Manipulation under anesthesia for pain
 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:
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.
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