Intravenous Immunoglobulin to Fight Complex Regional Pain Syndrome: Is Hope Gone?
Authors: Frank Birklein, Claudia Sommer
Journal: Annals of Internal Medicine (2017)

Editorials3 October 2017Intravenous Immunoglobulin to Fight Complex Regional Pain Syndrome: Is Hope Gone?Frank Birklein, MD and Claudia Sommer, MDFrank Birklein, MDFrom University of Mainz, Mainz, and University of Würzburg, Würzburg, Germany.Search for more papers by this author and Claudia Sommer, MDFrom University of Mainz, Mainz, and University of Würzburg, Würzburg, Germany.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-1943 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2010, we wrote an Annals editorial on a study using polyvalent intravenous immunoglobulin (IVIg) to treat complex regional pain syndrome (CRPS) (1). That study, a randomized controlled crossover trial of low-dose IVIg (0.5 g/kg of body weight) in patients with CRPS, was conducted after the authors observed IVIg's effectiveness in single patients (2). The results showed that pain was reduced during the treatment period, but because this pilot study included only a few patients treated at a single center, our 2010 editorial expressed both hope and doubt (1): hope, because immune mechanisms in CRPS pathophysiology were demonstrated, and we ...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]. doi:10.7326/0003-4819-152-3-201002020-00013 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]. doi:10.7326/0003-4819-152-3-201002020-00006 LinkGoogle Scholar3. Birklein F, Drummond PD, Li W, Schlereth T, Albrecht N, Finch PM, et al. Activation of cutaneous immune responses in complex regional pain syndrome. J Pain. 2014;15:485-95. 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Longstanding complex regional pain syndrome is associated with activating autoantibodies against alpha-1a adrenoceptors. Pain. 2014;155:2408-17. [PMID: 25250722] doi:10.1016/j.pain.2014.09.022 CrossrefMedlineGoogle Scholar8. Goebel A, Bisla J, Carganillo R, Frank B, Gupta R, James M, et al. Low-dose intravenous immunoglobulin treatment for long-standing complex regional pain syndrome. A randomized trial. Ann Intern Med. 2017;167:476-83. doi:10.7326/M17-0509 LinkGoogle Scholar9. Wurster U, Haas J. Passage of intravenous immunoglobulin and interaction with the CNS. J Neurol Neurosurg Psychiatry. 1994;57 Suppl:21-5. [PMID: 7964846] CrossrefMedlineGoogle Scholar10. Maihöfner C, Handwerker HO, Neundörfer B, Birklein F. Mechanical hyperalgesia in complex regional pain syndrome: a role for TNF-alpha? Neurology. 2005;65:311-3. [PMID: 16043808] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Mainz, Mainz, and University of Würzburg, Würzburg, Germany.Grant Support: By the German Research Foundation (Bi 579/8) and the Hopp Foundation (Dr. Birklein). Drs. Birklein and Sommer are funded by the European Union's Seventh Framework Programme (“ncRNAPain”; grant 602133).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1943.Corresponding Author: Frank Birklein, MD, University of Mainz, Department of Neurology, Langenbeckstrasse 1, Mainz 55131, Germany; e-mail, frank.[email protected]de.Current Author Addresses: Dr. Birklein: University of Mainz, Department of Neurology, Langenbeckstrasse 1, Mainz 55131, Germany.Dr. Sommer: Department of Neurology, University of Würzburg, Josef-Schneider-Strasse 11, Würzburg 97080, Germany. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLow-Dose Intravenous Immunoglobulin Treatment for Long-Standing Complex Regional Pain Syndrome Andreas Goebel , Jatinder Bisla , Roy Carganillo , Bernhard Frank , Rima Gupta , Joanna Kelly , Candy McCabe , Caroline Murphy , Nick Padfield , Ceri Phillips , Mark Sanders , Mick Serpell , Nick Shenker , Karim Shoukrey , Lynne Wyatt , and Gareth Ambler Metrics 3 October 2017Volume 167, Issue 7Page: 515-516KeywordsAutoantibodiesC-reactive proteinsCytokinesImmunomodulationInflammationIntravenous immunoglobulinKeratinocytesNeurologyNociceptorsPilot studies ePublished: 12 September 2017 Issue Published: 3 October 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...