The ischemic model of chronic muscle spasm and pain
https://doi.org/10.4081/ejtm.2022.10323
Accepted: 8 January 2022
HTML: 98
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
This article was not intended to be a complete review of the electromyography of pathological muscle states, but it was written to illustrate how the “Coletti Method of EMG ChemoDenervation” (CMECD®) protocol for the treatment of chronic pain resulting from chronic muscle spasm was developed and established. That process led to an unexpected understanding of the underlying pathophysiology of chronic muscle spasm, which represents a paradigm shift in our understanding and ultimately in our treatment of muscle spasm-induced chronic pain. Other investigators had brought to light the presence of spontaneous electrical activity (SEA) in states of muscle spasm. Those findings were all but ignored by standard EMG/Nerve conduction studies in clinical practice. Starting with a simple EMG device I experimented with various medications to treat patients with chronic pain associated with chronic muscle spasm. Suppression of SEA with long-acting medications resolved both the chronic spasm and chronic pain. A successful protocol using phenoxybenzamine was established and clinical outcomes were followed. More than 200 patients were successfully treated during last 12 years. Correlating known exercise muscle physiology with the development of the pathological state of chronic muscle spasm as seen by electromyography led to the postulation of the ischemic model of chronic muscle spasm. Light microscopy pathophysiologic supportive findings are presented and discussed. Predictions from this model to various aspects of treatment were supportive. Implications regarding treatment by the CMECD procedure, as well as other standard therapies, are discussed. Application of the ischemic model to other pain conditions was explored with implications of therapeutic modification. Recommendations for changes in rehabilitation therapy are discussed.
Dirksen RT. Sarcoplasmic reticulum-mitochondrial through-space coupling in skeletal muscle. Appl Physiol Nutr Metab. 2009 Jun;34(3):389-95. DOI: https://doi.org/10.1139/H09-044
Minerbi A, Vulfsons S. Challenging the Cinderella Hypothesis: A New Model for the Role of the Motor Unit Recruitment Pattern in the Pathogenesis of Myofascial Pain Syndrome in Postural Muscles. Rambam Maimonides Med J. 2018 Jul 30;9(3):e0021. DOI: https://doi.org/10.5041/RMMJ.10336
Mazza DF, Boutin RD, Chaudhari AJ. Assessment of Myofascial Trigger Points via Imaging: A Systematic Review. Am J Phys Med Rehabil. 2021 Oct 1;100(10):1003-1014. DOI: https://doi.org/10.1097/PHM.0000000000001789
Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004 Dec;8(6):468-75. DOI: https://doi.org/10.1007/s11916-004-0069-x
Ghuran AV, Camm AJ. Ischaemic heart disease presenting as arrhythmias. Br Med Bull. 2001;59:193-210. DOI: https://doi.org/10.1093/bmb/59.1.193
Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004 May 6;350(19):1953-9. DOI: https://doi.org/10.1056/NEJMoa032566
Umana E, Solares CA, Alpert MA. Tachycardia-induced cardiomyopathy. Am J Med. 2003 Jan;114(1):51-5. DOI: https://doi.org/10.1016/S0002-9343(02)01472-9
Kloner RA. Stunned and Hibernating Myocardium: Where Are We Nearly 4 Decades Later? J Am Heart Assoc. 2020 Feb 4;9(3):e015502. Epub 2020 Feb 4. DOI: https://doi.org/10.1161/JAHA.119.015502
Ravara B, Gobbo V, Carraro U, Gelbmann L, Pribyl J, Schils S. Functional Electrical Stimulation as a Safe and Effective Treatment for Equine Epaxial Muscle Spasms: Clinical Evaluations and Histochemical Morphometry of Mitochondria in Muscle Biopsies. Eur J Transl Myol. 2015 Mar 11;25(2):4910. DOI: https://doi.org/10.4081/bam.2015.2.109
Schils S, Carraro U, Turner T, Ravara B, Gobbo V, Kern H, Gelbmann L, Pribyl J. Functional Electrical Stimulation for Equine Muscle Hypertonicity: Histological Density and Distribution, Journal of Equine Veterinary Science 2015; 35: 907-916. DOI: https://doi.org/10.1016/j.jevs.2015.08.013
Simons DG. Cardiology and myofascial trigger points: Janet G. Travell's contribution. Tex Heart Inst J. 2003;30(1):3-7.
