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Immunoglobulin Responsive Chronic Pain

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Journal of Clinical Immunology Aims and scope Submit manuscript

Abstract

Introduction

Over the last 15 years, clinical and experimental data have emerged that suggest that peripheral and central, glial-mediated neuroimmune activation is both necessary and sufficient to sustain chronic pain. Immune modulation appears to be, therefore, a possible new therapeutic option.

Materials and Methods

The Medline database and international trial registry databases were searched using the keywords “intravenous immunoglobulin” or “IVIG,” “pain” or “chronic pain,” “neuropathic pain,” “CRPS,” “complex regional pain syndrome” or "fibromyalgia.”

Results

Evidence from RCTs suggest that IVIG is effective to reduce pain in complex regional pain syndrome (low-dose IVIG) and post-polio syndrome (high-dose IVIG), and open trials have suggested efficacy in additional pain conditions.

Conclusion

IVIG therapy may emerge as a novel treatment modality for refractory cases. However, before this drug can be confidently used by clinicians, important questions need to be answered concerning optimal treatment doses, duration of treatment, and its effect on function and quality of life.

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Notes

  1. A “noxious” stimulus actually or potentially causes tissue damage.

  2. Macrophages and T-lymphocytes have been shown to later migrate to the perisynaptic space, yet their contribution has not yet been fully defined [8].

  3. The type of the immune activation differs among the various initiating noxious stimuli [9].

  4. Nociceptors are peripheral receptors that sense noxious signals. Sometimes neurons that mainly serve this function are also called nociceptors.

  5. Not all complex pains that develop regionally after trauma qualify for the diagnosis of CRPS. The diagnosis requires the presence of certain autonomic, motor, or skin signs [18].

  6. Neu, in 1983, reported that a single infusion of 10-g IVIG did not improve pain in 7 patients with postherpetic neuralgia [34].

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Acknowledgments

The Pain Relief Foundation, Liverpool, UK, has supported the author’s work. Prof. J. J. van Hilten for contributions to the manuscript.

Conflict of Interest

The author has received grant support from CSL-Behring, Bern, Switzerland, and from Talecris, Irmo, SC, USA, and speaker honoraria from Baxter, USA.

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Authors and Affiliations

  1. Pain Research Institute, 3rd Floor, Clinical Sciences Centre, Liverpool University, Lower Lane, Liverpool, L9 7AL, UK

    Andreas Goebel

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Correspondence to Andreas Goebel.

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Goebel, A. Immunoglobulin Responsive Chronic Pain. J Clin Immunol 30 (Suppl 1), 103–108 (2010). https://doi.org/10.1007/s10875-010-9403-8

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