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Intravenous Immunoglobulin Treatment of the Complex Regional Pain Syndrome FREE

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The summary below is from the full report titled “Intravenous Immunoglobulin Treatment of the Complex Regional Pain Syndrome. A Randomized Trial.” It is in the 2 February 2010 issue of Annals of Internal Medicine (volume 152, pages 152-158). The authors A. Goebel, A. Baranowski, K. Maurer, A. Ghiai, C. McCabe, and G. Ambler.

Ann Intern Med. 2010;152(3):I-48. doi:10.7326/0003-4819-152-3-201002020-00003
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What is the problem and what is known about it so far?

The complex regional pain syndrome (CRPS) is an uncommon condition that usually develops after injury to an arm or leg. The main symptom is chronic, severe pain in the affected limb, but there also are changes in skin, bone, blood vessels, and muscle power that lead to additional symptoms and disabilities. The cause is unknown. Early treatment with pain medicines, physical therapy, drugs that are injected into nerves to numb them, and other treatments can be effective, but medication is much less effective after 6 months (this early treatment enhances recovery, but most patients do get better with or without treatment).

Why did the researchers do this particular study?

Several years ago, some of the researchers gave intravenous immunoglobulin (IVIG), which contains antibodies from the blood of human donors, to a patient who had low levels of antibodies in his blood. The patient also had widespread pain of unknown cause. The patient unexpectedly had pain relief that was temporary but was reproduced when the IVIG treatment was repeated. Since then, the researchers have tried IVIG treatment in other patients with chronic pain syndromes of unknown cause, and they have found that patients with CRPS are likely to benefit from the treatment.

Who was studied?

13 patients who had had CRPS for 6 to 30 months and were being cared for at an academic pain management center in London.

How was the study done?

The researchers gave patients either IVIG first and salt-water placebo second or placebo first and IVIG second. The researchers took elaborate precautions to prevent patients and their doctors from figuring out which treatment the patient got. Patients described their pain levels before and after treatment on a scale from 0, which indicated no pain, to 10, which indicated pain as bad as the patient could imagine.

What did the researchers find?

Patients reported that their pain decreased more after IVIG than after placebo. The average difference was 1.6 units.

What were the limitations of the study?

The study had few patients, so it is difficult to know whether the results in these patients apply to most other patients with CRPS or only to some of them. Also, the small number of patients increases the possibility that chance affected the results.

What are the implications of the study?

The body's immune system may contribute to the cause or the continuation of CRPS. Treatment with IVIG can reduce pain in patients who have had CRPS for 6 to 30 months, but additional studies are needed to determine which patients are more likely to benefit and which IVIG doses and schedules are more effective.





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