Diagnosi e trattamento della sindrome dolorosa regionale Complessa

According to IASP, complex regional pain syndrome (CRPS) is defined as continuing (spontaneous and/or evoked) regional pain that is disproportionate in time or degree to the natural course of any known trauma or other lesion. Women are most commonly affected with wrist fracture being the most commonly (45%) causative event. The diagnosis is clinical and based on the recently validated "Budapest" criteria. These criteria consider the objective and subjective aspects of the diagnosis including the motor impairements of the syndrome not considered otherwise. Instrumental diagnostic methods, triphasic bone scintigraphy in particular, are useful for differential diagnosis and to confirm the diagnosis in doubt cases. Difficult diagnosis, unclear etiopathogenesis and eterogeneus studies with few patients in the literature might be responsible for the absence of a validated therapeutic algorithm. Treatment approach is multimodal, involving physical therapy, drugs and invasive procedure. Goals of treatment should be pain relief, functional restoration, and psychological stabilization. Recently, a central causative role for activated macrophages and osteoclasts has been recognized in the etiophatogenesis of the syndrome. Therefore bisphosphonates, acting as inhibitors of osteoclasts activity and macrophages activation, are being increasingly used in CRPS treatment. In particular, endovenous administration of Neridronate demonstreted to be effective.