Outcomes for Chronic Neck and Low Back Pain Patients After Manipulation Under Anesthesia: A Prospective Cohort Study

Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal

“…The prospective cohort study undertaken by Peterson et al (Level II evidence) suggests a contributory role of anxiety and stress levels on outcome for patients in receipt of SMUA for chronic neck or low back pain [ 29 ]. When comparing short-term patient outcomes after a single MUA procedure dose (at 2 and 4 weeks posttreatment), statistically significant differences were found for those improved vs not improved when assessing for the variable of anxiety/stress [ 29 ]. Patients with higher levels of anxiety and stress, identified by the Bournemouth Questionnaire (BQ), had a tendency of non-responsiveness to SMUA [ 29 ].…”

“…When comparing short-term patient outcomes after a single MUA procedure dose (at 2 and 4 weeks posttreatment), statistically significant differences were found for those improved vs not improved when assessing for the variable of anxiety/stress [ 29 ]. Patients with higher levels of anxiety and stress, identified by the Bournemouth Questionnaire (BQ), had a tendency of non-responsiveness to SMUA [ 29 ].…”

“…Elsewhere, for the 42 chronic low back pain patients who received medication-assisted manipulation after MRI, the presence or absence of disc pathology is not reported in revealing the nature of the conditions under study [ 39 ]. For the 30 chronic neck or low back pain patients in receipt of SMUA in the prospective cohort study undertaken by Peterson et al, there is no indication of a verified source of pain [ 29 ].…”

“… a When assessed by Bournemouth Questionnaire, as per the findings of a recent prospective cohort study (Level II evidence) [ 29 ] b Examples include identifiable factors of unfavorable outcome, as reported by prior investigators, as well as relative and absolute contraindications to manipulation of unconscious patients. Contraindications and/or potential exclusion criteria are not limited to those shown c Modification of technique may be required with this risk category, assuming that medical clearance has been obtained via sufficient multidisciplinary input for the specific precaution/s for harm.…”

Novel Electromyographic Protocols Using Axial Rotation and Cervical Flexion-Relaxation for the Assessment of Subjects With Neck Pain: A Feasibility Study

“…1 Although quite common, neck pain is difficult to quantify in an objective manner. Subjective measures are commonly used, such as the visual analog scale 2 or the numerical rating scale for pain, 3 or questionnaires aimed at the ease/difficulty of performing physical tasks. 4 Because there is no way to objectively quantify pain directly, efforts have been made to develop objective methods that rate alternative indicators of pain such as pressure pain threshold and electromyographic (EMG) amplitude of specific muscles.…”