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Researchers discover new treatment for complex regional pain syndrome
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Treating the immune system of patients with complex regional pain syndrome leads to a significant reduction in pain, according to researchers with the University of Liverpool.
The team discovered that a single, low-dose infusion of intravenous immunoglobulin (IVIG) significantly reduced pain in nearly 50% of patients and produced few adverse effects. They also found that pain relief lasted an average of 5 weeks.
The findings were published in Annals of Internal Medicine.
“In CRPS, the real effect of this treatment in clinic may turn out to be even greater than what we have already seen, because IVIG can be given in higher doses and repeated treatment may have additional effects,” Andreas Goebel, MD, PhD, the lead author of the study, stated in a University of Liverpool press release. “IVIG is normally repeated every 4 weeks and we are working to develop ways which would allow patients to administer the treatment in their own home.
“The discovery is expected to have a real impact on the treatment of other unexplained chronic pain conditions,” he added. “If one pain condition can be effectively treated with an immune drug, then it is possible that other types will also respond.”
L. Andrew Koman, MD, an orthopedic surgeon at Wake Forest University Baptist Medical Center, Winston-Salem, N.C., told OrthoSuperSite.com that the study was “interesting” and included an appropriate design. However, he cautioned that patients have to be careful when interpreting the results.
“Patients should be cautions in overinterpreting this information, as it requires additional trials,” Koman said. In addition, he cited limitations of the study which included a small sample size.
The investigators conducted a randomized, double-blind, placebo-controlled crossover trial at the University College London Hospitals Pain Management Centre. The intervention included 0.5g/kg of IVIG and normal saline in separate treatments that were divided by a washout period of at least 28 days.
The study included patients who rated their intensity of pain as greater than four on a 0 to 10 scale and had CRPS (refractory to standard treatment) for 6 to 30 months. Thirteen participants were randomly assigned to the study between Nov. 2005 and May 2008, and 12 patients completed the trial.
The primary measured outcome for the study was pain intensity at 6 to 19 days after the initial and crossover treatments. The average pain intensity after IVIG treatment was measured to be 1.55 units lower than that of saline treatment. In three patients, pain intensity after IVIG was reduced by 50% or more when compared to the saline treatment.
According to the researchers, studies are still required to determine the best immunoglobulin dose, the duration of its effect and when repeated treatments are needed.
- References:
Goebel A, Baranowski A, Maurer K, et al. Intravenous immunoglobulin treatment of the complex regional pain syndrome: A randomized trial. Ann Intern Med. 2010 Feb 2;152(3):152-158.
