Medical Necessity for I.V. Mannitol Treatment In RSD/CRPS Patients

November 1, 2011 | Posted in , , | 0

RSD/CRPS is a very painful condition and patients need to search out and try methods beneficial in relieving their painful condition.

Many RSD/ CRPS patients suffer from attacks of inflammation in the form of edema in the extremities and bouts of reddish discoloration of the skin over the extremities.

The sympathetic system has three main functions:

  1. Control of the vital signs (BP, pulse and respiration)
  2. Control of the temperature
  3. Regulation of the immune system

The sympathetic dysfunction results in disturbance of the immune system manifested by attacks of fever, swelling, skin rash and spontaneous bruises. These symptoms cause clinical pictures identical to Carpal Tunnel Syndrome, Tarsal Tunnel Syndrome or Thoracic Outlet Syndrome. Instead of surgery, the patient should be treated with medications such as Mexitil , ACTH, Epsom Salt, as well as Mannitol, since surgery causes disastrous deterioration in RSD/ CRPS cases. These patients need to be treated with a specific type of medication that counteracts inflammation without any adverse side effects.

Mannitol, an inert sugar, is a selective, strong diuretic which exclusively reduces the intracellular water retention and does not cause electrolyte imbalance, weakness or fatigue. The Mannitol is helpful in counteracting the neuroinflammation in postoperative stage, and specifically in patients who cannot tolerate the inflammatory response against hardware inserted surgically.

Necessity for Removal of Hardware

Because the patient has sympathetic dysfunction (RSD/CRPS), the foreign body of devices such as screws, spinal cord stimulators, etc, is considered by the immune system as an extraneous agent. Therefore the patient’s immune system is stimulated to mobilize WBC’s and macrophages to attack these foreign bodies leading to edema and osteopenia. Removal of the foreign body, and treatment with I.V. Mannitol thru central line, as well as staying active are effective treatments for this condition.

When RSD/CRPS patients are treated with this medication, the swelling of the extremities is reduced and symptoms suggestive of Carpal Tunnel or Thoracic Outlet Syndrome disappear. The 45-60 minute treatment is done 1 to 3 times as an outpatient resulting in optimum pain reduction.


In the past decade, specialists have noted the beneficial effect of I.V. Mannitol in neuro-inflammation. This is especially true in patients suffering from post herpetic neuralgia, RSD/CRPS, and other forms of neuropathic pain. The common denominator in the various neuropathic pain is involvement of thermoreceptor sensory nerves and the sympathetic system at some stage of the disease, where the sympathetic system has three main functions:

  1. Thermal regulation;
  2. Control of vital signs;
  3. Regulation and modulation of the immune system function.

In the neuropathic pain patients, it is not unusual for the dysfunctional immune system to cause neuroinflammation accompanied by intercellular and axonal edema. If such patients are treated with plasma diuretics such as Hydrochlorothiazide or Lasix, these diuretics reduce the plasma volume which can have the potential of causing edema ex-vacuole and aggravate the neuroinflammatory edema.

On the other hand, intracellular dehydrants such as Mannitol and Diamox selectively counteract neuroinflammation and reduce the intracellular edema. On this basis, clinics in the United States and as well as Doctor Veldman’s group in Holland have applied IV Mannitol to counteract neurogenic edema. Such neurogenic edema is especially more prominent in patients who have undergone surgery for sympathectomy, infusion pump treatment, and spinal stimulators. At times the neuroinflammation is severe enough to cause a skin rash and neurodermatitis as well.

For Full Text Of Clinical Review: The Mechanism of Action of Mannitol

Leave a Reply

Your email address will not be published. Required fields are marked *

Contact Us Today

Required field *
or Live Chat right now!