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Chronic Post-Ischemia Pain Model for Complex Regional Pain Syndrome Type-I in Rats
Published on: January 21, 2020
Efficacy and safety of neridronate in paediatric type I complex regional pain syndrome: a multicentre experience
Lisa Gamalero1, Teresa Giani2, Nicola Rebellato3
1Paediatric Division, ULSS2 Marca Trevigiana, Conegliano Hospital, Conegliano, Italy.
Insights
Neridronate shows promise as a safe and effective treatment for pediatric Complex Regional Pain Syndrome type I (CRPS I). This bisphosphonate improved pain and function in children unresponsive to other therapies.
Area of Science:
- Pediatric rheumatology
- Pain management
- Bone metabolism
Background:
- Complex Regional Pain Syndrome type I (CRPS I) is a debilitating condition with limited treatment options for children.
- Evidence for neridronate's efficacy in adults is growing, but pediatric data is scarce.
Purpose of the Study:
- To evaluate the safety and efficacy of neridronate in pediatric patients diagnosed with CRPS I.
- To assess treatment outcomes in children who have not responded to conventional therapies.
Main Methods:
- A case series involving five pediatric patients with CRPS I from three centers.
- Neridronate administered intravenously or intramuscularly.
- Efficacy assessed via pain intensity (VAS), physical function, medication use, and MRI findings.
Main Results:
- Four out of five patients experienced significant pain reduction (VAS 9.6 to 2.6) and improved physical function.
- Bone edema on MRI resolved in three patients.
- Neridronate was well-tolerated, with only mild, transient flu-like symptoms reported in one patient.
Conclusions:
- Neridronate appears to be a safe and effective treatment for pediatric CRPS I.
- It is a viable option for children refractory to other pain management strategies.
Objectives:
Evidence regarding the efficacy of neridronate in the treatment of complex regional pain syndrome type I (CRPS I) is increasing, however, very little data are available in paediatric age. Our aim was to analyse the safety and the efficacy of neridronate in a case series of children with CRPS I, according to the Budapest criteria, who did not respond to previous pharmacological and physical therapy.
Methods:
We collected data of children affected by CRPS I from three paediatric rheumatology centres who received neridronate. Efficacy was evaluated by changes in pain intensity, vasomotor changes, physical function, need for pain medications and MRI findings. Adverse effects were also documented.
Results:
Five children (3 females and 2 males, mean age 10.4 years, range 7-13 years) who received neridronate (4 intravenous, 1 intramuscular) were included. All patients had failed previous medical treatments (NSAIDs in 4, local steroids in 2, gabapentin, vitamin D and calcium supplementation in 1) and non-medical therapies (physiotherapy in 4, magnetotherapy in 2, laser in 1). Four out of five patients reported a significant improvement in pain (average VAS pre-treatment 9.6, post-treatment 2.6), recovery of physical function, and a reduced need for pain medications. Before treatment, all patients underwent MRI which revealed bone oedema that disappeared in the three of them after treatment. Neridronate was well-tolerated as only one patient experienced mild flu-like symptoms.
Conclusions:
Our data suggest that in children as in adults with CRPS I, neridronate may represent an effective and safe treatment option, particularly in those who do not respond to other pain treatments.
