# Teriparatide and clodronate combination as a potential treatment for complex regional pain syndrome type I in delayed consolidation after foot surgery: a case report and review of the literature

## TL;DR

A combination of teriparatide and clodronate may help treat complex regional pain syndrome after foot surgery when healing is delayed.

## Contribution

The paper presents a novel case where teriparatide, combined with clodronate, effectively treats complex regional pain syndrome linked to delayed healing.

## Key findings

- Clodronate alone was ineffective in treating the patient's complex regional pain syndrome.
- Adding teriparatide improved healing and alleviated symptoms in the patient.
- Teriparatide may be useful when complex regional pain syndrome is caused by delayed union.

## Abstract

Complex regional pain syndrome type I is a pathological condition characterized by an exaggerated response of tissues to low or moderate pain stimuli. The exact pathogenesis and optimal medical treatment for complex regional pain syndrome type I are still not fully understood, although bisphosphonates have shown positive effects in reducing pain. Foot surgery can be complicated by the development of complex regional pain syndrome type I, leading to functional decline and difficulties in weight-bearing.

The authors present a clinical case involving complex regional pain syndrome type I that developed after surgical foot arthrodesis. The patient, a 42-year-old Caucasian male, did not respond to clodronate treatment but experienced successful outcomes upon the addition of teriparatide, which effectively stimulated the healing of arthrodesis.

Teriparatide cannot be considered the primary treatment for complex regional pain syndrome due to insufficient solid clinical data. However, when complex regional pain syndrome is associated with or caused by delayed union, teriparatide can be used to address the underlying cause of complex regional pain syndrome.