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• Clodronate (intravenous)
• Alendronate (intravenous)

Although most clinical trials showed significant improvement in active movement and motor function, there are some studies where the data regarding efficacy for treatment of RSD was inconclusive.

Side effects of bisphosphonates include:

• Fever and flu-like symptoms
• Hypocalcemia (low levels of calcium)
• Bone and joint pain. The U.S. Food and Drug Administration notes that some people taking bisphosphonates may experience severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain
• Kidney damage
• Osteonecrosis (breakdown of bone tissue) of the jaw
• Constipation or diarrhea

Muscle Relaxants

Muscle relaxants are used to control and provide relief from muscle cramps and muscle spasms that may be associated with RSD. Examples of muscle relaxants include:

• Clonazepam (Klonopin)
• Baclofen (Lioresal)

Side effects of muscle relaxants include:

• Drowsiness
• Dry mouth
• Dizziness
• Fatigue
• Nausea
• Unpleasant taste in the mouth
• Blurred vision

Adrenergic Active Drugs

Based on anecdotal evidence, many physicians use sympatholytic agents, medications that decrease the activity of the sympathetic nervous system, including:

• Clonidine (Catapres - oral or transdermal patch)
• Phenoxybenzamine (Dibenzyline)
• Reserpine (Harmonyl)

Studies have reported that intravenous phentolamine (Regitine) is not effective in controlling pain in RSD.

Although the mechanism of action is not entirely understood, it is thought that these adrenergic active drugs work by blocking the action of norepinephrine on nerve receptors that become active in neuropathic pain.

Side effects include:

• Nervousness
• Agitation
• Sleep disturbances

Corticosteroids

This class of drugs is used to reduce inflammation and swelling and has been used to control many types of pain for many years. After going through a period of not being used for RSD, they are once again being investigated in clinical trials for treatment of RSD-related pain. So far, corticosteroids, such as prednisone and methylprednisolone, have demonstrated good analgesic efficacy for patients with early-stage RSD. Patients must be monitored carefully for potentially serious side effects including susceptibility to infections and avascular necrosis of bone.

Other side effects include:

• Increased appetite
• Nervousness
• Indigestion
• Dizziness

Oral Opioids

This class of drugs may help relieve severe cases of RSD with widespread pain. Use of opioids for RSD is controversial, although it remains the gold standard of treatment for acute pain in general. The potential side effects, however, such as drug tolerance, addiction, and drowsiness are serious considerations.

Tramadol (Ultram) is an atypical opioid that is effective for chronic neuropathic pain and may be effective for RSD as well. It is not a controlled substance, like other opioids such as morphine, and also has less of an effect on the gastrointestinal tract (constipation, nausea) than classic opioids.

For further information regarding medications for chronic pain that may be effective for RSD as well, please click on the following link: http://www.ncbi.nlm.nih.gov/pubmed/17164107