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 :As with other manual therapies, it is challenging to conduct quality research in this area. Eligibility for MUA often includes a requirement for prior failed SMT, making SMT alone a poor control group because those proceeding to MUA already would have been identified as not responding to SMT.24 Furthermore, it would not be ethically justifiable not to treat these infants as the time frame for obtaining best results is limited.
Further exploring the rationality of evidence informed practice: A semiotic analysis of the perspectives of a school federation
2017, International Journal of Educational ResearchCitation Excerpt :Likewise, analysis by Mincu (2014) suggests that where research is used as part of high quality initial teacher education and ongoing professional development, that this makes a positive difference in terms of teacher, school and system performance. Yet, at the same time, there exists a recognized failure, on an international scale, of evidence to make a widespread and sustained impact on the practices of educators (Bryk, Gomez, & Grunow, 2011; Nelson, Mehta, Sharples, & Davey, 2015); and, despite considerable activity, the development of system-wide processes to meaningfully connect research and practice across the piece remain underdeveloped (Gough, Tripney, Kenny, & Buk-Berge, 2011). In part this research and practice ‘gap’ may be a reflection of the critique often levelled at the perceived use value of educational research for practitioners.
Medical 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 :The audible separation of these joints is associated with release of tissue adhesions, stimulation of the afferent nerve to the Z-joint and spinal muscles, and reflex neurologic and possibly immunologic sequelae and inflammatory chemical down-regulation.10-14 There are a percentage of patients in whom cavitation of the spinal facet joint is not possible because of spasm, guarding, and inhibitory mechanisms15-17 despite meeting clinical criteria for its use.18-20 Manipulation under anesthesia (MUA) is a pain management procedure using passive stretches combined with spinal manipulation under conscious sedation or general anesthesia with the goal of relieving musculoskeletal pain.
The Role of Manual Therapies in Equine Pain Management
2010, Veterinary Clinics of North America - Equine PracticeCitation Excerpt :The risks of manipulation under sedation or general anesthesia include the inability of patients to provide verbal feedback on pain or to resist overzealous manipulation because intrinsic guarding mechanisms associated with voluntary muscle contraction are absent, which can produce an increased risk of iatrogenic injuries.113 There is currently insufficient evidence to make any recommendations regarding the use of manipulation under anesthesia for chronic low back pain in humans.112 Spinal manipulation under sedation and anesthesia has been used in horses to address reduced joint mobility; however, controlled studies are lacking.101,114,115
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