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CRPS Treatment: pain in foot and ankle for 4 months

General details and patient's info

Gender:Female.
Age:30 years old at the time treatment.
Home Country:United States of America.
Illness duration:4 months prior to the Neridronate Treatment.
Cause:Ankle fracture, horse-riding fall.
Symptoms:Redness of the foot/leg when they are not elevated; temperature changes; burning pain, sometime pricking or stabbing- burning mostly in the toes; constant throbbing (like the limb “is going to explode”); abnormal nails growth; fatigue; swelling; stiff joints; loss of ankle movement range; not able to walk, using a knee scooter most of the time.
Clinical evaluation:CRPS diagnosis. Trigger point pain is present at the gluteal muscle bilateral, prominence of the greater trochanter bilateral. Right lower extremity sensation decreased to light touch and to pin prick. Joint pain, joint stiffness muscle cramps. Right and left sciatic notch moderate to severe in nature. Sleep disturbances. Pain level from 4 to 10.
Time of treatment:May 2019.

Why the Patient decided to undergo the CRPS Treatment in Italy

The patient, a professional horse rider, tried several treatments which brought no relief and, in one case, worsened her condition. She found some relief with pain medications. Her doctor talked to her about the Neridronate infusions, and she decided to try those at soonest, in order to expect the best results.

Medical treatment the Patient underwent in Italy

Complex regional pain syndrome (CRPS) is a severely painful and disabling disease for which a multitude of therapeutic interventions have been proposed. In the past two decades, only Bisphosphonates gained credibility. In recent years, more convincing evidence has become available on the use of Parenteral Neridronate. Since 2014, this drug is registered and marketed in Italy for the treatment of CRPS. To date, the only therapeutic schedule that is recognized to be able to confer benefit is the intravenous (IV) administration of 100 mg given 4 times.

4 neridronate infusions (100mg, I.v. in saline Solution 0,9% 250 ml)
See the Official Study on the Oxford Academics website: https://academic.oup.com/rheumatology/article/52/3/534/1777330
4 Pantoprazole infusions; Paracetamol;

2 sessions, 2 hours, of Neuromuscular Rehabilitation Treatment with the Osteopath and Physiotherapist.
Rehabilitation therapy is a full body workout which focuses on the general wellbeing of the body, to help the affected limb get back to its normal self.

13 days Light Therapy (in hotel room, 30+ more minutes each day)
30 minutes or more of usage of the MTI Light Therapy reduces inflammation, increase micro-circulation, relax nerves and muscles, reduces pain transmission, accelerates healing, regenerates cells, and promotes cells activation.

Daily Report

DAY 1: Arrival at the airport, greeted by her Patient Manager and check-in at the hotel in Sirmione. Light therapy has been installed in her hotel room; her Patient Manager has explained all details on how to operate the machine.

DAY 2: Rest day, in contact with her Patient Manager.

DAY 3: Morning pick-up by her Patient Manager and 1st visit with the Rheumatologist Professor. The patient is anxious due to the difficult access to her veins and past experiences with needles and I.V. But in the end, the 1st infusion went well. She then proceeds with Light therapy in her hotel room.

DAY 4: Morning meeting with her Patient Manager, rest day, the patient feels tired. She then proceeds with Light therapy in her hotel room.

DAY 5: Morning meeting with her Patient Manager, rest day to allow the patient to recover. She then proceeds with Light therapy in her hotel room.

DAY 6: Morning pick-up by her Patient Manager and 2nd visit with the Rheumatologist Professor. The patient is much calmer, and she does not have side effects, we go on with the 2nd Neridronate infusion. She then proceeds with Light therapy in her hotel room.

DAY 7: Morning pick-up by her Patient Manager and 1st Rehabilitation session. She then proceeds with Light therapy in her hotel room.

DAY 8: Morning pick-up by her Patient Manager and 3rd visit with the Rheumatologist Professor; the patient feels quite well, we go on with the 3rd Neridronate infusion. She then proceeds with Light therapy in her hotel room.

DAY 9: Morning meeting with Patient Manager, rest day. She then proceeds with Light therapy in her hotel room.

DAY 10: Morning pick-up by her Patient Manager and 4th visit with the Rheumatologist Professor. The patient looks in less pain, time for the last Neridronate infusion. She then proceeds with Light therapy in her hotel room.

DAY 11: Morning pick-up by her Patient Manager, 2nd rehabilitation session. Light therapy in her hotel room.

DAY 12-13: Rest days. Light Therapy in her hotel room.

DAY 14: Morning pick-up by her Patient Manager, check-out at the hotel and drop-off the airport.

Follow up

JUNE 2019 (1 month after treatment): the patient refers small improvements with swelling and mottled skin. She decreased the quantity of some medications she was taking.

JULY 2019 (2 months after treatment): the patient walks perfectly; she is cheerful and positive. She feels some burning pain, but she stopped all medications. Average pain level is 1.

SEPTEMBER 2019 (4 months after treatment): the patient is doing much better; she still experiences some swelling and color changes.

NOVEMBER 2019 (6 months after treatment): the patient is back to horse riding.

AUGUST 2023 (4 years after treatment): the patient confirms a general lasting improvement of 90%. She sometimes has some light pain at night, after a whole day of standing on her leg, but she is off all her medications.

Conclusion

This patient had really good outcomes, and after 6 months she could go back to her beloved horse riding. 4 years post treatment, she still confirms her lasting improvements of about 90%.

DISCLAIMER
This is not a medical case study; it merely describes each patient’s journey, and it omits all personal data. The people who redacted it are not doctors but all the facts reported are objective and represent the patient’s reality thanks to the information in our possession. The report is not part of any clinical trials. It was written to provide more information to patients who have made multiple requests for treatment outcomes of cases like theirs.