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

A total of 75 patients, 68 women (91%) and seven men (9%), with a mean age of 58 (range 38–82) years with early Complex Regional Pain Syndrome Type 1 (CRPS Type 1), present for less than 4 months, were given in-patient treatment with 10% mannitol 2 × 250 ml per day and 8 mg dexamethasone per day for 1 week. Measurements assessed included the pain, the range of finger movements, grip strength and our own clinical severity scoring system for CRPS Type 1 (CRPS score). The results were assessed at 1 week and, finally, at a mean of 9 (range 8–12) months. At 1-week assessment, all variables decreased significantly: pain from a mean Visual Analogue Scale (VAS) of 6.7 to 2.3, loss of finger flexion (6–0.3 cm) and the CRPS score (7.6–2.2 points). Total grip strength did not improve. At the final assessment of 70 patients, the VAS score was a mean of 1.8, loss of finger flexion a mean of 0.1 cm, the CRPS score was a mean of 1.6 and grip strength a mean of 34% of the strength of the unaffected hand. All these variables showed statistically significant improvement.