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March 21, 1964

Treatment for the Disuse Phenomenon

JAMA. 1964;187(12):961-962. doi:10.1001/jama.1964.03060250079028

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To the Editor:—  In the Journal communication, "Disuse Phenomenon of Lower Extremity: Diagnosis and Treatment" (186:1129 [Dec 28] 1963), the authors describe the course of nine patients with severe disuse phenomenon who underwent sympathectomy. While I heartily agree with the vigorous use of sympathetic nerve blocks as a therapeutic measure in this condition, I advise extreme caution in subjecting many of these patients with chronic disability to sympathectomy until it is well proved that orthostatic hypotension does not develop in the face of a fully effective sympathetic block of the lower extremity. The superimposition of orthostatic hypotension upon an already partially disabled patient seems only to worsen an already bad situation. It should be pointed out that hypertensive subjects are particularly prone to have this disorder after sympathectomy. It would seem more appropriate to reserve sympathectomy for only those patients who fail to respond to a course of repeated

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