Rsd and Neridronate

RSD – What are the benefits of Neridronate treatment and why choose it

Reflex sympathetic dystrophy (RSD) is another common name for complex regional pain syndrome (CRPS). This condition occurs due to malfunctions of the sympathetic nervous system and the immune system. RSD causes severe pain in one or more limbs that lasts for months or longer. In general, the condition develops after an injury or other medical condition. RSD can lead to many physical and emotional symptoms. A variety of treatments are available for RSD, and it is important to be treated early to prevent the worsening of symptoms.

Symptoms

RSD occurs at the ends. It most commonly affects the upper limbs, but can also start in the lower limbs. In particular, you can experience RSD in: hands, fingers, arms, shoulders, legs, hips, knees.

Symptoms include: stiffness, discomfort, pain or burning sensation, swelling, sensitivity to heat or cold, feeling of warmth to the touch, skin redness, skin pallor with a blue tone, sweating around the affected area, skin changes, in the affected area, muscle weakness, muscle spasms, muscle atrophy, joint pain and stiffness, changes in nails and hair. Most symptoms begin where the condition is, but can spread as RSD progresses. Symptoms can start as mild and then become more severe, interfering with daily life.

Your mental health can also be affected by RSD. You may experience anxiety, depression, or post-traumatic stress disorder related to the condition.

Causes

RSD occurs when the sympathetic nervous system and immune system do not function properly due to nerve damage. It affects up to 200,000 Americans per year. Damaged nerves send excessive pain signals from the affected area to the brain.

If you are undergoing periods of stress, such as emotional distress or work pressure, your symptoms and pain may get worse.

According to the National Institute of Neurological Disorders and Stroke, 90% of people with CRPS may indicate their medical history to determine what caused the condition. The target group of patients presents the following characteristics as common characters:

• traumas, such as fractures, broken bones or amputations infection
• soft tissue injuries such as burns and bruises, sprains, radiotherapy, tumor surgery
• paralysis of one side of the body, heart attack, emotional stress, nerve pressure strokes

RSD can also occur without any prior trauma. In this case, the physician will attempt to determine the cause of the RSD, taking into account the factors that may determine the onset of this disease:

• age between 40 and 60 years
• woman
• having other inflammatory or autoimmune conditions

Diagnosis

The diagnosis of RSD is mainly based on the symptoms present. There is no specific blood test for RSD, but blood tests can exclude other disorders. Some specialized diagnostic tests may be useful to confirm the diagnosis of RSD in some individuals. In some cases, your doctor may recommend an X-ray to check for thinning of bones or patterns in your body. It is important to diagnose the condition in advance to prevent it from getting worse, even if the diagnosis is not always easy. It can take many months or even longer before RSD is diagnosed.

Tests that your doctor can perform include:

• Bone scans
• MRI scans X-rays
• test of the sympathetic nervous system skin temperature readings

Your doctor may check other medical conditions before diagnosing RSD. These conditions are treated differently from RSD and include:

• Arthritis
• Lyme Disease muscle diseases blood clots in the veins small-fibre polyneuropathies

The treatment

Early treatment is essential to prevent the worsening or spread of RSD, even if the difficulty of diagnosis does not always make it easy to do so. in fact in these cases, many people with RSD have relief of symptoms within 18 months. Unfortunately, other individuals develop chronic pain and disability. Researchers do not know why some people improve, while others do not.

Treatments for RSD vary. Some interventions and medications can help alleviate and treat symptoms. You can also look for physical therapy and psychotherapy to reduce the effects of MSDs. You may find that your condition improves greatly with treatment, but some people need to learn how to manage their symptoms.

Medical procedures

RSD interventions include:

• Transcutaneous electrical stimulation of the electric nerve 
• biofeedback 
• peripheral nerve blocks
• spinal cord stimulation 
• Pump system
• sympathectomy, chemical or surgical, which destroys some of your sympathetic nerves deep brain stimulation
• pumps for intrathecal drugs (in the spine) electroacupuncture

Medicine

A variety of drugs are available for RSD, ranging from over-the-counter painkillers and topical creams to prescription drugs. These drugs include:

anticonvulsants, antidepressants, beta-blockers, benzodiazepines, bisphosphonates, guanethidine, Diaphragm stabilizers, muscle relaxants, non-steroidal anti-inflammatory drugs, opioids, systemic steroids, topical anaesthetics, vasodilators…

Therapies

Physiotherapy can help rehabilitate the affected limb. This type of therapy ensures that the limb continues to move to maintain its capacity. It also improves blood flow and reduces symptoms related to circulation problems. Regular physical therapy may be necessary to reduce symptoms, through limb movement in order to preserve the limb’s motor skills and improve blood flow.

