Pamidronate Works Again – For Childhood Leg Pain – Complex Regional Pain

Pamidronate has been show to work in Complex Regional Pain – Often triggered by fractures. Now severe pain after a leg fracture was helped by pamidronate in a child

I have written about pamidronate before here:

Pamidronate and Clodronate – hope for Reflex Sympathetic Dystrophy (aka CRPS) and Back Pain

Is Crushed Vertebrae a RSD? – New RX

Resistant Shoulder Tendonitis Treatments (discusses use in ankylosing spondylitis shoulder pains)
—————

Bone. 2010 Apr;46(4):885-8.
The successful use of pamidronate in an 11-year-old girl with complex regional pain syndrome: response to treatment demonstrated by serial peripheral quantitative computerised tomographic scans.
Simm PJ, Briody J, McQuade M, Munns CF. abstract here

• distal tibia/fibula fracture
• needed surgical decompression for compartment syndrome
• 4 months later – much muscle wasting and pain – couldn’t go to school
• IV pamidronate 10 mg per 100 ml of normal saline started 0.5 mg/kg – later 1 mg/kg – infused over 4 hours) – every 2 months
• at 6 months was better and 1.5 mg /kg every 3 month was tried but with worsening condition, switched back to 1 mg/kg every 2 months for 3 more doses.
• had 11 treatments altogether. Had “intensive physiotherapy, using activities such as trampolining,
  treadmill, exercise bike, and hydrotherapy.”
• Demonstrated improved bone mineralization on serial xray films
• Potential issues of pamidronate:
  • acute flu-like symptoms
  • hypocalcaemia after the first infusion
  • disturbed metaphyseal modelling
  • reduced bone turnover
  • persistence of calcified cartilage inthe metaphysis
  • delayed bone healing in children with osteogenesis imperfecta [25].
  • Bisphosphonate-related osteonecrosis NOT SEEN in children
• State felt pamidronates are standard of care for children with bone mineralization problems.
• Recover and bone density returned to normal

Comment – looks like dose is 1 mg/kg every 2 months while monitoring bone density for any worsening. Giving Ibuprofen or acetominophen post infusion for ?few days would help any post IV myalgia flares. Now, getting the drug plan to cover…
Any comments?