Propranolol for Causalgia And Sudek Atrophy

To the Editor.— The dramatic response following propranolol hydrochloride therapy used in two desperate clinical situations prompts me to share this experience with other physicians. The first patient had intractable causalgia of her foot, presumably due to medicaments injected near the sciatic nerve. Her pain was controlled poorly by increasing quantities of narcotics. Minimal response followed several sympathetic blocks. She was seen for a routine evaluation prior to planned sympathectomy. The physical findings were classical for causalgia. The patient could not tolerate the slightest air motion near her foot. After three months of medication, she was thought by all of her physicians to be addicted to narcotics. Propranolol hydrochloride treatment in a dosage of 40 mg every four hours was started. Within 48 hours, her condition, both objectively and subjectively, had improved by more than 50%. During the ensuing week, improvement continued and she was able to discontinue the narcotics