Intravenous treatment with biphosphates in Complex Regional Pain Syndrome.

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Marianna Faggiani
Alice Piccato
Chiara Baroni
Salvatore Risitano
Luigi Giulio Conforti


Complex Regional Pain Syndrome, intravenous biphosphates.


Background. Complex Regional Pain Syndrome (CRPS) is a pathological persistence of spontaneous or evoked disproportionate pain. Several drugs are employed, but only bisphosphonates seem to have good outcomes. The purpose of our research is to analyze the characteristics of the cases victims of CRPS and study the beneficial effect of the intravenous nerindronic acid sodium salt (Nerixia®), in an attempt to improve the results in this disabling disease. Materials and methods: We retrospectively examined 30 cases of CRPS that had undergone intravenous nerindronic acid sodium salt therapy in our center. The patients were contacted after 12 months from the start of therapy and their clinical situation was assessed with Quick DASH Score. Results: The average age of our group was 59,76 years (span, 42–78), and female subjects were 84% (p-value <0.05). 72% of all cases were complications of wrist fractures.). The Quick DASH Score (19 points are the best result, 95 the worst outcome) average was 41,1 points. The values of Quick DASH Score differed significantly (p-value <0.001) according to the age of the patient. In addition, the DASH Score values were related to the sex of the patient (p-value <0.001). Male subjects have obtained a better score. After 12 months of intravenous therapy, 52% of cases reports that they still have joint stiffness. The DASH values differed significantly depending on the onset of intravenous treatment (p-value <0.001). Conclusion: Our study showed that the CRPS affects a population between 42 and 78 years, especially women. Treatment with intravenous bisphosphonates seems to lead to an improvement in CRPS symptoms, in particular administration between 3 and 6 months after the onset of the disease. In particular, women over 61 years of age seem to have a lower improvement in symptomatology after treatment. 52% of cases report that they still have joint stiffness.


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1. Giannotti S, Bottai V, Dell'Osso G, Bugelli G, Celli F, Cazzella N, Guido G. Algodystrophy: complex regional pain syndrome and incomplete forms. Clin Cases Miner Bone Metab. 2016 Jan-Apr;13(1):11- 4. doi: 10.11138/ccmbm/2016.13.1.011.
2. Satteson ES, Harbour PW, Koman LA, Smith BP, Li Z. The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome. Scand J Pain. 2017 Jan; 14:84-88. doi: 10.1016/j.sjpain.2016.10.005.
3. Marinus J, Moseley GL, Birklein F, Baron R, Maihöfner C, Kingery WS, van Hilten JJ. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011 Jul;10(7):637-48. doi: 10.1016/S1474-4422(11)70106-5.
4. Bruehl S. Complex regional pain syndrome. BMJ. 2015 Jul 29;351:h2730. doi: 10.1136/bmj.h2730.
5. Hernández-Porras BC, Plancarte-Sánchez R, Alarcón-Barrios S, Sámano-García. Complex regional pain syndrome: A review. M. Cir. 2017 Jul-Aug;85(4):366-374. doi: 10.1016/j.circir.2016.11.004.
6. Urits I, Shen AH, Jones MR, Viswanath O, Kaye AD. Complex Regional Pain Syndrome, Current Concepts and Treatment Options. Curr. Pain Headache Rep. 2018 Feb 5; 22(2):10. doi: 10.1007/s11916-018-0667-7.
7. Tajerian M, Clark JD. New Concepts in Complex Regional Pain Syndrome. Hand Clin. 2016 Feb;32(1):41-9. doi: 10.1016/j.hcl.2015.08.003.
8. Shim H, Rose J, Halle S, Shekane P. Br J Anaesth. Complex regional pain syndrome: a narrative review for the practising clinician. 2019 Aug;123(2): e424-e433. doi: 10.1016/j.bja.2019.03.030.
9. Méndez-Rebolledo G, Gatica-Rojas V, Torres-Cueco R, Albornoz-Verdugo M, Guzmán-Muñoz E. Update on the effects of graded motor imagery and mirror therapy on complexregional pain syndrome type 1: A systematic review. J Back Musculoskelet Rehabil. 2017;30(3):441-449. doi: 10.3233/BMR-150500.
10. Smart KM, Wand BM, O'Connell NE. Physiotherapy for pain and disability in adults with complex regional painsyndrome (CRPS) types I and II..Cochrane Database Syst Rev. 2016 Feb 24;2:CD010853. doi: 10.1002/14651858.
11. Neumeister MW, Romanelli MR. Complex Regional Pain Syndrome.Clin Plast Surg. 2020 Apr;47(2):305-310. doi: 10.1016/j.cps.2019.12.009.
12. Iolascon G, Moretti A. Pharmacotherapeutic options for complex regional pain syndrome. Expert Opin Pharmacother. 2019 Aug;20(11):1377-1386. doi: 10.1080/14656566.2019.1612367.
13. Luthi F, Buchard PA, Cardenas A, Favre C, Fédou M, Foli M, Savoy J, Turlan JL, Konzelmann M.Complex regional pain syndrome. Rev Med Suisse. 2019 Feb 27;15(640):495-502.
14. Erhard L. Complex pain regional syndrome after distal radius fractures. Hand Surg Rehabil. 2016 Dec; 35S:S144-S149. doi: 10.1016/j.hansur.2016.03.010.
15. Aïm F, Klouche S, Frison A, Bauer T, Hardy P. Efficacy of vitamin C in preventing complex regional pain syndrome after wrist fracture: A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2017 May;103(3):465-470. doi: 10.1016/j.otsr.2016.12.021.
16. Chang C, McDonnell P, Gershwin ME. Complex regional pain syndrome - False hopes and miscommunications. Autoimmun Rev. 2019 Mar;18(3):270-278. doi: 10.1016/j.autrev.2018.10.003.
17. Raaf M, Fontaine R, Faymonville ME. How I treat? complex regional pain syndrome. Rev Med Liege. 2016 Dec;71(12):531-536.
18. David Clark J, Tawfik VL, Tajerian M, Kingery WS. Autoinflammatory and autoimmune contributions to complex regional painsyndrome. Mol Pain. 2018 Jan-Dec; 14:1744806918799127. doi: 10.1177/1744806918799127.
19. Pagani S, Veronesi F, Aldini NN, Fini M. Complex Regional Pain Syndrome Type I, a Debilitating and Poorly Understood Syndrome. Possible Role for Pulsed Electromagnetic Fields: A Narrative Review. Pain Physician. 2017 Sep;20(6): E807-E822.
20. Robins H. Ozone Therapy for Complex Regional Pain Syndrome: Review and Case Report. Curr Pain Headache Rep. 2019 May 6;23(6):41. doi: 10.1007/s11916-019-0776-y.

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