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'Manipulation under anesthesia' stirs controversy
Submitted by administrator on Fri, 03/30/2007 - 19:33.
By JOHN HILL and KEVIN YAMAMURA
Saturday, March 31, 2007
Anesthesia lulls the patient's protective reflexes to sleep. Then a chiropractor goes to work on the spine, making adjustments that, without anesthesia, might cause the patient to tense up or wince in pain.
The procedure, known as "manipulation under anesthesia," is at the heart of recent controversy at the state Board of Chiropractic Examiners, where appointees of Gov. Arnold Schwarzenegger, including two longtime friends from his bodybuilding days, have tangled with their own staff over the board's oversight of California's 15,000 or so chiropractors.
Critics call it a lucrative and largely unnecessary procedure. Supporters say it's been practiced safely and successfully for years on patients who don't respond to more conventional treatment, pointing out that it has been endorsed by the state board at least since 1990.
The debate over MUA, as it is known, also reflects a wider disagreement over how far chiropractors can go into territory that was uncharted in 1922, when California voters passed an initiative governing the profession.
Medical groups argue that "manipulation under anesthesia" blurs the lines between their territory and chiropractic. Chiropractors who favor it say that MUA relies on exactly the same methods they use on conscious patients, only with the help of an anesthesiologist.
At its March 1 meeting, the Board of Chiropractic Examiners approved a resolution stating that MUA falls under chiropractors' scope of practice.
But even as the board was passing its resolution, a prosecutor in San Joaquin County was pursuing criminal charges against chiropractors who performed MUA. By working on patients who had been administered medication, the chiropractors were practicing uncertified medicine, according to a criminal complaint that lists several other charges.
The discrepancy highlights the quirks of the chiropractic profession in California. Chiropractors are governed by a 1922 initiative that put them largely beyond the reach of the Legislature and the state bureaucracy.
But those origins have also left the profession, in some ways, frozen in time, creating legal uncertainty about techniques that chiropractors have embraced in the eight decades since the initiative was approved by voters.
Schwarzenegger's appointees on the board have wasted no time wading into the fray. The board includes Chairman Richard Tyler, one of Schwarzenegger's earliest friends in bodybuilding, and two-time Mr. Olympia Franco Columbu, who trained with the governor, stood as best man in his wedding and appeared in some of his movies.
Another Schwarzenegger appointee, Fred Lerner, is a chiropractor who three years ago appeared before the board to speak on behalf of MUA, calling it "a very effective procedure." Lerner told the board that he had performed MUA "fairly regularly."
In one of several moves signifying that they take an expansive view of chiropractors' scope of practice, the board, in its first meeting with Tyler at the helm, endorsed MUA.
An earlier attempt in December had failed, when two holdovers appointed by former Gov. Gray Davis _ Barbara Stanfield and David Yoshida _ voted against it.
Tyler nonetheless made an impassioned plea in favor of MUA, arguing that a constricted view of chiropractors' scope of practice would leave the profession stuck in the 1920s.
"I personally will not practice MUAs, but my concerns are that we are continuing to let others decide what we can and cannot do based on their personal, professional and legal bias," Tyler said.
The resolution failed in that December meeting after a deputy attorney general representing the board pointed out that it had been written by a lawyer for the California Chiropractic Association.
"It may be a little troubling to you and you might want to put this off," Deputy Attorney General Jana Tuton said. "To be given this professional association's opinion the day before the board meeting doesn't really allow you to thoughtfully spend some time considering it."
After The Bee and state legislators started examining the board's actions, the board backed away from the March 1 resolution, voting at a special meeting last Friday to revisit the issue.
Both sides of the MUA debate agree that the technique has been around for decades.
Chris Cotton of Pleasanton decided to have MUA after injuries to his lower back from a car accident did not respond to other treatments. He had two days of one- to two-hour treatments under general anesthesia. Cotton said he was sore at first, but that his mobility and range of motion soon improved dramatically,
"It was one of the best things ever," said Cotton, who designs fire protection systems. "It just made a world of difference."
