Treatment of reflex sympathetic dystrophy with pamidronate: 29 cases.

OBJECTIVE To evaluate the efficacy of treatment with pamidronate in reflex sympathetic dystrophy (RSD) refractory to previous treatment. METHODS We studied the response (disappearance of pain and functional improvement) to pamidronate (60 mg/day for 3 days) in 29 patients with RSD refractory to previous treatment for at least 14 days. RESULTS On day 45, complete pain disappearance was observed in 86.2% of patients and functional improvement in 70%. The mean delay until the pain disappeared was 20+/-14 days and the delay until functional improvement was observed was 29+/-18 days. The mean delay of functional improvement was shorter in patients with post-traumatic RSD. Multivariate analysis did not reveal any factor predictive of response to treatment. Six (20.7%) patients suffered from side-effects (fever, diarrhoea). CONCLUSION Pamidronate appeared to be effective in the treatment of refractory RSD; however, these results need to be confirmed by a controlled placebo study.