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To the Editor:
—I should like to comment briefly on the answer by Dr. Evan Calkins to the question on Pain in Lower Extremity, which appeared in the June 2 issue of The Journal (180:795).I think it improper to dismiss this question without some mention of peripheral vascular disorder. Nocturnal pain in a great toe is very suggestive of thromboangiitis obliterans (Buerger's disease) which should be considered in any heavy smoker. Oscillometric examination cannot rule out the presence of this disease. Galvanometric temperature readings taken before and after the patient has smoked several cigarettes constitute a very effective test.One should not overlook the fact that organic disease can occur simultaneously with psychosomatic disease such as hysteria, and in the face of the bewildering array of symptoms which anxious patients bring to the physician, one is often inclined to explain glibly the bizarre syndromes on a psychogenic basis.
Lee D. Pain in the Lower Extremity. JAMA. 1963;183(3):222. doi:10.1001/jama.1963.03700030098027