Only in recent years did it become controversial - the result, some critics say, of increasing use of the procedure and growing costs for insurers, particularly in the realm of workers' compensation.
No one knows for certain how often the procedure is used. But workers' comp carriers face bills of as much as $20,000 to pay for three successive days of MUA treatments, said Steve Jimenez, an attorney who has often found himself opposing chiropractors in workers' compensation cases.
In many cases, the chiropractors own shares of the surgery centers where the procedures are done, Jimenez said, giving them a "huge economic incentive" to recommend that their patients undergo the treatment.
"It's being litigated left and right," he said.
Jimenez said that there has never been a large-scale scientific study proving that MUA works any better than spinal manipulations done on conscious patients.
Ed Cremata, a chiropractor who advocates for MUA, said there's at least as much evidence as there is for other options for patients with back, shoulder and neck problems, such as physical therapy and injections.
It's true that some chiropractors own shares of surgery centers where MUA is done, Cremata said. But physicians have owned surgery centers for two decades, he said, and could be accused of having a financial interest in recommending just about any medical treatment.
He said most MUA treatments cost $2,000 to $3,500 per day, considerably less than the figure cited by Jimenez.
Cremata and others argue that nothing in the 1922 initiative prohibits MUA, since chiropractors are not administering the drugs themselves.
Others disagree. The California Society of Anesthesiologists opposes MUA and advises its 4,000 members - roughly 80 percent of practitioners in the state - not to participate in the procedure.
CSA President Mark Singleton said his group believes there is little evidence attesting to the safety of MUA. He said the group also objects because it believes the 1922 Chiropractic Act prohibits chiropractors from engaging in any procedure that involves medicine even if they don't administer it themselves.
There are also practical reasons for the group's opposition, Singleton said. In normal chiropractic procedures, "the patient is awake and able to report objective feelings, and that is a critical element of maintaining the safety of manipulation," he said. "By masking that and having the patient unconscious, you remove a critical safety element."
The Osteopathic Physicians and Surgeons of California also oppose MUA and spoke against the chiropractic board's resolution in December.
Likewise, the California Medical Association opposed MUA in 2004, when the board unsuccessfully tried to pass a regulation to govern use of the technique. Because MUA wasn't taught in chiropractic schools in 1922, the association said, it could not be considered within chiropractors' scope of practice.
Cremata says that the technique is perfectly safe. Patients under anesthesia are only subjected to a normal range of motion to relieve the buildup of scar tissue, he said. While the manipulation might cause pain in a conscious patient, Cremata said, it would not do any damage.
Cremata and other supporters say that California case law has made it clear that the profession should not be stuck in 1922.
The court decisions, Cremata said, "always support the fact that it wasn't meant to be static."
(Contact John Hill at jhill@sacbee.com.)
I would much rather have a
I would much rather have a chiropractor stretch my neck and back under anethesia than a medical doctor with little or no experience in this field.
Not sure about MUA yet
One of the people in charge of the office I visit sometimes for my bad back told me that he had very good news for me. I asked him if I had won the lottery and he told me that it was even better. He handed me a pamphlet with information about MUA and latter on told me a little bit about it and how much it would help me. He looked very exited and happy about it and told me that the procedure costs $85,000!!! (Is this true or was he pulling my leg?) but that I wouldn't have to pay a penny out of my pocket and I could stay with my family in a hotel for three days in the city where this procedure would take place.
He wanted me to enlist me right away for the procedure and was very insisting about it. The day after this someone called me from the chiropractors office asking for me trying to get me to use the procedure - thankfully I wasn't home because I don't like to hounded for something, even if(?) it could be good for me - It seems that someone other than the office which performs this procedure is bound to make a lot of money (my chiropractors office) since they are insisting so much on it.
