Background The treatment of CRPS remains controversial, but multidisciplinary and interdisciplinary approaches is mandatory to prevent long-standing or permanent disability. Bisphosphonates, apart from their antiresorptive activity, have been shown to have an analgesic or anti-inflammatory effect. Bisphosphonate therapy has been suggested for the therapy for CRPS.
Objectives to evaluate the efficacy of intravenous bisphosphonates in reducing pain in patients with CRPS.
Methods 52 patients (14 males and 38 females; mean age 64.3±8 years) diagnosed with CRPS of carpal and metacarpals bones (confirmed by clinical, x-ray and MRI) from two to six weeks, previously treated with non-steroidal anti-inflammatory drugs (NSAID), calcium, Vitamin D, physical therapy. All patients were treated with iv clodronate 300 mg/day for 2 weeks, followed by im clodronate 200 mg/weekly for 3 months. Pain scale (VAS 0-100) and joint examination were performed before, after two weeks and after 3 months of clodronate therapy. X-ray and MRI were performed at the diagnosis and after 3 months.
Results Clodronate reduced pain significantly (p=0.0001) after two weeks of therapy (87.7±8 mm vs 15.7±4 mm). After 3 months, a further reduction of pain (10.4±3 mm) was found (p<0.001). After two weeks of therapy reduction of pain was associated also to a reduction of hyperhidrosis, edema and joint stiffness. X-ray showed a stability of radiological features, and MRI a significant reduction of bone oedema. No adverse events were reported.
Conclusions Iv clodronate achieves a rapid reduction of pain in patients with CRPS. Early intervention and reduction of pain is associated with a rapid clinical and imaging improvement, may prevent long-standing disability.
Tran de QH, Duong S, Bertini P, Finlayson RJ. Treatment of complex regional pain syndrome: a review of the evidence. Can J Anaesth. 2010 Feb;57(2):149-66.
Disclosure of Interest None declared
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