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

Letters15 June 2010Skepticism About Intravenous Immunoglobulin Treatment in Long-Standing Complex Regional Pain SyndromeFrank Birklein, MD, PhD and Claudia Sommer, MD, PhDFrank Birklein, MD, PhDFrom University Medical Centre Mainz, Mainz 55131, Germany; and University of Würzburg, Würzburg 97080, Germany.Search for more papers by this author and Claudia Sommer, MD, PhDFrom University Medical Centre Mainz, Mainz 55131, Germany; and University of Würzburg, Würzburg 97080, Germany.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-12-201006150-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the lively discussion with Dr. Goebel and colleagues on their pilot randomized, controlled trial on IVIG in patients with long-standing CRPS. We did not state that CRPS is of psychogenic origin or that patients with CRPS are psychiatrically ill in the classic sense. Although previous studies did not report strong psychosomatic factors, more vigorous and prospective testing might provide different results (1), and the experience of many researchers, which we systematically collected in the national German guideline of CRPS diagnosis and treatment (2), provide some indication that stressful life events (3), latent anxiety, posttraumatic stress disorder, ...References1. Zachariae L. Incidence and course of posttraumatic dystrophy following operation for dupuytren's contracture. Acta Chir Scand. 1964;15 Suppl 1-51. Google Scholar2. Birklein F. Diagnostik und therapie komplexer regionaler schmerzsyndrome (CRPS).. In: Diener HC, Putzki N, eds. Leitlinien fuer Diagnostik und Therapie in der Neurologie. Stuttgart: Thieme Verlag; 2008:640-52. Google Scholar3. Geertzen JH, de Bruijn-Kofman AT, de Bruijn HP, van de Wiel HB, Dijkstra PU. Stressful life events and psychological dysfunction in complex regional pain syndrome type I. Clin J Pain. 1998;14:143-7. [PMID: 9647456] CrossrefMedlineGoogle Scholar4. Verdugo RJ, Ochoa JL. Reversal of hypoaesthesia by nerve block, or placebo: a psychologically mediated sign in chronic pseudoneuropathic pain patients. J Neurol Neurosurg Psychiatry. 1998;65:196-203. [PMID: 9703170] CrossrefMedlineGoogle Scholar5. Fazekas F, Strasser-Fuchs S, Hommes OR. Intravenous immunoglobulin in MS: promise or failure? J Neurol Sci. 2007;259:61-6. [PMID: 17449063] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University Medical Centre Mainz, Mainz 55131, Germany; and University of Würzburg, Würzburg 97080, Germany.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 Andreas Goebel , Andrew Baranowski , Artemis Ghiai , Konrad Maurer , Candy McCabe , and Gareth Ambler Metrics 15 June 2010Volume 152, Issue 12Page: 830KeywordsC-reactive proteinsDrugsForecastingMagnesiumMultiple sclerosisPatientsPosttraumatic stress disorderResearch reporting guidelinesTreatment guidelines ePublished: 15 June 2010 Issue Published: 15 June 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...