I am trying to find out as much as I can over the Internet about this procedure before I make a decision on it.
Looking for Results of MUA - positive or negative
I am still in limbo about this procedure. I would like to hear from people who have had MUA performed on them and where they had it done.
In search of more information. There is alway critics out there but so far I have not read any disaster stories via the internet.
How long does the procedure hold it's benefits?
ethical question
does MUA come under physios' scope of practice..?
MUA
Did you have the procedure? What was the outcome, and would you recommend it?
best treatment ever
I know couple of hundreds of people who have been in neck manipulation and they all said it is a relief. None of them have had any problems. Most of them have received it more than once and most of them will go again when necessary because they know it is the best help.
Many athletes use it from Tiger Woods to Arnold Swarzenegger. Even many doctors use it. It has helped many.
Then I had two young friends who died mysteriously (broken blood vain in brain) without having any neck manipulation. Other was my 16yrs old cousine. So in my experience neck manipulation is very safe and very good treatment for some neck problems. And people die and if they die after neck manipulation, it might have nothing to do with manipulation because thousands of people just die even without it. How to tell what was the real reason?
Many of my friends have seen many different doctors like I did and we got pills, pills and some physical excercises. No help from them! Pain pills kill thousands of people every year.
There are many university studies about some manipulation being the best treatment for pains! Not all of them are good or safe. You have to have skills to be good! Only very few are...
Looking for Results
Has anyone had this done? I'm considering having it done in Brooklyn, NY
recently had MUA
It's Tuesday and on Wednesday I will start the PT. But As I have been trying to sleep still after having had this done, I am still not able and am still in as much pain and now i am in MORE pain than I was before the procedure.
Dr Brian worked on my neck were I have 3 herniated discs and my left arm frequently goes numb and my mid back were all the spasms are and the compression fracture and my lower back, where there are herniated discs, degenerative disc disease and nerve damage (sciatica in both legs) and issues with my knees (both need to be replaced due to patella-femoral disorder). I get 20 to 25 migraines and tension headaches every month.
I have bruises all over my body now. Something I complained about since day one (Saturday.) But this evening as I was lying here moaning in pain, my mate tells me that even after they gave me the anesthesia, I was screaming and moaning in pain. When he asked the nurses, they told him that I was the very first patient to ever do that. But they did not stop. And no one said anything to me about it, he also told me that Sunday's procedure, I was screaming even louder and then Monday morning was the worse. I was hysterically crying, begging them to stop, screaming out, "NO!" and more and still they persisted. Ignoring my cries for mercy and for help. Deciding that It was just due to the fact that I had a low pain thresh-hold. I'm pissed as hell that my own husband did not make them stop. But I am even more upset that these doctors and nurses did not stop. Especially because I complained of more pain, more numbness and was just told that I needed to give it time to work. No one bothered to mention that while I was under general anesthesia, I had been begging for mercy, and begging them to stop hurting me.
I don't understand why.
But I will be asking someone that on Wed when I go in for PT and this time I will be awake and I will be in charge of what they are doing so if they hurt me, then I am going to raise hell.
Question to Maggie
Were the manipulations done by medical doctors or doctors of chiropractic?
PS hope you are feling better
MUA therapy
My husband and i both had this proceedure done in march of this year. Myself because of chronic pain from a bout with shingles months ago and a diagnosis of fibromyelgia and chronic fatigue for years now. My husband because of rotator cuffs that did not allow him to raise his arms above his head. We were both on narcotics for almost a year at this point, and were not seeing any relief. To us both this proceedure was a miracle.....we are both back in charge of our lives, and have a range of motion that we havent seen in years. I am 56 and my husband is 76. We have not taken any pain meds since having this done. I would recommend it to anyone that is in chronic pain. We live in florida and had the proceedure done locally, with the recommendation of our regular doctor. We had never seen a chiroprator before this was done. We do stretching exercises daily now, and feel years younger. Any pain we experience with over exertion is now tolerable with no narcotic pain relievers.
