Neurological Associates

Pain Management Center

Vero Beach, Florida

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Mannitol Treatment For CRPS

Dear Doctor,

At the request of your patient, I am sending this report to your office. I am certain you are quite familiar with this patient's illness. The patient has asked me to report to you regarding IV Mannitol treatment.

In the past 8 years, we have noted the beneficial effect of I.V. Mannitol in neuro-inflammation. This is especially true in patients suffering from post herpetic neuralgia, 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. As you are well aware, 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 the basis, we in Neurological Associates as well as researchers 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.

As long as the patient has normal renal clearance (no protein in the urine), the IV Mannitol treatment is quite safe. As the Mannitol has a tendency to crystallize, the IV should be applied in 1-1 ½ hours. If the IV drip is prolonged up to 4-6 hours, there is the risk of crystallization of the Mannitol. Certainly, a filter should help prevent any such risk as well. The usual dose is 100gm Mannitol in 500cc D5W.

Many thanks,

H. Hooshmand, M.D.