Immunoglobulin responsive chronic pain.
BACKGROUND
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.


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.


CONCLUSIONS
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.
Goebel
Andreas
A
Pain Research Institute, 3rd Floor, Clinical Sciences Centre, Liverpool University, Liverpool, UK. andreasgoebel@rocketmail.com
D002908:Chronic Disease; D020918:Complex Regional Pain Syndromes / Q000628:therapy; D016207:Cytokines / Q000378:metabolism; D005356:Fibromyalgia / Q000628:therapy; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008407:Mast Cells / Q000378:metabolism; D018448:Models, Immunological; D008959:Models, Neurological; D009437:Neuralgia / Q000628:therapy; D009457:Neuroglia / Q000378:metabolism; D009619:Nociceptors / Q000502:physiology; D010146:Pain / Q000503:physiopathology; D059408:Pain Management; D020671:Posterior Horn Cells / Q000503:physiopathology; D016262:Postpoliomyelitis Syndrome / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D011984:Sensory Receptor Cells / Q000502:physiology; D013116:Spinal Cord / Q000503:physiopathology
D016207:Cytokines; D016756:Immunoglobulins, Intravenous