Presented at the 2012 AAPM Annual Meeting « Back

Manipulation Under Anesthesia for the Treatment of Refractory Hip and Pelvic Pain

Cory Harow, MD, coryharow11@gmail.com¹, Bruce Fischer, DC², (1) ACEP, Boca Raton, Florida, (2) American Chiropractic Association, Boca Raton, Florida

Introduction: Patients with chronic pain often find that pain limits their quality of life and activities of daily living. Often, fibrotic adhesions develop in painful joints, further limiting patients' range of motion and functionality. We evaluated the effect of joint manipulation under sedation for the treatment of chronic, refractory hip and pelvis pain. Materials and Methods: This was a multicenter prospective cohort study in ambulatory settings from July 2010 to July 2011. Participants were patients with chronic pain, with refractory symptoms despite multiple treatment modalities, and had undergone 4–6 weeks of physical therapy with minimal or transient benefit. Patients completed an Oswestry Disability Questionnaire to determine an overall score that quantifies their degree of disability secondary to their pain. Patients then underwent a joint manipulation under sedation protocol. Four weeks after the procedure, patients were contacted and asked to fill out a second Oswestry Questionnaire. Mean scores were compared using a two-tailed students t-test. Results: 135 patients were enrolled and 102 filled out follow-up questionnaires for a loss to follow-up rate of 24%. The mean age was 46 years old and 56% were women. The average initial disability score was 27+/- 15 and 13+/- 12 post-procedure, for a relative reduction of 48% (p = <.001). Conclusion: Joint manipulation under sedation is an effective modality with which to treat chronic, refractory hip and pelvis pain. With proper patient selection, joint manipulation under sedation should be considered for patients whose pain has not responded to conventional pain management modalities. References: 1)Kohlbeck FJ, Haldeman S. Medication-assisted spinal manipulation. Technical report. Spine J. 2002 Jul- 2)National Academy of Manipulation Under Anesthesia Physicians (NAMUAP). National Guidelines accessed Sept 8, 2011 http://www.muaonline.com/pages/mua_phys_corner_proc_proto.htm. 3)Fairbank JC, Pynsent PB, 4)Kohlbeck FJ, Haldeman S, Hurwitz EL, Dagenais S. Supplemental care with medication-assisted manipulation versus spinal manipulation therapy alone for patients with chronic low back pain. J Manipulative Physiol Ther. 2005 May;28(4):245-52 5)Luukkainen R, Sipola E, Varjo P. Successful treatment of frozen hip with manipulation and pressure dilatation. Open Rheumatol J. 2008;2:31-2. Epub 2008 Apr 11 6)Garden F. Contractures. In: Frontera: Essentials of Physical Medicine and Rehabilitation, 1st ed. Ch 7)Cremata E, Collins S, Clauson W, Solinger AB, Roberts ES. Manipulation under anesthesia: a report of four cases. J Manipulative Physiol Ther. 2005 Sep;28(7):526-33.

Funding: None