Skepticism About Intravenous Immunoglobulin Treatment in Long-Standing Complex Regional Pain Syndrome
Authors: Andreas Goebel
Journal: Annals of Internal Medicine (2010)

Letters15 June 2010Skepticism About Intravenous Immunoglobulin Treatment in Long-Standing Complex Regional Pain SyndromeAndreas Goebel, MD, PhD, Andrew Baranowski, MD, Artemis Ghiai, RGN, Konrad Maurer, MD, Candy McCabe, PhD, and Gareth Ambler, PhDAndreas Goebel, MD, PhDFrom University of Liverpool, Liverpool L9 7AL, United Kingdom; The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom; University Hospital Zurich, 8091 Zurich, Switzerland; The National Hospital for Rheumatic Diseases, Bath BA1 1RL, United Kingdom; and Joint University College London Hospitals/University College London Biomedical Research Unit, London WC1E 6DB, United Kingdom.Search for more papers by this author, Andrew Baranowski, MDFrom University of Liverpool, Liverpool L9 7AL, United Kingdom; The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom; University Hospital Zurich, 8091 Zurich, Switzerland; The National Hospital for Rheumatic Diseases, Bath BA1 1RL, United Kingdom; and Joint University College London Hospitals/University College London Biomedical Research Unit, London WC1E 6DB, United Kingdom.Search for more papers by this author, Artemis Ghiai, RGNFrom University of Liverpool, Liverpool L9 7AL, United Kingdom; The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom; University Hospital Zurich, 8091 Zurich, Switzerland; The National Hospital for Rheumatic Diseases, Bath BA1 1RL, United Kingdom; and Joint University College London Hospitals/University College London Biomedical Research Unit, London WC1E 6DB, United Kingdom.Search for more papers by this author, Konrad Maurer, MDFrom University of Liverpool, Liverpool L9 7AL, United Kingdom; The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom; University Hospital Zurich, 8091 Zurich, Switzerland; The National Hospital for Rheumatic Diseases, Bath BA1 1RL, United Kingdom; and Joint University College London Hospitals/University College London Biomedical Research Unit, London WC1E 6DB, United Kingdom.Search for more papers by this author, Candy McCabe, PhDFrom University of Liverpool, Liverpool L9 7AL, United Kingdom; The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom; University Hospital Zurich, 8091 Zurich, Switzerland; The National Hospital for Rheumatic Diseases, Bath BA1 1RL, United Kingdom; and Joint University College London Hospitals/University College London Biomedical Research Unit, London WC1E 6DB, United Kingdom.Search for more papers by this author, and Gareth Ambler, PhDFrom University of Liverpool, Liverpool L9 7AL, United Kingdom; The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom; University Hospital Zurich, 8091 Zurich, Switzerland; The National Hospital for Rheumatic Diseases, Bath BA1 1RL, United Kingdom; and Joint University College London Hospitals/University College London Biomedical Research Unit, London WC1E 6DB, United Kingdom.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-12-201006150-00024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We appreciate the editorial by Birklein and Sommer (1) on our study of intravenous immunoglobulin (IVIG) treatment in long-standing complex regional pain syndrome (CRPS) (2). We wish to comment on 4 important issues.Birklein and Sommer speculate that CRPS has psychological comorbid conditions and that this will sway providers' payment decisions against the expensive IVIG treatment. They cite 2 studies of mixed patient populations that suggest that fixed dystonia and abnormal movements in CRPS are sometimes psychogenic. The editorialists should be reassured by recent evidence (3) that patients with CRPS do not have preceding psychological comorbid conditions ...References1. Birklein F, Sommer C. Intravenous immunoglobulin to fight complex regional pain syndromes: hopes and doubts [Editorial]. Ann Intern Med. 2010;152:188-9. [PMID: 20124237] LinkGoogle Scholar2. Goebel A, Baranowski A, Maurer K, Ghiai A, McCabe C, Ambler G. Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial. Ann Intern Med. 2010;152:152-8. [PMID: 20124231] LinkGoogle Scholar3. de Mos M, Huygen FJ, Dieleman JP, Koopman JS, Stricker BH, Sturkenboom MC. Medical history and the onset of complex regional pain syndrome (CRPS). Pain. 2008;139:458-66. [PMID: 18760877] CrossrefMedlineGoogle Scholar4. Beerthuizen A, van ‘t Spijker A, Huygen FJ, Klein J, de Wit R. Is there an association between psychological factors and the complex regional pain syndrome type 1 (CRPS1) in adults? A systematic review. Pain. 2009;145:52-9. [PMID: 19573987] CrossrefMedlineGoogle Scholar5. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133:581-624. [PMID: 17592957] CrossrefMedlineGoogle Scholar6. Groeneweg G, Huygen FJ, Niehof SP, Wesseldijk F, Bussmann JB, Schasfoort FC, et al. Effect of tadalafil on blood flow, pain, and function in chronic cold complex regional pain syndrome: a randomized controlled trial. BMC Musculoskelet Disord. 2008;9:143. [PMID: 18937830] CrossrefMedlineGoogle Scholar7. Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study. Pain. 2009;147:107-15. [PMID: 19783371] CrossrefMedlineGoogle Scholar8. Forouzanfar T, Köke AJ, van Kleef M, Weber WE. Treatment of complex regional pain syndrome type I. Eur J Pain. 2002;6:105-22. [PMID: 11900471] CrossrefMedlineGoogle Scholar9. Brunner F, Schmid A, Kissling R, Held U, Bachmann LM. Biphosphonates for the therapy of complex regional pain syndrome I—systematic review. Eur J Pain. 2009;13:17-21. [PMID: 18440845] CrossrefMedlineGoogle Scholar10. Kalita J, Vajpayee A, Misra UK. Comparison of prednisolone with piroxicam in complex regional pain syndrome following stroke: a randomized controlled trial. QJM. 2006;99:89-95. [PMID: 16428335] CrossrefMedlineGoogle Scholar11. Collins S, Zuurmond WW, de Lange JJ, van Hilten BJ, Perez RS. Intravenous magnesium for complex regional pain syndrome type 1 (CRPS 1) patients: a pilot study. Pain Med. 2009;10:930-40. [PMID: 19496957] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Liverpool, Liverpool L9 7AL, United Kingdom; The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom; University Hospital Zurich, 8091 Zurich, Switzerland; The National Hospital for Rheumatic Diseases, Bath BA1 1RL, United Kingdom; and Joint University College London Hospitals/University College London Biomedical Research Unit, London WC1E 6DB, United Kingdom.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIntravenous Immunoglobulin to Fight Complex Regional Pain Syndromes: Hopes and Doubts Frank Birklein and Claudia Sommer Intravenous Immunoglobulin Treatment of the Complex Regional Pain Syndrome Andreas Goebel , Andrew Baranowski , Konrad Maurer , Artemis Ghiai , Candy McCabe , and Gareth Ambler Skepticism About Intravenous Immunoglobulin Treatment in Long-Standing Complex Regional Pain Syndrome Frank Birklein and Claudia Sommer Metrics 15 June 2010Volume 152, Issue 12Page: 829-830KeywordsC-reactive proteinsConflicts of interestDrugsDystoniaMagnesiumPatientsPopulation statisticsSteroidsSystematic reviews ePublished: 15 June 2010 Issue Published: 15 June 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...