Friday, August 29, 2008

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

Abstract - selected

Copyright © 2008 American Pain Society Published by Elsevier Inc.

Original report

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

Roberto S. Perezlow asterisk, , , Corresponding Author Contact Information, E-mail The Corresponding Author, Elien Pragt§, José Geurts, short parallel, Wouter W. Zuurmondlow asterisk, , Jaap Patijnshort parallel and Maarten van Kleef, §, short parallel

Research Consortium Trauma RElated Neuronal Dysfunction (TREND), Delft, The Netherlands. Research Institute for Extramural Medicine (EMGO), Amsterdam, The Netherlands. low asteriskVU University Medical Center, Department of Anesthesiology, Amsterdam, The Netherlands. short parallelPain Knowledge Center Maastricht, Maastricht, The Netherlands. §University Hospital Maastricht, Department of Anesthesiology, Maastricht, The Netherlands

Received 27 September 2007;
revised 6 February 2008;
accepted 12 February 2008.
Available online 10 April 2008.


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: Complex regional pain syndrome; mannitol; scavengers

Article Outline

Methods
Sample and Data Collection
Measurement of Effects
Analysis of Data
Results
Outcomes and Estimation
Pain
Impairment and Function Level
Quality of Life
Adverse Events and Side Effects
Success of Blinding
Discussion
Acknowledgements
References



The Journal of Pain
Volume 9, Issue 8, August 2008, Pages 678-686











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