Geez - $85,000? (Sorry, I
Geez - $85,000? (Sorry, I am just now coming across your post.) I'm in Venice, FL, and the 3-day procedure costs $4,800 total - all the chiropractors, the anesthesiologist, and the surgery center fee. I haven't done it yet - it's alot of money for me - but I'm not being pressured either. I've suffered from horrible, horrible headaches for 20 years and am thinking this might be a small price to pay for relief...
Sedation Manipulation (MUA)
I perform Sedation Manipulation (MUA) on a regular basis and have gotten excellent results from my patients. I have also personally witnessed hundreds of patients that have undergone the procedure and have had their pain levels decreased from a 9 to a 2 (1-10 pain scale)after only one MUA treatment.
As with all health treatments, patients should always be well educated on both their condition and all available treatment options prior to beginning care.
Performing MUA
I've performed about 45 mua's and although this would not be considered a large amount the results i've seen thus far have been favorable. About 80 to 85 percent have done well. Everyone must remember that there are no guarantees with any treatment that is out there, but besides the anesthesia it is very non-invasive(no cutting or injections). I have to admit that I was very sceptical at first, mainly because even after my training and research that I'd completed I don't believe I really crasped what changes we were actually making. There is just something about doing the procedure that gives you a better perspective on what your trying to accomplish. The surgical nurses and MD's at the surgery center where I perform my mua's have come around because you just can't deny results.
Maggie, out of curiousity how was your husband anywhere near the surgery room when the anesthesia was being administered? That is just not allowed....and you would have not remembered even if you were only partially sedated. Please explain...
MUA complications
I had MUA done one month ago (July)and it has not helped. I was truly looking for it to help me. I have lower back pain, sciatica pain,herniated discs and the major problem is a pelvis that rotates incorrectly or just does not move when it should, as I have been told. It causes my leg length to be off by almost three quarters of an inch. My chiropractor went on vacation after my third day of MUA and gave me a script for therapy. My back went out of alignment the next day and I went to therapy and was alo very sore from the procedure and after a few days of therapy I went to a chiropractor in their office too. Now after a about five or six times of having my back put back in place, my chiro returned from vacation and said I was not to have had any manipulation and it has messed me up all over again. How frustrating. The only relief I ever felt was when they used the tens electrodes. Nothing was thoroughly explained to me. I did not know I was not to have any manipulation for a few weeks after the procedure. He said it was not in the script he wrote. My first day at therapy I was told by the therapist that he had never heard of MUA. And yet, he was treating me for post MUA??? That right there should have triggered me. I did give him the website info and asked him to contact the other chiro my chiro had mentioned to me and he would fill him in. Did they? I am inclined to think they did not. I stopped going to the chiro and therapy since I am not sure what to do at this point. My back is so very bad and I feel horrible and am unable to do much of anything without pain. Can anyone please give me some much needed advice!
answer to considering having mua
Please make sure you research as much as you can about it before having it done. I did not, and it may not have been the best procedure for me to have done and now i regret it. I think it really depends on what problem you have. Good luck!
MUA absolutely works!!! I
MUA absolutely works!!!
I have worked in a clinic that had an MUA certified chiropractor and I have seen AMAZING response with 90% of the patients, including my mother. She had 10 years of pain that grew to worsen day by day until she was limited physically and bed ridden once a week. She recieved her MUA in July 2002 and she has been 95% better since. She can participate in activities which she couldnt before, she hasn't had a headache caused by neck pain since the day of her MUA. The bulk of the resolution of pain comes when rehabilitation is complete, so to those who have recently had the procedure I would advise a positive outlook and a little more patience. The KEY TO A SUCCESSFUL MUA is the physical therapy that follows the procedure and patient compliance with all instructions post MUA. I'm sure that not every doctor, MD or DC is of the same caliber as my former employer but when a patient undergoes the procedure with the right physician, (in my opinion DC's are endlessly more qualified to do this procedure than any MD) the possibilities are endless. It has changed lives 35-40 that I have seen personally changed, including my mothers which was more than she or my family ever could have asked for. She says she would do it all over again even if it only offered a year of pain free living and she is at 6+ years.
