Can Mecobalamin Prevent Pain Syndrome After Foot and Ankle Surgery?

Postoperative rates of complex regional pain syndrome type 1 and pain and functional outcomes may improve among patients receiving prophylactic mecobalamin following foot and ankle surgery.

By
Andrea Surnit
July 10, 2026
3 min

MDSpire News

Objective:

To evaluate whether mecobalamin can prevent complex regional pain syndrome type 1 (CRPS-1) following foot and ankle surgery.

Approach:

Study Design: A single-center trial conducted between June 2022 and May 2025 involving 440 adult patients.
Intervention: Patients were randomly assigned to receive either mecobalamin 500 μg or placebo three times daily for 50 days post-surgery.
Outcomes: Primary outcome was the incidence of CRPS-1 diagnosed using the Budapest criteria; secondary outcomes included pain (VAS), activities of daily living (FAAM), and quality-of-life scores (SF-36).

Key Findings:

2% of patients receiving mecobalamin developed CRPS-1 compared to 9% in the placebo group.
Adjusted absolute risk reduction for CRPS-1 was about 8%; number needed to treat to prevent one case was 14.
Patients in the mecobalamin group experienced greater improvement in postoperative pain and functional outcomes.

Interpretation:

Prophylactic mecobalamin significantly lowered the event rate of CRPS-1 after foot and ankle surgery.

Limitations:

Conducted at a single center.
CRPS-1 diagnoses made by one reviewer using standardized criteria.
Baseline differences in functional and mental health scores required adjusted analyses.
Magnitude of treatment effects was relatively modest and needs confirmation in larger multicenter studies.