Hubbard DR. Myofascial trigger points show spontaneous needle EMG activity. Hubbard DR, Berkoff GM. Spine (Phila Pa 1976). 1993 Oct 1;18(13):1803-7. DOI: https://doi.org/10.1097/00007632-199310000-00015
Hubbard DR. Chronic and Recurrent Muscle Pain: Pathophysiology and Treatment, and Review of Pharmacologic Studies in Clinical Overview and Pathogenesis of the Fibromyalgia Syndrome, and Other Pain Syndromes. Jon Russel, M, Editor, The Hawthorne Medical Press, 1996. Pages 123-142. DOI: https://doi.org/10.1300/J094v04n01_08
Press Release - University of Calgary. Botulinum toxin A creates muscle weakness and atrophy following long term use, study suggests. ScienceDaily. ScienceDaily, 2 December 2010. www.sciencedaily.com/releases/2010/12/101202124248.htm.
V1: Treatment of IT Band Syndrome with injection of the tensor fascia lata muscle: https ://www.youtube.com/watch?v=f6npZiwNs7s .
V2: Cessation of SEA with the injection: https://www.youtube.com/watch?v=bQrhNlOjOvw.
V3: Treatment of chronic back muscle spasm with CMECD® procedure: https://www.youtube.com/ watch?v=fAAfK5n3uP8.
Mills KR. The basics of electromyography. J Neurol Neurosurg Psychiatry. 2005 Jun;76 Suppl 2(Suppl 2):ii32-5. DOI: https://doi.org/10.1136/jnnp.2005.069211
Coletti R, Proposd new diagnostic entity of acquired chronic muscle spasm. Abstract in Muscle & Nerve, Volume 58/ No. S2/September 2018, Pages: S1-S120; First Published: 02 October 2018, page S34, https://onlinelibrary.wiley.com/toc/1097 4598/58/S2.
Coletti R. EMG guided chemodenervation procedure of acquired chronic muscle spasm designated as CMECD®. Abstract in Muscle & Nerve, Volume 58/ No. S2/September 2018, Pages: S1-S120; First Published: 02 October 2018, Page S36, https://onlinelibrary.wiley.com/toc/10974598/ 58/S2. DOI: https://doi.org/10.1002/mus.26353
Coletti R. Limitations of EMG and nerve conductionstudies in clinical practice. Abstract in Muscle & Nerve, Volume 58/ No. S2/September 2018, Pages: S1-S120; First Published: 02 October 2018, page S31, Page S36, https://online library.wiley.com/toc/10974598/58/S2. DOI: https://doi.org/10.1002/mus.26353
Coleti R. Non skeletal ethiology of foot drop with therapeutic reversal. Abstracts 2019 AANEM Annual Meeting Abstract Guide Austin, TX, October 16–19, 2019 Muscle & Nerve, Volume 60, Issue S1 First published: 13 August 2019, https://doi.org/10.1002/mus.26647 . DOI: https://doi.org/10.1002/mus.26647
Vadivelu N, Kai AM, Kodumudi V, Sramcik J, Kaye AD. The Opioid Crisis: a Comprehensive Overview. Curr Pain Headache Rep. 2018 Feb 23;22(3):16. DOI: https://doi.org/10.1007/s11916-018-0670-z
Movin T, Gad A, Reinholt FP, Rolf C. Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. Acta Orthop Scand. 1997 Apr;68(2):170-5. DOI: https://doi.org/10.3109/17453679709004002
Chen TM, Rozen WM, Pan WR, Ashton MW, Richardson MD, Taylor GI. The arterial anatomy of the Achilles tendon: anatomical study and clinical implications. Clin Anat. 2009 Apr;22(3):377-85. DOI: https://doi.org/10.1002/ca.20758
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
