Although I have been unimpressed by the long-term effectiveness and safety of a family medications called biphosphonates for the treatment of osteoporosis, finding natural remedies to be dramatically more effective, and much safer and lower cost, here is a fascinating study suggesting that an intravenous biphosphonate available in Italy can be dramatically effective at treating a horrible pain condition called CRPS (Complex Regional Pain Syndrome – Previously Called Reflex Sympathetic Dystrophy). At the end of one year, the patients were largely pain-free.
This pain condition usually begins in one extremity, often after an injury to that extremity or to the hip or shoulder. The pain is very severe, and when I walk into the waiting room and see a person hide an arm or leg to make sure nobody pushes against it, the 1st thing I will ask about is CRPS.
To give an idea of the severity of this disease, the 1st patient I ever saw who had it, found somebody to amputate her leg, hoping the pain go away (it did not).
The pain often occurs from a neurologic reflex arc that becomes self-sustaining. It affects the blood flow to the arm or leg as well, with the extremity initially being red, and over time becoming more cold and pale. Interestingly, research shows that children with higher vitamin C intakes were less likely to get RSD after fracture injuries, but overall it is not clear why some people will get this after injuries and while others will not.
Until now, the best treatments have included things such as early and aggressive nerve blocks. The most promising option was to use a special intravenous anesthetic to essentially keep people in coma for a week or at least pain-free. In this new study, simply giving for doses of this biphosphonate medication over 2 weeks appears to even be more effective than the anesthetic – and certainly much simpler in low-cost. Given the dramatic benefits and the low side effects seen in the study, I think this represents a dramatic step forward in treating CRPS!
For more information on CRPS see the chapter on neuropathy in my book Pain Free 1-2-3
Treatment of complex regional pain syndrome type I with neridronate: a randomized, double-blind, placebo-controlled study
Massimo Varenna1, Silvano Adami2, Maurizio Rossini2, Davide Gatti2, Luca Idolazzi2, Francesca Zucchi1, Nazzarena Malavolta3 and Luigi Sinigaglia1
Objective. Complex regional pain syndrome type I (CRPS-I) is a severely disabling pain syndrome for which no definite treatment has been established. The aim of this multi-centre, randomized, double-blind placebo-controlled trial was to test the efficacy of the amino-bisphosphonate neridronate in patients with CRP-I.
Methods. Eighty-two patients with CRP-I at either hand or foot were randomly assigned to i.v. infusion of 100 mg neridronate given four times over 10 days or placebo. After 50 days the former placebo patients were given open label the same regimen of neridronate.
Results. Within the first 20 days, visual analogue scale (VAS) score decreased significantly more in the neridronate group. In the following 20 days, VAS remained unchanged in the placebo group and further decreased in the active group by 46.5 mm (95% CI −52.5, −40.5) vs 22.6 mm (95% CI −28.8, −16.3) for placebo group (P < 0.0001). Significant improvements vs placebo were observed also for a number of other indices of pain and quality of life. During the open-extension phase in the formerly placebo group the results of treatment were superimposable on those seen during the blind phase in the active group. A year later none of the patients was referring symptoms linked to CRPS-I.
Conclusion. In patients with acute CRPS-I, four i.v. infusions of neridronate 100 mg are associated with clinically relevant and persistent benefits. These results provide conclusive evidence that the use of bisphosphonates, at appropriate doses, is the treatment of choice for CRPS-I.
1Rheumatology Unit, Ospedale G. Pini, Milan, 2Rheumatology Unit, Department of Medicine, University of Verona, Verona and 3Rheumatology Unit, Ospedale Malpighi, Bologna, Italy.
Correspondence to: Silvano Adami, Rheumatology Unit, Policlinico GB Rossi, Piazzale Scuro, 37121 Verona, Italy. E-mail: firstname.lastname@example.org
Submitted 7 May 2012: revised version accepted 1 October 2012