Intravenous immunoglobulin treatment of Complex Regional Pain Syndrome: A randomized trial
Goebel, A., Baranowski , A., Maurer, K., Ghiai, A., McCabe, C. and Ambler, G. (2010) Intravenous immunoglobulin treatment of Complex Regional Pain Syndrome: A randomized trial. Annals of Internal Medicine , 152 (3). pp. 152-158. ISSN 0003-4819
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Publisher's URL: http://www.annals.org/content/152/3/152.short
Background: The treatment of longstanding 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 may significantly reduce pain in some patients. Objective: To evaluate intravenous immunoglobulin efficacy in patients with longstanding CRPS under randomized controlled conditions. Design: A randomized, double-blind, placebo-controlled crossover trial. Setting: The University College London Hospitals Pain Management Centre. Patients: We included patients with a pain intensity of > 4 on an 11-point (0-10) numeric rating scale who were refractory to standard treatment and had a disease duration between 6 and 30 months. Intervention and Measurements: Study participants received 0.5g/kg intravenous immunoglobulin and normal saline in separate treatments divided by a washout period of at least 28 days. The primary outcome was the pain intensity between days 6-19 after the initial and the crossover treatments. Results: 13 eligible participants were randomized between November 2005 and May 2008; 12 completed the trial. The average pain intensity after intravenous immunoglobulin treatment was 1.55 units lower than after saline treatment (95% confidence interval: 1.29 to 1.82, p<0.001). In 3 patients the pain intensity after IVIG in CRPS 3 intravenous immunoglobulin was below that after saline by 50% or more. No serious adverse reactions were reported. Limitations: This is a small trial in which recruitment bias and chance variation can influence results and their interpretation. Conclusions: Our findings support the idea that 0.5g/kg intravenous immunoglobulin can reduce pain in refractory CRPS of between 6 and 30 months duration. Further studies are required to determine the best immunoglobulin dose, the duration of effect, and when repeat treatments are needed.
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