Allan A. Maltbie

Long-term use of narcotic/antidepressant medication in the management of phantom limb pain

&NA; The successful management of 5 consecutive patients with intractable phantom limb pain is described. The main therapy is a combination of a narcotic and antidepressant. Medication remained effective during the average observation time of 22 months. There were no signs of habituation or addiction. We conclude that narcotics can be safely and successfully utilized for long‐term management of phantom limb pain.

Platelet-monoamine-oxidase activity predicts response to lithium in manic-depressive illness.

Platelet-monoamine-oxidase activity predicts treatment response to lithium in manic-depressive illness. In the treatment-responsive group enzyme activity is similar to that in normal controls, whereas in the treatment-refractory group enzyme activity is significantly less than both control and treatment-responsive groups.

Illness behavior as a predictor of pain and overt behavior patterns in chronic low back pain patients.

This study examined the relationship of self-reports of illness behavior to pain ratings and overt pain behaviors in a group of chronic low back pain patients referred for pain management. Illness behavior was measured using the Pilowsky and Spence Illness Behavior Questionnaire (IBQ) and pain behavior was recorded using a standard behavioral observation method. Multivariate regression analyses revealed that scores on the IBQ were highly predictive of a variety of indices of pain and pain behavior. These results were obtained even after controlling for significant demographic and medical status variables. The findings of this study support the utility of the IBQ in the behavioral assessment of chronic pain patients.

Catatonia in the emergency department

The catatonic syndrome has a wide differential diagnosis that includes both psychiatric and organic disorders. We present the cases of two patients with catatonia seen acutely in the emergency department. In these cases, the striking clinical picture proved to be secondary to psychiatric disturbances, and were accompanied by dementia in the second patient. The examining physicians were confused by the presentations, and the correct diagnosis and disposition were delayed. The clinical presentation of the catatonic complex, its differential diagnosis, and the pertinent physical signs are discussed.

A diagnostic approach to pain.

Abstract Various factors involved in pain, including the causative stimulus, the affective-cognitive reaction, and the subsequent coping reaction, are explored, and a composite model is provided that may be helpful in narrowing the diagnosis and thus localizing areas where effective intervention may be possible.