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This procedure has not been established as either safe or effective for the treatment of musculoskeletal disorders such as neck and back problems.
Critical issues such as selection criteria, outcome assessments, and long-term benefits need to be addressed by well-designed studies before this Manipulation in 30 seconds can be considered as an essential part of conservative therapy. In this regard, the Guidelines for Chiropractic Quality Assurance and Practice Parameters published from the proceedings of a consensus conference commissioned by the Congress of Chiropractic State Associations declared that chiropractic involvement in MUA is a new area of special interest that needs further investigation.
Aetna considers MUA medically necessary for the following indications: Arthrofibrosis of knee following total knee arthroplasty, knee surgery, or fracture see Appendix ; or Chronic, refractory frozen shoulder adhesive capsulitis see Appendix ; or Temporomandibular joint disorders.
This policy is not intended to apply to examinations under anesthesia, or to setting fractures or complete joint dislocations under anesthesia.
Background Manipulation under anesthesia MUA is a noninvasive treatment technique used to treat acute and chronic conditions, including muscular or spinal pain. Under anesthesia, spastic muscles are believed to relax and pain sensations diminish, which theoretically may permit joint manipulation through a full range of motion.
During manipulation under anesthesia, in addition to the manipulation, passive stretches and specific articular and postural kinesthetic maneuvers may be performed in order to break up fibrous adhesions and scar tissue around the spine and surrounding tissues.
Spinal manipulation under anesthesia SMUA has been used mostly by osteopaths and to a much lesser degree by orthopedists to treat spinal dysfunction. More recently, some chiropractors, with the assistance of anesthesiologists, have also employed this technique to alleviate acute and chronic neck and back pain.
The rationale for this approach is that fibrotic changes in the peri-articular and intra-articular soft tissues hinder movement, and sometimes it is necessary to anesthetize patients to reduce muscle tone and protective reflex mechanisms so that the spine can be manipulated effectively.
This maneuver supposedly will break up adhesions within the surrounding spinal joints and stretch the restricting fibrotic tissue to a length compatible with motion, thereby, increasing joint function and reducing pain.
Anesthesia is usually induced by intravenous Pentothal sodium thiopentaland manipulation of the affected joints takes about 7 to 10 minutes. Although the risks associated with spinal manipulation and SMUA appear remote, serious complications following lumbar spinal manipulation, including massive cauda equina compression and vertebral pedicle fracture have been reported.
Additionally, general anesthesia carries a small but clinically significant risk of anaphylaxis or malignant hyperpyrexia. An assessment on SMUA Kohlbeck and Haldeman, concluded that medicine assisted spinal manipulation therapies have a relatively long history of clinical use and have been reported in the literature for over 70 years.
However, evidence for the effectiveness of these protocols remains largely anecdotal, based on case series mimicking many other surgical and conservative approaches for the treatment of chronic pain syndromes of musculoskeletal origin.
There is, however, sufficient theoretical basis and positive results from case series to warrant further controlled trials on these techniques. There is a lack of reliable evidence in the peer-reviewed published medical literature of the effectiveness of spinal manipulation under anesthesia.
Evidence of spinal manipulation under anesthesia is of low quality, consisting primarily of case reports and uncontrolled case series. Limitations of current literature include small sample sizes, lack of random assignment, and limited evidence of durability.
Other issues include uncertainties in patient selection criteria, and differences in protocols reported in studies, making generalizations difficult.
Studies have reported on attendant risks of spinal manipulation see. Guidelines from the American College of Occupational and Environmental Medicineand the Work Loss Data Institute state that spinal manipulation under anesthesia is not recommended.
In a prospective cohort study of 68 chronic low-back pain LBP patients, Kohlbeck et al measured changes in pain and disability for LBP patients receiving treatment with medication-assisted manipulation MAM and compared these to changes in a group only receiving spinal manipulation therapy SMT.
Outcomes were measured using the Version 2.Dec 24, · Do at least 30 seconds of kneading to each section/muscle, concentrating on the wrist area.
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