by Roger H. Coletti, MD, FACC, FASNC, FSCAI, Medical Director at Fasano Underwriting

One of the most common ills of humankind is chronic pain. In some cases, the associated chronic muscle spasm is known to be the culprit. However, in some cases, there is not an obvious connection between the pain and the chronic muscle spasm that was responsible for the chronic pain. In any case, treatment of chronic pain requires knowledge of its source. If chronic muscle spasm is indeed the source, then it is necessary to have a diagnostic tool to identify the muscle or muscles in chronic spasm. Ultimately, a treatment that specifically targets chronic muscle spasms is then needed to successfully treat the chronic pain.

What is not generally known is that muscles in chronic spasm are very electrically active. The use of an EMG device, which is essentially an EKG for muscle, is all that is needed to identify a muscle in chronic spasm. Unlike EKG devices, a needle must be inserted into the muscle to record the electrical activity. Surface recordings of EMG are possible but only tell of generalized electrical activity and do not identify specific muscles. When treatment of muscles in chronic spasm involves an injection technique, the specific muscle and all segments of the muscle demonstrating enhanced electrical activity need to be identified. Successful treatment by injection will result in the elimination of the enhanced electrical activity. Medications such as Botox have a slow onset and the results peak in about two weeks. Medication combinations such as Lidocaine/Phenoxybenzamine have an initial immediate effect of resolution of the enhanced electrical activity and a secondary effect that can last for months. When Lidocaine is utilized, it is possible to map the entire muscle and verify that all parts of the muscle that demonstrated enhanced electrical activity have been treated and adequately suppressed.

Prolonged elimination of the enhanced electrical activity, identified in the scientific literature as Spontaneous Electrical Activity or SEA, results in the resolution of the chronic spasm and sustained relief of chronic pain if it was secondary to the chronic muscle spasm.

If it can be identified that a muscle is in chronic spasm and appears to be the source of chronic pain, then treatment of the chronic muscle spasm rather than suppression of the chronic pain with pain medications such as opioids should be the focus of treatment. A treatment protocol named CMECD has been shown in a somewhat limited but statistically significant clinical setting to relieve chronic pain by prolonged suppression of the SEA. Fortunately, when this protocol is utilized, the SEA does not return, nor does the muscle spasm or the resulting chronic pain.

We believe that SEA is the result of poor blood supply. SEA not only identifies the presence of chronic muscle spasm but is the ongoing cause of the chronic spasm. It is like an electrical stimulator, constantly depolarizing the skeletal muscle and keeping it in a state of constant contraction, limiting its blood supply and resulting in an unending state of contraction. I call it the black hole of muscle pathophysiology.

So, what does this newfound knowledge do for us? To start with it provides us with a method of identifying muscle in true chronic spasms. With that knowledge, we can seek alternative treatments to resolve the chronic spasm and the means to verify the success or failure of those treatments.

The CMECE procedure is one proven way to treat chronic muscle spasms and resultant chronic pain secondary to chronic muscle spasms. It can be performed by any medical professional who can do intra-muscular injections and has minimal risk.

Other procedures should be able to be developed given the understanding of the cause of chronic muscle spasms and may not require injection of any medication. Hopefully, these treatments will emerge. In the meantime, the CMECD procedure is available to be performed worldwide and holds the opportunity to relieve chronic pain in a large portion of those with chronic pain.