The Clinical journal of pain
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This study used a radionuclide imaging technique to map the spread and density contours of phenol in glycerin injected into the epidural space of cancer patients. Correlations were made between phenol injectate volume, sequence of injection, position of patient, and resultant epidural spread and analgesic outcome. Fifteen patients with cancer pain (average age of 61 years) were treated with serial epidural phenol in glycerin injections. ⋯ Good analgesia was obtained in 14 patients (93%). Epidural neurolysis using serial injections of small volumes of phenol in glycerin is an effective, safe technique for cancer pain relief. Injectate volumes larger than 3 ml may be unnecessary and potentially dangerous.
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The choice of an appropriate control group has been recognized as one of the most difficult problems in the methodology of case/control studies, both in theory and in practice. In the study of chronic pain, a "well control group" has frequently been employed. ⋯ Second, controls should be selected independently of exposure to the putative risk factors under investigation. To illustrate the nature of this problem we present two numerical examples, using a chronic pain disorder.
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Comment Letter Case Reports
In response to article by Drs. Petriccione di Vadi and Hamann.
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Temporomandibular disorders (TMDs) are likely the most common cause of persistent pain in the head and neck. Treatment for TMDs can be quite varied although, in general, favorable treatment outcome is reported to be on the order of 75-80%, regardless of treatment approach. However, it has been reported that patients suffering from posttraumatic TMDs, and, in particular, patients who have been involved in motor vehicle accidents (MVAs), do not respond as well to therapy. ⋯ In view of the above, it appears that posttraumatic TMD patients do not respond to therapy as well as the control subjects. While the mechanisms underlying this finding are not clear, it could be related to a difference in underlying pathophysiology. The data showing that posttraumatic TMD patients develop significantly more symptoms suggestive of affective disorders than control TMD patients could imply that there is a relationship between these findings that requires further study.