Definitely research your doctor and your options before ANY procedure, but not every ailment requires a knife or a bottle of pain killers, some can be resolved without the invasion and risk of surgery or medication.
Good luck to all who are looking into MUA to change their lives!
MUA absolutely works
What are the after treatments? I have been trying to find out. I am 60+ and am concerned about anesthesia three days in a row. I have Asthma, Mitral valve problems, Hiatel Hernia, Barrets Esophagus, have had breast cancer, diabetes, and a very painful back (lower, upper, mid, and neck). Just how safe is it? What am I expected to do after the treatment to make it stay? I also work very full time.Any answers?
Degenerative Disks
I have battled degenerative disk disease for a few years now...I recently underwent MUA with moderate success...I must say that along with my normal spinal decompression therapy, this procedure alleviated my pain from a 7 to about a 3.
I recommend the treatment for people who are currently utilizing low back and neck strengthening machines like the med-x and spinal traction devices like the vax-d.
It is absolutely KEY that
It is absolutely KEY that you have a responsible physician in charge of your pre mua and post mua care. I'm not positive if any of the things you have mentioned are contra indications to the procedure. What state do you live in? I would be glad to do a little research of my own to see what your option are in your area.
You would need to take two week off work at least to recover. You would be treated with modalities such as ultrasound, muscle stim, stretching and adjustment in the weeks following and your physical activity would need to be drastically limited until you reach the strengthening part of your rehab.
That element is ABSOLUTELY ESSENTIAL!
Good luck.
Im going in on 9-10-08 thru 9-12-08
I had back surgery as a 24 year old in 1994. The procedure was a Laminectomy and a disectomy and my L4 L5 had an 8mm herniation and my L5 S1 had a 4mm herniation. The surgery only reduced my sciatic pain but created local lumbar pain that would shoot to my right him and then to my left hip. I have been suffering back pain for 14 years now and I still remain active and go to the gym 4 days a week to stay strong and fit. I am 39 years old now and have discovered the MUA. I cannot find any real solid negative reasons why I should not persue the 3-day procedure here in Boca Raton Florida. If any one has some valid reasons why I should not pursue it please let me have some feed back. Im nervous and very exited in hopes that my daily pain can be gone or subside so I can wash the car or play actively with my son and not feel miserably stiff for almost 24 hours.
I am assuming you mean a
I am assuming you mean a Physical therapist. If this is the case, then no it does not. The reason for this is because Physio's (Physical therapists) are not licensed to perform spinal manipulation.This should in no way limit the role that the physio plays, however, in post manipulation functional rehabilitation of the patient, which I believe is just as important. Patients deserve to be stabilized through proper exercise therapy after they have joint kinematics normalized through manipulation(MUA). Hope this helps and I welcome any comments you might have.
What is a physio?
What is a physio?
MUA
HI I read the problem you were having and if one leg seems shorter you may be having a problem with your sacroiliac joint. You should see aphysical therapist that specializes in manual therapy and ask them to check your sacroliliac joints to see if one os hyper or hypo mobile this condition can usually be corrected easily and without anestheia.
What the.....?!?!?!?!?
What the heck are you talking about? What does any of this have to do with death? Were you drunk when you wrote this????
MUA's
I have been involved in 100's of cases of chiropractic MUAs. I have also ask each person after the series of MUA's if the MUAs helped them. No scientific study - just me asking. I have find that is is about 50-50. About half says the MUAs helped dramatically and the other half says that the MUA either didn't help or made things worse.
psychologist equal to money
Psychologist always watch the clock and take more money even if 10 minutes pass to one hour.
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