OBJECTIVE: To determine the effects of the antiresorptive agent bisphosphonate in hemiplegic patients with CRPS and to compare its effects to standard steroid pulse therapy. METHOD: Thirteen randomly selected hemiplegic patients diagnosed with CRPS received bisphosphonate therapy which consisted of intravenous pamidronate injection of a total cumulative dose of 180 mg in one week. Eleven hemiplegic patients with CRPS received the standard 2-week steroid pulse therapy. Clinical assessments were made for temperature, pain score, volumetry and circumference of both the third digit and wrist. All assessments were carried out twice; before the initiation of therapy and two weeks after pamidronate or steroid therapy. RESULTS: The steroid group showed statistical improvement in pain (p=0.039), total hand volume(p=0.006) wrist (p= 0.007) and 3rd digit (p=0.003) circumference. The pamidronate group showed statistical improvement in pain (p=0.011), wrist (p=0.043) and 3rd digit (p=0.021) circumference; however no statistical improvement was observed in total hand volume (p=0.767). Neither group showed any statistical significance in temperature change. CONCLUSION: Pamidronate therapy may be an alternative method in managing CRPS in hemiplegic patients with multiple medical comorbidities who are not eligible to receive the conventional steroid therapy.
Comorbidity ; Diphosphonates ; Hand ; Hemiplegia ; Humans ; Reflex Sympathetic Dystrophy ; Steroids ; Wrist