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Treatment of Patients With Complex Regional Pain Syndrome Type I With Mannitol: A Prospective, Randomized, Placebo-Controlled, Double-Blinded Study

  • Roberto S. Perez
    Correspondence
    Address reprint requests to Dr. Robert S. Perez, VU University Medical Center, Department of Anesthesiology, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
    Affiliations
    VU University Medical Center, Department of Anesthesiology, Amsterdam, The Netherlands.

    Research Consortium Trauma RElated Neuronal Dysfunction (TREND), Delft, The Netherlands.

    Research Institute for Extramural Medicine (EMGO), Amsterdam, The Netherlands.
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  • Elien Pragt
    Affiliations
    University Hospital Maastricht, Department of Anesthesiology, Maastricht, The Netherlands
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  • José Geurts
    Affiliations
    Research Consortium Trauma RElated Neuronal Dysfunction (TREND), Delft, The Netherlands.

    Pain Knowledge Center Maastricht, Maastricht, The Netherlands.
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  • Wouter W. Zuurmond
    Affiliations
    VU University Medical Center, Department of Anesthesiology, Amsterdam, The Netherlands.

    Research Consortium Trauma RElated Neuronal Dysfunction (TREND), Delft, The Netherlands.
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  • Jaap Patijn
    Affiliations
    Pain Knowledge Center Maastricht, Maastricht, The Netherlands.
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  • Maarten van Kleef
    Affiliations
    Research Consortium Trauma RElated Neuronal Dysfunction (TREND), Delft, The Netherlands.

    University Hospital Maastricht, Department of Anesthesiology, Maastricht, The Netherlands

    Pain Knowledge Center Maastricht, Maastricht, The Netherlands.
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      Abstract

      To assess the effects of intravenous administration of the free radical scavenger mannitol 10% on complaints associated with complex regional pain syndrome Type I (CRPS I), a randomized, placebo-controlled, double-blinded trial was performed. Forty-one CRPS I patients according to the Bruehl et al diagnostic criteria, were included in 2 outpatient pain clinics of 2 university medical centers and randomly assigned to receive either 10% mannitol iv in 1 L 0.9% NaCL in 4 hours for 5 consecutive days or equal volumes of 0.9% NaCL (placebo). Patients in both groups received physical therapy according to protocol and rescue pain medication if required. Complaints on impairment and disability level and quality of life were assessed up to 9 weeks after baseline, with primary measurement points at 2, 6, and 9 weeks. Monitoring of pain using the visual analogue scale took place continuously during the course of the trial. Except for a significant improvement on a subscale of the Jebsen-Taylor hand function test, no significant differences were found between mannitol and placebo treatment. Changes in both groups in the course of the trial were small and clinically irrelevant on all measurement indices. We conclude that intravenous administration of 10% mannitol is not more effective than placebo in reducing complaints for CRPS I patients and provides no addition to already-established interventions for CRPS I. Whether 10% mannitol can provide beneficial effects for subgroups of CRPS I patients with a pathophysiological profile more closely fitting the presumed mode of action for this intervention remains to be established.

      Perspective

      This article addresses the efficacy of the intravenous administration of the free radical scavenger mannitol for treatment of CRPS type 1. This intervention is not more effective than placebo in reducing complaints for CRPS I patients and provides no addition to already-established interventions for CRPS I.

      Key words

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