It is also advisable to follow a psychological therapy that helps to overcome the trauma of chronic pain related to the disease, or follow alternative therapies such as acupuncture or some methods of relaxation.

Perspectives

The RSD can produce a variety of results. You may find that early intervention and treatment minimizes symptoms and allows you to return to life as usual. On the other hand, symptoms may get worse and not be diagnosed in a timely manner. In such cases, it is necessary to learn how best to manage the symptoms for as complete a life as possible.

Pharmacological Treatments

Early detection and treatment of RSD are the best. A pain specialist should be part of the treatment team for an individual with RSD. Steroid drugs such as prednisone can provide pain relief. Opioid pain medications such as morphine are also effective.

Other treatments may include antiepileptic drugs, antidepressants and creams applied to the skin to treat pain. Some individuals may have pain relief with an injection of local anaesthetic around the nerves of the affected area (nerve block). This should be done in parallel with ongoing investigations and specific management of any potentially relevant pathologies that could feed the pain.

Another good principle to follow is to follow a holistic approach to treatment supported by psychological therapy.

Recent studies conducted on a sample of 80 patients with CRPS have shown the effectiveness of neridronate, considered one of the few drugs that can relieve pain and lead to definitive recovery.

Neridronate is an amino-bisphosphonate that has been officially approved as a treatment for imperfecta osteogenesis, Paget’s disease and complex regional pain syndrome type I in Italy. Neridronate is administered both intravenously and intramuscularly and is therefore a valid option for both cases with contraindications to the use of oral bisphosphonates and for cases with contraindications or inability to receive intravenous administration of these drugs. 

Moreover, although the official authorized use of neridronate is limited to only 3 bone diseases, many experimental and clinical studies confirm the logic of its use and demonstrate its effectiveness in other pathological bone conditions characterized by changes in bone remodeling.

These studies have shown that following the path of neridronate is the best and most appropriate way to treat patients and to relieve the pain. In fact, recent studies have demonstrated its effectiveness on a sample of patients with CRPS I, with whom it emerged that although the mechanism of action responsible for the results observed with bisphosphonates for the treatment of CRPS-I remains conceptual, mainly because the exact pathophysiology of the disease is still unknown, the bisphosphonate can act in the bone by interrupting the formation and activity of osteoclasts, and high levels of markers of bone resorption at the baseline level. This is equivalent to a positive response to therapy with bisphosphonates whose action is concentrated in local suppression of the vicious circle responsible for maintaining bone turnover. This favours the acceleration of the healing process, with positive results on the clinical aftermath of the disease.

The effectiveness of the use of neridronate for the treatment of CRPS is also demonstrated by the use of this drug for other bone related diseases. In this regard, some research has proven the excellent results achieved through the administration of neridronate in patients with BMES bone marrow oedema syndrome.

Bone marrow oedema syndrome (BMES) is a severely disabling painful syndrome without well-established definitive treatment. Also in the case of this disease, a study was conducted on a sample of patients who saw as a result a significant improvement in their condition and in pain relief. This further underlines the need for well-designed double-blind studies while new therapies are being tested for CRPS-I.

The studies conducted so far have shown both how the reaction to the neridronate treatment can be subjective, but at the same time and this is what we would like to highlight, the real effectiveness of neridronate in providing pain relief in patients and in presenting itself as a decisive drug for the treatment of patients with CRPS. It is no coincidence that all the patients examined after months of treatment with neridronate have shown a significant improvement and an almost total overcoming of symptoms.

In many cases it was possible to talk about the full resolution of symptoms and signs of the disease. The data show that in patients with BMES, 100 mg neridronate infusions every 3 days over 10 days provided clinically relevant and persistent benefits without significant differences between the two therapeutic skeletons. These results provide conclusive evidence that the use of bisphosphonates, at appropriate doses, is the treatment of choice against CRPS.

The mechanism of action responsible for the results observed with bisphosphonates for the treatment of CRPS I remains conceptual, basically because the exact pathophysiology of the disease is still unknown.

Finally, there is a significant awareness of how treatment with bisphosphonates is associated with the permanent remission of the disease. It is possible that these, by suppressing locally the increased bone turnover, allow to extinguish an unknown vicious circle responsible for maintaining a high bone turnover.

This helps to speed up the healing process, with positive results on the clinical aftermath of the disease. In addition to the action of bisphosphonates on bones, an alternative mechanism of action could include metabolic aspects related to inflammation and pain. These include a decrease in the local concentration of lactate and acidosis as low pH is a recognized factor inducing local release of plasma bound peptides.

In conclusion, these studies have significantly demonstrated the benefits of neridronate use for CRPS-I patients taking an i.v. neridronate course, providing conclusive evidence that the use of bisphosphonate at appropriate doses is the treatment of choice for CRPS-I.