Treatment of Early Complex Regional Pain Syndrome Type 1 by a Combination of Mannitol and Dexamethasone

Author(s): Zyluk A, Puchalski P

Source: J Hand Surg 33E:130-136, 2008.


The authors treated 75 patients with Complex Regional Pain Syndrome Type 1 (CRPS Type 1, reflex sympathetic dystrophy, nerve intact) using a combination of mannitol and dexamethasone.  All patients were diagnosed within 4 months of injury.  After 1-week of treatment, hand pain and swelling had decreased and finger motion had increased to a near normal range in all but 2 cases.  Continued improvements in hand pain and finger motion were noted at a mean of 9 months after treatment.  Grip strength remained unchanged at 1 week, but partly improved at latest follow-up examination (average 34% of the unaffected hand).  

  Various treatments have been proposed for CRPS Type 1: physiotherapy, regional bretylium and anesthetic blocks, antidepressants, narcotics, calcium blockers, and steroids.  One theory of causation holds that an exaggerated inflammatory response to injury is mediated by an overproduction of toxic oxygen and hydroxyl free radicals.  Mannitol is a free radical scavenger and dexamethasone is a potent anti-inflammatory agent.  The therapeutic effects of both drugs may be increased when used in combination (Zyluk, 1999).  Although the findings from this study are intriguing, additional studies with placebo control and one or more comparison groups are warranted.