Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin

Spinal manipulation under anesthesia: a narrative review of the literature and commentary

“…It has been suggested or hypothesized that the efficacy of the MUJA procedure, or proposed manipulation following periarticular anesthetics, may be related to facilitation of the manipulative maneuver [47,48]. Specific to MUEA, it has been postulated that observed treatment efficacy for radiculopathic conditions of the cervical or lumbar regions is related to the combined effect of addressing both the inflammatory and mechanical components of pain [9].…”

“…For each of the varied forms of MAM, treatment is reserved for individuals who have already pursued traditional modes of care [3-5,7,9,11,12,14-16,18,25],[31,33,36,38,47] (including, in part, spinal manipulation), but for whom the condition is recalcitrant [47]. Significant pain and dysfunction typically preclude a return to normal activities [5], whether personal, occupational or recreational.…”

“…MUJA has been said to be a clinical correlate of MUA [47]. However, it would be an oversimplification to compare MUJA or MUEA with the MUA procedure in general.…”

“…Nonetheless, as health care professionals charged with the public trust, chiropractors who perform spinal manipulation under anesthesia, or make referrals for the like, should know and rely upon existing published medical evidence when making clinical decisions for individual patients. Once the influences of anything other than the findings of bona fide clinical investigation or best practice consensus statements enter the patient-care decision making process, particularly with regard to a procedure that has had a history of being controversial [32,35,38,47], the integrity of the doctor patient relationship may become compromised. When educated health care professionals allow their views on patient care approaches to be shaped by testimonials (anecdotal evidence), as if such declarations are somehow akin to research evidence, a doctor’s decision making abilities become compromised and, in essence, are relegated to the level of the laity.…”