Roger H Coletti

  • Designation: Interventional Health
  • Country: USA
  • Title: Putting an End to Chronic Opioid Use for Chronic Back Pain with the CMECD® Procedure


Coletti received a BA from Georgetown University College of Arts and Sciences. He received a Master of Arts from Hofstra University. He received his MD from the State University of New York at Downstate.  His medical internship and residency were performed at Nassau County Medical Center in East Meadow, NY. He did two years of cardiology fellowship at Columbia Presbyterian Medical Center in New York and then transferred to Westchester County Medical Center where he completed one year of Interventional Cardiology fellowship. He was awarded FACC, FASNC, and FSCAI fellowship status. My current interest is chronic muscle spasms and pain.


Chronic back pain is likely the most common indication for the chronic use of opioid medications. Even patients who undergo back surgery have a significant risk of chronic back pain. This is called “Post Laminectomy Syndrome” and is reported in 20-40% of patients following back surgery. Chronic muscle spasm is frequently if not predominantly the cause of chronic back pain. Despite the availability of multiple modes of therapy, it is uncommon for cessation of opioid use once begun for this indication. The CMECD® procedure that I have developed and used for the past 15 years provides a unique method of relieving chronic muscle spasms. It involves EMG guidance to identify muscles in chronic spasms demonstrating spontaneous electrical activity (SEA) that is responsible for maintaining the muscle in chronic spasms. Injection to all sites in the muscle demonstrating SEA with a cocktail of phenoxybenzamine/lidocaine/dexamethasone resolves the SEA. The effect is long-lasting as the phenoxybenzamine forms a covalent bond on the alpha-adrenergic receptor and replacement of the inactive receptors takes two to three months. Muscle relaxation and pain relief are immediate and long-lasting. Patient surveys showed statistically significant relief from chronic pain. It was also demonstrated that the length of time the muscle was in spasm did not affect the success in relief of spasm and pain. Muscles in chronic spasms for over 20 years were as successfully treated as those in spasms for a few months. Patients with relief of chronic pain were frequently able to stop use or at least decrease the use of opioid drugs. Phenoxybenzamine is an FDA-approved drug used in an off-label manner in the CMECD® procedure and can be compounded by any sterile compounding pharmacy. Information on the procedure is available at the physician teaching website CMECD.info. The accompanying presentation will provide further background and practical information for the procedure.

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