The objective of this study is to evaluate the effectiveness of pamidronate for the treatment of chronic neuropathic pain refractory to previous management. Intravenous pamidronate (60 mg/day for 3 days) was administered to 2 adolescents with neuropathic pain refractory to previous multidisciplinary treatments. Pain intensity, functional improvement, and adverse effects were evaluated. There were no significant reductions in pain intensity or improvements in function initially or at follow-up at 1 week, 1 month and 4 months. Minor side effects included myalgia and skeletal pain that were relieved by acetaminophen. There was no long-term morbidity. In contrast to recent positive reports in adults, pamidronate was not effective in decreasing pain or improving function in 2 adolescents with chronic neuropathic pain. Pamidronate may be effective only when pain is accompanied by abnormal bone density. Future trials should include scans to document bone density pretherapy and posttherapy.