Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial. 2010

Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
University of Liverpool, Clinical Sciences Building, University Hospital Aintree, Liverpool L9 7AL, United Kingdom.

BACKGROUND Treatment of long-standing complex regional pain syndrome (CRPS) is empirical and often of limited efficacy. Preliminary data suggest that the immune system is involved in sustaining this condition and that treatment with low-dose intravenous immunoglobulin (IVIG) may substantially reduce pain in some patients. OBJECTIVE To evaluate the efficacy of IVIG in patients with longstanding CRPS under randomized, controlled conditions. METHODS A randomized, double-blind, placebo-controlled crossover trial. (National Research Registry number: N0263177713; International Standard Randomised Controlled Trial Number Registry: 63918259) METHODS University College London Hospitals Pain Management Centre. METHODS Persons who had pain intensity greater than 4 on an 11-point (0 to 10) numerical rating scale and had CRPS for 6 to 30 months that was refractory to standard treatment. METHODS IVIG, 0.5 g/kg, and normal saline in separate treatments, divided by a washout period of at least 28 days. METHODS The primary outcome was pain intensity 6 to 19 days after the initial treatment and the crossover treatment. RESULTS 13 eligible participants were randomly assigned between November 2005 and May 2008; 12 completed the trial. The average pain intensity was 1.55 units lower after IVIG treatment than after saline (95% CI, 1.29 to 1.82; P < 0.001). In 3 patients, pain intensity after IVIG was less than after saline by 50% or more. No serious adverse reactions were reported. CONCLUSIONS The trial was small, and recruitment bias and chance variation could have influenced results and their interpretation. CONCLUSIONS IVIG, 0.5 g/kg, can reduce pain in refractory CRPS. Studies are required to determine the best immunoglobulin dose, the duration of effect, and when repeated treatments are needed. BACKGROUND Association of Anaesthetists of Great Britain and Ireland, University College London Hospitals Charity, and CSL-Behring.

UI MeSH Term Description Entries
D007155 Immunologic Factors Biologically active substances whose activities affect or play a role in the functioning of the immune system. Biological Response Modifier,Biomodulator,Immune Factor,Immunological Factor,Immunomodulator,Immunomodulators,Biological Response Modifiers,Biomodulators,Factors, Immunologic,Immune Factors,Immunological Factors,Modifiers, Biological Response,Response Modifiers, Biological,Factor, Immune,Factor, Immunological,Factors, Immune,Factors, Immunological,Modifier, Biological Response,Response Modifier, Biological
D008297 Male Males
D004311 Double-Blind Method A method of studying a drug or procedure in which both the subjects and investigators are kept unaware of who is actually getting which specific treatment. Double-Masked Study,Double-Blind Study,Double-Masked Method,Double Blind Method,Double Blind Study,Double Masked Method,Double Masked Study,Double-Blind Methods,Double-Blind Studies,Double-Masked Methods,Double-Masked Studies,Method, Double-Blind,Method, Double-Masked,Methods, Double-Blind,Methods, Double-Masked,Studies, Double-Blind,Studies, Double-Masked,Study, Double-Blind,Study, Double-Masked
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D016756 Immunoglobulins, Intravenous Immunoglobulin preparations used in intravenous infusion, containing primarily IMMUNOGLOBULIN G. They are used to treat a variety of diseases associated with decreased or abnormal immunoglobulin levels including pediatric AIDS; primary HYPERGAMMAGLOBULINEMIA; SCID; CYTOMEGALOVIRUS infections in transplant recipients, LYMPHOCYTIC LEUKEMIA, CHRONIC; Kawasaki syndrome, infection in neonates, and IDIOPATHIC THROMBOCYTOPENIC PURPURA. Antibodies, Intravenous,Human Intravenous Immunoglobulin,IV Immunoglobulin,IVIG,Intravenous Antibodies,Intravenous Immunoglobulin,Intravenous Immunoglobulins,Alphaglobin,Endobulin,Flebogamma DIF,Gamimmune,Gamimmune N,Gamimune,Gamimune N,Gammagard,Gammonativ,Gamunex,Globulin-N,IV Immunoglobulins,Immune Globulin Intravenous (Human),Immune Globulin, Intravenous,Immunoglobulins, Intravenous, Human,Intraglobin,Intraglobin F,Intravenous IG,Intravenous Immunoglobulins, Human,Iveegam,Modified Immune Globulin (Anti-Echovirus Antibody),Privigen,Sandoglobulin,Venimmune,Venoglobulin,Venoglobulin-I,Globulin N,Human Intravenous Immunoglobulins,Immunoglobulin, Human Intravenous,Immunoglobulin, IV,Immunoglobulin, Intravenous,Immunoglobulins, Human Intravenous,Immunoglobulins, IV,Intravenous Immune Globulin,Intravenous Immunoglobulin, Human,Venoglobulin I
D018592 Cross-Over Studies Studies comparing two or more treatments or interventions in which the subjects or patients, upon completion of the course of one treatment, are switched to another. In the case of two treatments, A and B, half the subjects are randomly allocated to receive these in the order A, B and half to receive them in the order B, A. A criticism of this design is that effects of the first treatment may carry over into the period when the second is given. (Last, A Dictionary of Epidemiology, 2d ed) Cross-Over Design,Cross-Over Trials,Crossover Design,Crossover Studies,Crossover Trials,Cross Over Design,Cross Over Studies,Cross Over Trials,Cross-Over Designs,Cross-Over Study,Crossover Designs,Crossover Study,Design, Cross-Over,Design, Crossover,Designs, Cross-Over,Designs, Crossover,Studies, Cross-Over,Studies, Crossover,Study, Cross-Over,Study, Crossover,Trial, Cross-Over,Trial, Crossover,Trials, Cross-Over,Trials, Crossover
D020918 Complex Regional Pain Syndromes Conditions characterized by pain involving an extremity or other body region, HYPERESTHESIA, and localized autonomic dysfunction following injury to soft tissue or nerve. The pain is usually associated with ERYTHEMA; SKIN TEMPERATURE changes, abnormal sudomotor activity (i.e., changes in sweating due to altered sympathetic innervation) or edema. The degree of pain and other manifestations is out of proportion to that expected from the inciting event. Two subtypes of this condition have been described: type I; (REFLEX SYMPATHETIC DYSTROPHY) and type II; (CAUSALGIA). (From Pain 1995 Oct;63(1):127-33) Acute Regional Pain Syndrome,Chronic Regional Pain Syndrome,Complex Regional Pain Syndrome,Pain Syndromes, Regional Complex,CRPS (Complex Regional Pain Syndromes)

Related Publications

Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
October 2017, Annals of internal medicine,
Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
October 2014, Trials,
Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
February 2010, Annals of internal medicine,
Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
October 2017, Annals of internal medicine,
Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
October 2017, Annals of internal medicine,
Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
October 2023, Regional anesthesia and pain medicine,
Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
September 2021, Acta bio-medica : Atenei Parmensis,
Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
January 2011, Acta medica Iranica,
Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
February 2006, The Clinical journal of pain,
Andreas Goebel, and Andrew Baranowski, and Konrad Maurer, and Artemis Ghiai, and Candy McCabe, and Gareth Ambler
July 2005, Pediatrics,
Copied contents to your clipboard!