiropractic/, exp
Harms
Although older forms of MUA using more forceful long-lever techniques were associated with adverse events (AEs) such as cauda equina syndrome, paralysis, and fracture, more recent studies have not reported any serious AEs [1]. If malpractice insurance premiums may be used as a proxy for the safety of a procedure, it should be noted that two large chiropractic insurers provide MUA coverage at no additional charge to their members [2]. Temporary flare-ups in lumbosacral pain have been reported
Summary
As noted in previous studies, generalizing prior MUA literature is very challenging—perhaps even inappropriate—because of participant heterogeneity and differences in treatment procedures used several decades ago and those used today [1], [16]. Overall, the methodological quality of the studies uncovered related to MUA, MUESI, and MUJA is weak and evidence consists mainly of observational studies. None of the MAM procedures have been subjected to a RCT and the absence of a rigorous, comparable
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Manipulation Under Anesthesia in Infants With Arthrogenic Newborn Torticollis: A Retrospective Case Series
2018, Journal of Chiropractic MedicineCitation Excerpt :Other contraindications to MUA are those of its individual components (eg, anesthesia and SMT). The relaxation brought about by MUA is postulated to allow the manual therapist to more effectively break up joint and soft-tissue adhesions and reduce segmental dysfunction with less force than would otherwise be required to overcome patient resistance or apprehension.24 Proper patient selection, a well-versed practitioner, preanesthesia instructions, and accurate monitoring of the patient during and after the procedure will help to minimize the chance of adverse effects.25
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2017, International Journal of Educational ResearchMedical Management of Neck and Low Back Pain
2016, Benzel's Spine Surgery: Techniques, Complication Avoidance and Management: Volume 1-2, Fourth EditionManipulation under anesthesia for lumbopelvic pain: A retrospective review of 18 cases
2014, Journal of Chiropractic MedicineCitation Excerpt :Anesthesia minimizes pain, muscle spasm, and protective guarding that may occur during manipulation. Manipulation on a sedated patient is purported to enhance the practitioner’s ability to break apart adhesions and repair segmental dysfunction,11,15,17,30 leading to increased ligament, tendon, muscle, and articular flexibility.22 Manipulation under anesthesia has been used as an intervention for back pain in some form for more than 80 years.31
The Role of Manual Therapies in Equine Pain Management
2010, Veterinary Clinics of North America - Equine PracticeCitation Excerpt :Joint mobilization and manipulation can be combined with sedation or general anesthesia, which provides increased relaxation and analgesia for evaluation of subtle joint motion restrictions or treatment of joint contractures and spinal pain, without the influence of conscious pain or protective muscle guarding.111 Manipulation under anesthesia generally consists of 4 stages: sedation, mobilization/stretching/traction, manipulation, and aftercare of active rehabilitation and additional manual therapy.112 Indications for manipulation under anesthesia in humans include pain that will not allow conscious manipulation, conditions that do not respond to conscious spinal manipulation within 4 to 8 weeks, chronic joint or soft tissue fibrosis, acute myofascial rigidity and painful inhibition, severe joint dysfunction, refractory contained disc herniation, and multiple recurrences of a condition.113
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