Bisphosphonates for Complex Regional Pain Syndrome: New Zealand study now recruiting

Bisphosphonates for Complex Regional Pain Syndrome: New Zealand study now recruiting

06 February 2019

A decade ago a systematic review in the European Journal of Pain1 found evidence that bisphosphonates were of some benefit in CRPS, based on four adequate quality randomised controlled trials; one of these, published in Pain Medicine in 20042, was done at Burwood Pain Management Centre in Christchurch.

In 2017, another review in Bone Joint Spine3 again found four reasonable quality randomised controlled trials (again, one of which was the Burwood RCT), and again concluded, “bisphosphonates reduce pain in patients with Complex Regional Pain Syndrome type 1.  Other studies are needed to determine their effectiveness”.   

Neridronic acid is one such bisphosphonate.  An RCT published in Rheumatology in 20134 found that four infusions of intravenous neridronate were associated with “clinically relevant and persistent benefits” in CRPS-1.  A few months later another rheumatology journal, Nature Reviews Rheumatology, published a commentary on the potential mechanisms of CRPS based on the action of bisphospnates5.

Optimal Clinical Trials are currently recruiting for the New Zealand arm of a trial of the efficacy and safety of intravenous neridronic acid for adults with CRPS. 

More information about the study can be found at the Australian New Zealand Clinical Trials Registry. 


1 Brunner, F., Schmid, A., Kissling, R., Held, U., & Bachmann, L. M. (2009). Biphosphonates for the therapy of complex regional pain syndrome I – Systematic review. European Journal of Pain, 13(1), 17-21. doi:10.1016/j.ejpain.2008.03.005

2 Robinson, J. N., Sandom, J., & Chapman, P. T. (2004). Efficacy of Pamidronate in Complex Regional Pain Syndrome Type I. Pain Medicine, 5(3), 276-280. doi:10.1111/j.1526-4637.2004.04038.x

3 Chevreau, M., Romand, X., Gaudin, P., Juvin, R., & Baillet, A. (2017). Bisphosphonates for treatment of Complex Regional Pain Syndrome type 1: A systematic literature review and meta-analysis of randomized controlled trials versus placebo. Joint Bone Spine, 84(4), 393-399. doi:10.1016/j.jbspin.2017.03.009

4 Varenna, M., Adami, S., Rossini, M., Gatti, D., Idolazzi, L., Zucchi, F., . . . Sinigaglia, L. (2013). Treatment of complex regional pain syndrome type I with neridronate: a randomized, double-blind, placebo-controlled study. Rheumatology, 52(3), 534-542. doi:10.1093/rheumatology/kes312

5 Geoffrey, L. (2013). Therapy: Bisphosphonates for early complex regional pain syndrome. Nature Reviews Rheumatology, 9(4), 199. doi:10.1038/nrrheum.2013.6



NZ Pain Research