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Intravenous immunoglobulin treatment of the complex regional pain syndrome: A randomized trial

Goebel, Andreas; Baranowski, Andrew; Maurer, Konrad; Ghiai, Artemis; McCabe, Candy; Ambler, Gareth

Authors

Andreas Goebel

Andrew Baranowski

Konrad Maurer

Artemis Ghiai

Candy McCabe Candy.Mccabe@uwe.ac.uk
Professor of Clinical Research and Practice

Gareth Ambler



Abstract

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. Design: A randomized, double-blind, placebo-controlled crossover trial. (National Research Registry number: N0263177713; International Standard Randomised Controlled Trial Number Registry: 63918259) Setting: University College London Hospitals Pain Management Centre. Patients: 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. Intervention: IVIG, 0.5 g/kg, and normal saline in separate treatments, divided by a washout period of at least 28 days. Measurements: 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. Limitation: The trial was small, and recruitment bias and chance variation could have influenced results and their interpretation. Conclusion: 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. Primary Funding Source: Association of Anaesthetists of Great Britain and Ireland, University College London Hospitals Charity, and CSL-Behring. © 2010 American College of Physicians.

Citation

Goebel, A., Baranowski, A., Maurer, K., Ghiai, A., McCabe, C., & Ambler, G. (2010). Intravenous immunoglobulin treatment of the complex regional pain syndrome: A randomized trial. Annals of Internal Medicine, 152(3), 152-158. https://doi.org/10.7326/0003-4819-152-3-201002020-00006

Journal Article Type Article
Online Publication Date Feb 2, 2010
Publication Date Feb 2, 2010
Journal Annals of Internal Medicine
Print ISSN 0003-4819
Electronic ISSN 1539-3704
Publisher American College of Physicians
Peer Reviewed Peer Reviewed
Volume 152
Issue 3
Pages 152-158
DOI https://doi.org/10.7326/0003-4819-152-3-201002020-00006
Keywords intravenous, immunoglobulin,treatment, regional pain, sydrome
Public URL https://uwe-repository.worktribe.com/output/981503
Publisher URL http://dx.doi.org/10.7326/0003-4819-152-3-201002020-00006