Evaluation of the efficacy and tolerance of pamidronate in complex regional pain syndrom type 1.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Conflict of interest: The authors declare no conflicts of interest. No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article. 4. Diagnostics (Basel). 2025 Sep 20;15(18):2397. doi: 10.3390/diagnostics15182397. The Warm Phase of CRPS Type-1: Is It Time to Review the Budapest Criteria? Saviola G(1), Rosini S(2), Molfetta L(3), Dalle Carbonare L(4), Malavolta N(5), Di Meglio N(6), Mazzei MA(6), Muratore M(7), Frediani B(8); G.E.O.D.E.I.T (“Bone Marrow Edema Diagnosis and Therapeutic Treatment” Italian Group). Author information: (1)Rheumatology Unit, Clinical Scientific Institutes Maugeri IRCCS, Castel Goffredo, 46042 Mantua, Italy. (2)Biomaterial Research Center, 57121 Livorno, Italy. (3)DISC Department, School of Medical and Pharmaceutical Sciences, Research Center of Osteoporosis and Osteoarticular Pathologies, University of Genoa, 16132 Genoa, Italy. (4)Department of Engineering for Innovation Medicine, University of Verona, 37129 Verona, Italy. (5)Casa di Cura Madre Fortunata Toniolo, 40141 Bologna, Italy. (6)Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy. (7)Rheumatology Unit, Fazzi Hospital, 73100 Lecce, Italy. (8)Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy. Complex Regional Pain Syndrome (CRPS) type 1 is a painful and disabling localized syndrome with a pathogenesis that is still unclear. The last revised diagnostic criteria for CRPS-1 syndrome were developed in 2012 (the so-called Budapest criteria), based only on clinical features, while the presence of bone marrow edema (BME) and the response to treatments were completely absent. As BME is usually present on magnetic resonance imaging (MRI) in the early ("warm") phase of CRPS-1, this criterion should be added as a necessary criterion to Budapest criteria. In addition, hyperalgesia and/or allodynia are also commonly present in the warm phase. Therefore, both of these symptoms should be included as essential criteria. Furthermore, the response to bisphosphonates may be another important parameter to add to the list of treatment options, as well as hyperbaric oxygen therapy. Finally, it must be clear that BME is not an exclusive finding of CRPS-1. Therefore, a correct clinical history and, if needed, further radiological studies and laboratory tests should be performed to avoid a false diagnosis. In this paper, the "Bone Marrow Edema Diagnosis and Therapeutic Treatment" Italian Group (GEODEIT) proposes a revision of Budapest's criteria to make them more meaningful and effective in reaching a correct and quick diagnosis of the disease. DOI: 10.3390/diagnostics15182397 PMCID: PMC12468258