Over and over again Biphosphonates have been shown to help CRPS except one study that only bothered to give one infusion. A new agent not yet available in Canada, Neridronate, at 100 mg given FOUR times over 10 days was found to reduce pain over 50% in 73% cases versus 32% in placebo. The nature review article felt this was “estimated to be equivalent to pamidronate at 90 mg given FOUR times over 4–10 days”. As previously shown, the infusions have to be given repeatedly not like a previous stupid one infusion only study.
Nature Reviews Rheumatology. 2013 Jan 29. [Epub ahead of print]
Therapy: Bisphosphonates for early complex regional pain syndrome.
Littlejohn G. no abstract
In response to article:
Rheumatology (Oxford). 2012 Nov 30. [Epub ahead of print]
Treatment of complex regional pain syndrome type I with neridronate: a randomized, double-blind, placebo-controlled study.
Varenna M, Adami S, Rossini M, Gatti D, Idolazzi L, Zucchi F, Malavolta N, Sinigaglia L. abstract here
Will write more on this later
Comment – if I could only get drug plan to listen to this.
Previous articles:
Pamidronate and Clodronate – hope for Reflex Sympathetic Dystrophy (aka CRPS) and Back Pain
Pamidronate Works Again – For Childhood Leg Pain – Complex Regional Pain
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When will Neridronate via IV be available in Canada? My daughter suffers from CRPS in her ankle.
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did a DIN number Canada search:
https://health-products.canada.ca/dpd-bdpp/index-eng.jsp
not Canada number so not here
However, I did mention that “estimated to be equivalent to pamidronate at 90 mg given FOUR times over 4–10 days”
which is available in Canada. A recent review on Pamidronate found it worked in more acute CRPS but not late cases:
Varenna, Massimo, et al. “Predictors of Responsiveness to Bisphosphonate Treatment in Patients with Complex Regional Pain Syndrome Type I: A Retrospective Chart Analysis.” Pain Medicine (2016): pnw207.
https://academic.oup.com/painmedicine/article-abstract/doi/10.1093/pm/pnw207/2924769/Predictors-of-Responsiveness-to-Bisphosphonate
This is disappointing and I recently treated on an old arm case with disappointing results.
Late cases may respond to IV immunoglobulins or plasmaphoresis, and spinal stimulators. I recently discussed the treatment of an ankle case by pulse radiofrequency to superficial peroneal nerve:
http://painmuse.org/?p=5021. Blocking that nerve with semineurolytic doses has been discussed in link.
How old is this case?
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