Manipulation
under anesthesia for pain
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This procedure, manipulation under anesthesia (MUA), is a non-invasive
procedure increasingly offered for acute and chronic conditions, including:
neck pain, back pain, joint pain, muscle spasm, shortened muscles,
fibrous adhesions and long term pain syndromes. It is generally considered
safe and is utilized to treat pain arising from the cervical, thoracic
and lumbar spine as well as the sacroiliac and pelvic regions.
Manipulation
under anesthesia uses a combination of specific short lever manipulations,
passive stretches and specific articular and postural kinesthetic
maneuvers in order to break up fibrous adhesions and scar tissue around
the spine and surrounding tissue.
The manipulation procedures can be offered in any of the following
ways:
Under
general anesthesia
During
mild sedation
Following
the injection of anesthetic solutions into specific tissues of the
spine.
The treatment
is performed in a hospital or surgery center by licensed physicians
with specialized training and certification specifically for the procedure.
A team approach is required to have a safe and successful outcome.
The team
includes the anesthesiologist, the prime physician/surgeon/chiropractor
who performs the manipulation, and the first assistant, also a physician/chiropractor
certified in manipulation under anesthesia. The procedure is commonly
performed in a hospital or surgical center.
The combination
of manipulation and anesthesia is not new, as this treatment has been
part of the manual medical arena for more than 60 years.Manipulation
Under Anesthesia is an established medical procedure with a CPT Code
designate of 22505. This is noted in the American Medical Association’s
Current Procedural Terminology Publication.
Which patients should be considered for manipulation under anesthesia?
Certain neck, mid back, low back or other spinal conditions respond
poorly to conventional care. One proposed theory for this is that,
as a result of past or present injury, adhesions and scar tissue have
built up around spinal joints and within the surrounding muscles and
causes chronic pain.
Patients
often undergo various treatments, such as physical therapy, chiropractic
care, epidural injections, back surgery, or other treatments that
do not address fibrous adhesions. Some patients feel temporarily better
with these treatments, but their pain often returns.
In general,
patients selected for manipulation under anesthesia are those who
have received conservative care for six to eight weeks. If limited
or no improvements in symptoms or objective findings have occurred,
then manipulation under anesthesia may be an appropriate alternative.
Prior
to treatment, protocols of diagnostic testing should document the
nature of the diagnosis, support the need for treatment and eliminate
questions of psychosocial factors that can influence pain responses.
In addition to X-ray, MRI scan or CT scan, a musculoskeletal sonogram
or nerve conduction velocity test may be ordered.
