Frank Birklein, MD, PhD; Claudia Sommer, MD, PhD
Grant Support: By the German Research Foundation (Bi 579/1) and the University of Mainz.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-2704.
Requests for Single Reprints: Frank Birklein, MD, PhD, University of Mainz, Department of Neurology, Langenbeckstrasse 1, Mainz 55131, Germany; e-mail, email@example.com.
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.
Birklein F, Sommer C. Intravenous Immunoglobulin to Fight Complex Regional Pain Syndromes: Hopes and Doubts. Ann Intern Med. 2010;152:188-189. doi: 10.7326/0003-4819-152-3-201002020-00013
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Published: Ann Intern Med. 2010;152(3):188-189.
Chronic pain is multifaceted. It involves changes in somatosensory processing from the primary afferent neurons to the brain; it induces negative emotions, such as fear and depression; and it often entails serious consequences for working ability and personal life. Long-standing complex regional pain syndrome (CRPS) has all of these features and may be associated with substantial reduction of limb function, leading to physical impairment (1).
In recent years, we have made progress in understanding CRPS. Studies of the acute phase of posttraumatic CRPS show the importance of cytokines (2) and growth factors (3) for pain and hyperalgesia; the involvement of peptides in changes in skin perfusion (4), edema (5), and sweating (6); and the effect of sympathetic neurotransmission on pain in selected patients (7). We have learned that in long-standing CRPS, cortical reorganization of sensory (8), motor (9), and autonomic function (10) might underlie the profound disturbances of the body reference scheme (11). Although acute CRPS can be challenging to treat, the outcome is often favorable. Treatment of chronic CRPS, when central neuroplastic changes are fully established, is especially difficult. Strict adherence to ongoing multimodal treatment is the current gold-standard approach but is often unsuccessful (12).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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