Current treatment of chronic pain has led to an opioid crisis. A prime if not the most frequent cause of chronic pain is chronic muscle spasm. Identification of chronic muscle spasm has been hindered by the lack of a diagnostic tool and a characteristic finding. Spontaneous Electrical Activity (SEA) was thought to only be present in denervated muscle. However, the published work of Dr. Coletti indicates that SEA is found in muscle that has suffered an acute or overuse injury resulting in chronic spasm and resulting chronic pain.
Skeletal muscle that develops prolonged spasm, whatever the cause, will limit its own blood supply. When prolonged for 3-4 weeks there is evidence of membrane instability which presents as spontaneous electrical activity (SEA). The presumed sequence of events is inadequate energy to support the Sodium, Potassium and Calcium channels of the cellular membrane. As a result membrane instability occurs and presents as spontaneous depolarization, presenting as SEA. Steroid injections are know to partially stabilize membranes but the duration of action is seldom long enough to allow the muscle cells to return to normal. Opioid medications simply temporarily block the brains recognition of the pain.
SEA represents not only the identifying signature of true chronic muscle spasm but is the proximal that is actual cause of the sustained spasm maintaining the spasm indefinitely. Similar to what is seen in atrial fibrillation in cardiac muscle, no nerve activation, or lack thereof, is responsible for the continued electrical activity and erratic constant contraction of the atria. The most direct treatment of chronic muscle spasm is to suppress the SEA. The CMECD method suppresses the SEA for several months allowing the muscle to return to a normal state and avoids the need for opioid pain medications for relief of chronic pain caused by chronic muscle spasm. Because of its duration of action, the CMECD injection procedure typically requires one or at most two injections to fully treat a muscle or group of muscles in chronic spasm.
Dr. Coletti began his clinical research over 8 years ago. Initially using Botox he found phenoxybenzamine had been tried but abandoned. However, its safety, utility and cost led to its current usage in his protocol to successfully treat chronic spasm and resulting chronic pain. None of the several hundred patients treated by Dr. Coletti with the CMECD procedure were given opioid pain medication. He has now begun training other physicians in this technique.
Short for "Coletti Method Emg guided ChemoDenervation" His pioneering work has been now published in half a dozen abstracts in Muscle & Nerve and presented at four annual meetings of the Association of Neuromuscular and Electrodiagnostic Medicine. Its basis represents a paradyme shift in our understanding of muscle pathophysiology. Finally having a method to identify which muscles are in a state of chronic spasm, it will be possible to correctly tailor treatments for chronic pain.
Dr. Coletti is no longer in clinical practice but wanted to be sure that the technique he developed would be followed if cited. He holds no patent or restrictions on its use. Furthermore, supportive research requires adherence to a fixed protocol. His intent is to give a fixed point of reference for all therapies and developments that may follow. Independent research sites and funds are being sought and a medical school collaboration is in progress.
No epidural injection experience is required as the spine is never penetrated. Joint injections are also not performed. Any office based trigger point injection experience is adequate. With experience a comfort develops in the use of 2.5 to 3 inch EMG injection needles to do deep muscle injections especially in the low back and piriformis. The EMG tracing showing spontaneous electrical activity (SEA) identifies the muscle in chronic spasm. Small doses of the injection cocktail are given to essentially infuse the muscle diffusely. Residual pockets of SEA should be sought and treated. Injection should be extended into adjacent sites of SEA when possible to fully treat the muscles that are functioning together.
While full functioning EMG equipment can be used, smaller hand held units, especially those with sound and screens are adequate. The Myoview by Intronix is pictured above and is entirely adequate. EMG injection needles, such as those supplied by AMBU work well. An alcohol spray to numb and clean the site for injection is useful. Most injections are best performed with the patient is a standard massage chair which allows full relaxation of most muscles potentially being treated including the piriforim. Standard EKG electrode tabs can be used. Phenoxybenzamine can be obtained, sent overnight, compounded with a low dose of dexamethasone from Millers Pharmacy in NJ, shipped to any state, 888-891-3334 for $50 per treatment vial. Onsite dilutions with equal amounts of 2% lidocaine are then performed prior to injection.
It is recommended to have a staff member in the treatment room especially if there is not a patient's relative observing. This is primarily because occasionally patients may become lightheaded or rarely faint from simple needle insertion or the effects of the medication itself. Patient family members in observation often serve to support the patient and later to explain how the procedure was performed. Once demonstrated how the the device identifies sites of spasm, family members not uncommonly take great interest in the search for additional symptomatic sites. Billing personnel need to be trained to use EMG guided chemodenervation codes associated with codes for chronic pain and sites of injection and symptoms. Specific ICD 10 codes need to be identified for each patient interaction
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