Bisphosphonates in the treatment of complex regional pain syndrome: is bone the main player at early stage of the disease?

Rheumatology International
Massimo Varenna, Chiara Crotti

Abstract

Complex Regional Pain Syndrome type 1 (CRPS-1) is a disabling painful disease whose hallmark is pain disproportionate to inciting event. CRPS is also characterized by symptoms and signs, such as vasomotor, sudomotor, trophic and motor changes. Therapeutic approach of CRPS-1 still remains a challenge for clinicians treating a disease with potential heavy consequences on patient prognosis. In the past years, the treatment with bisphosphonates (BPs) has gained some success as confirmed by the results of a number of meta-analyses. The aim of this paper is to point out the pivotal role of bone in CRPS pathogenesis. The efficacy of BPs is likely to be related to bone tissue involvement in the early pathophysiological steps of the disease, as demonstrated by evidences highlighting the central role of bone in the initial phases. Bone can become a source of inflammatory cytokines when triggered by a direct injury. Moreover, peptidergic fibers that innervate both mineralized bone and bone marrow can play a role in triggering or maintaining the microvascular disturbance at bone level. Indeed, bone involvement is consistent with the mineralization disturbance as well as the results of instrumental investigations (e.g., MRI, bone scan). In ...Continue Reading

References

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Citations

Mar 4, 2020·Assay and Drug Development Technologies·Hermann A M Mucke
Nov 14, 2020·Postgraduate Medical Journal·Steven CuttsDominic Power
Jun 29, 2021·Therapeutic Advances in Musculoskeletal Disease·Massimo VarennaMaurizio Rossini

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