My primary areas of interest are in (1) chronic pain management, (2) in the area of anxiety disorders specifically obsessive compulsive disorder and related disorders. My background is in adult psychiatry and geriatric psychiatry. I am currently primarily involved in clinical activities and sponsored research from pharmaceutical agencies in the field of obsessive compulsive disorder, depression, and chronic pain. Addressing the different specialties individually: (1) the pain evaluation and treatment services is based in the Department of Psychiatry with a very long and recognized history of multidisciplinary approach to the management of chronic ellipsis and pain. The program has very close ties with the outpatient pain clinic run by the Department of Anesthesiology. Very close interactions are maintained with consultants in the Departments of Neurosurgery, Neurology, GI and General Medicine. To combine caseload of the Pain Clinic and the Pain Evaluation & Treatment Services is quite extensive. Referrals are from individual physicians and surgeons as well as other pain programs from various parts of the state and outside the state with some patients coming as far as Miami and New York. The clinic also runs a methadone maintenance program for chronic pain which is unique in that the fact that it uses a TIME CONTINGENT NARCOTIC MEDICATION for the management of non-cancer pain. Although some controversy exists in the medical field regarding use of certain narcotics or non-cancer pain, in the field of Chronic Pain Management, it is not an uncommon practice. We have had tremendous success in maintaining individuals on low dose narcotic maintenance. Data has been collected for many years and the combined data of Dr. Urban, Dr. Goli, and Dr. Keefe goes back to as far as ten years on individuals maintained on low dose narcotic medication. In addition, data is collected on a regular basis on various parameters including mood profiles, cognitive status, coping skills, pain level, etc. In addition to treating various pain syndromes, I have a special interest in treating pain in the elderly. I feel there is potential for further research in this area. Pain in the elderly population has a totally different presentation and outcome as compared to younger adults. Further data is needed in this arena of chronic pain management in the elderly. (2) Obsessive Compulsive Disrder and related disorders. The Obsessive Disorder Clinic under the Anxiety Disorders Clinic does evaluations and treatment recommendations from cases referred by physicians and psychiatrists in the community. Generally, the individuals referred are treatment resistant cases that have had some therapy in the past. In addition, related disorders including trichotillomania, psychoderma, and Tourette's Syndrome are occasionally seen. Consultation with the psychologist is usually done and treatment includes medication management and behavioral therapy. Occasionally inpatient and partial hospital is offered for the more intense cases. Trials of various medications have been performed in the past. These include chlomipramine, nefazodone, paroxectine and sertraline.
