The groundbreaking study that established these infusions as the preferred treatment in Italy is available in English through The Oxford Journal of Rheumatology. This research was a double-blind study and demonstrated that 100% of participants achieved remission with no recurrence of symptoms. However, the context has evolved: during the trial phase, the criteria were stringent—for example, CRPS had to result from a fracture and be present for no longer than four months. Following approval, though, the treatment was extended to patients with CRPS lasting several years, and the results have been encouraging.
The discovery of its effects on CRPS is an intriguing story. About 20 years ago, the potential benefits of bisphosphonates for CRPS were uncovered by chance when a patient with both bone cancer and CRPS experienced remission of CRPS symptoms after treatment with these drugs. This led to the development of Neridronate in 2012.
In Italy, it is now the preferred treatment for these conditions due to its safety, lack of long-term side effects, and suitability even for infants under 12 months old. Ideally, it requires just a single course of treatment. However, for chronic cases that respond positively initially, follow-up treatments may be recommended.
The treatment protocol for CRPS involves a series of four infusions, sometimes more depending on the doctor’s assessment during the pre-treatment visit. Each infusion lasts a couple of hours and delivers 100mg of Neridronate diluted in 250ml of saline, administered daily or every other day.
Currently, Neridronate is the only medication proven to address all symptoms of CRPS effectively. Known as algodystrophy in Italy, CRPS often arises after trauma such as fractures, surgeries, sprains, or prolonged immobilization. While the exact cause remains uncertain, it is linked to nerve damage in the affected area, triggering an inflammatory response as the body mistakenly continues to “fight” an injury that is no longer present. Neridronate works by normalizing the bone cell cycle, reducing inflammation, and stabilizing the condition. It is recommended for both CRPS types 1 and 2, as it also helps prevent or reverse osteoporosis associated with the condition. Once stabilized, patients can begin rehabilitation to regain functionality and reduce reliance on pain medications.
Italian doctors have noted that CRPS is more likely to spread when it affects a lower limb, possibly due to the impact of pain medications on the nervous system or co-existing neurological conditions. Misdiagnosis can also contribute to this phenomenon. The treatment process in Italy typically starts with a course of steroids to manage inflammation and facilitate diagnosis according to the Budapest Criteria. Once CRPS is confirmed, Neridronate infusions are administered, followed by tailored rehabilitation sessions. This approach is outlined in the National Guidelines for the Treatment of Algodystrophy and followed by the vast majority (93%) of Italian doctors. A 2016 study highlighted that bisphosphonates, including Neridronate, are the first-line treatment option for CRPS.
Italy’s public and universal healthcare system has widely adopted this protocol, making it standard practice across the country. While Neridronate is central to CRPS treatment, doctors may consider additional pain management therapies on a case-by-case basis. However, such therapies must not interfere with the effectiveness of the Neridronate infusions. Rehabilitation is an essential component of the treatment, tailored to the individual needs of each patient to ensure optimal recovery.
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