Comparison of Short-Term Effect between Bisphosphonate and Steroid Therapy in Hemiplegic Patients with CRPS Type I

Park, Geun Young; Park, Joo Hyun; Lee, Bena; Im, Sun; Min, Ji Hye

Abstract

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.