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CRPS Treatment: pain in foot, knee and arm for 7 years

General details and patient's info

Gender:Male.
Age:68 years old at the time of treatment.
Home Country:United States of America.
Illness duration:7 years prior to the Neridronate Treatment.
Cause:Skiing knee injury, hyperextension of right leg.
Symptoms:Swelling, constant sharp pain ranged from 4 to 7. Cool sensation at right foot and leg, discoloration. Due to difficult walking his posture is unbalanced, and he feels generally achy.
Clinical evaluation:CRPS diagnosis. Erythematous glistening quality to right hand and foot. Coldness to palpation of right limbs. Diffusely mildly weakness which can be due to disuse. Mild generalized atrophy on the right side. Mildly unsteady with EO, odd gait pattern with almost a spastic hemiplegic pattern with very minimal circulation off the right side, hold his arms abducted and flexed at the elbow. Coexistent R CTS and ulnar neuropathy.
Time of treatment:May 2019.

Why the Patient decided to undergo the CRPS Treatment in Italy

The patient’s wife and daughter had been actively looking for any possible treatment to bring him relief. He underwent for years a lot of different treatments and took many medications but kept on getting worse. Through some social media communities, they came to know about Neridronate and considered it their last chance.

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 each, 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.

7 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 Venice airport, greeted by his Patient Manager, followed by check-in at his Hotel in Vicenza. Briefing focused on next days. Light therapy has been installed in his hotel room; his Patient Manager has explained all details on how to operate the machine.

DAY 2: Morning pick-up by his Patient Manager, visit of Vicenza then rest. He then proceeds with Light therapy in his hotel room.

DAY 3: Morning pick-up by his Patient Manager, 1st visit with the Rheumatologist Professor, 1st Neridronate infusion. He then proceeds with Light therapy in his hotel room.

DAY 4: Morning pick-up by his Patient Manager and 2nd Neridronate infusion. 1st Rehabilitation session. He then proceeds with Light therapy in his hotel room.

DAY 5: Morning pick-up by his Patient Manager and day trip to Venice. He then proceeds with Light therapy in his hotel room.

DAY 6: Morning pick-up by his Patient Manager, 2nd visit with Rheumatologist Professor and 3rd Neridronate infusion. Visit of Verona center. He then proceeds with Light therapy in his hotel room.

DAY 7: Morning pick-up by his Patient Manager, 2nd Rehabilitation session and last Neridronate infusion. Visit of Verona center. He then proceeds with Light therapy in his hotel room.

DAY 8: Morning pick-up by his Patient Manager, drop-off Venice airport.

Follow up

JULY 2019 (2 months after Neridronate treatment): the patient feels a bit better: reduced swelling of 50% in right hand and arm and right foot. He is doing some of the exercises prescribed by the Rehabilitation team in Italy but finds it hard since he cannot move well.

JUNE 20219: (6 months after Neridronate treatment): the patient is doing better but does not move and exercise as he is supposed to do. He finds it hard when his family pushes him on the physiotherapy program: it is painful when he does it, but he feels much better during following days.

Conclusion

This case was particularly complex. The patient had been suffering from CRPS for over 7 years, he had other medical issues and was followed by several doctors at home. The doctors in USA and in Italy explained him the great importance of exercising every day, which has been difficult for him to follow. He could not find a therapist to take care of him after being back home. He still reported some improvements of his symptoms.
Unfortunately, several patients still consider Neridronate treatment as the last option, while it should be the first: the sooner it is undergone the better results it may bring.
This patient was still able to see improvements in swelling and pain levels.

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.