title: Immunoglobulin g for the treatment of chronic pain: report of an expert workshop.
abstract: BACKGROUND
  The treatment of chronic pain is still unsatisfactory. Despite the availability of different drugs, most patients with chronic pain do not receive satisfactory pain relief or report side effects. Converging evidence implicates involvement of the immune system in the pathogenesis of different types of nociceptive and neuropathic chronic pain.
  
  
  METHODS
  At a workshop in Liverpool, UK (October 2012), experts presented evidence suggesting immunological involvement in chronic pain and recent data supporting the concept that the established immune-modulating drug, polyvalent immunoglobulin G (IgG), either given intravenously (IVIg) or subcutaneously (SCIg), may reduce pain in some peripheral neuropathies and a range of other pain disorders. Workshop's attendees discussed the practicalities of using IVIg and SCIg in these disorders, including indications, cost-effectiveness, and side effects.
  
  
  RESULTS
  IgG may reduce pain in a range of nociceptive and neuropathic chronic pain conditions, including diabetes mellitus, Sjögren's syndrome, fibromyalgia, complex regional pain syndrome, post-polio syndrome, and pain secondary to pathological autoantibodies.
  
  
  CONCLUSIONS
  IgG is a promising treatment in several chronic pain conditions. IgG is a relatively safe therapeutic strategy, with uncommon and mild side effects but high costs. Randomized, controlled trials and predictive tests are needed to better support the use of IgG for refractory chronic pain.
authors.affiliation: Department of Neurological and Movement Sciences, University of Verona, Verona, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamburin
authors.forename: Kristian
authors.initials: K
authors.lastname: Borg
authors.forename: Xavier J
authors.initials: XJ
authors.lastname: Caro
authors.forename: Stefano
authors.initials: S
authors.lastname: Jann
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Clark
authors.forename: Francesca
authors.initials: F
authors.lastname: Magrinelli
authors.forename: Gen
authors.initials: G
authors.lastname: Sobue
authors.forename: Lars
authors.initials: L
authors.lastname: Werhagen
authors.forename: Giampietro
authors.initials: G
authors.lastname: Zanette
authors.forename: Haruki
authors.initials: H
authors.lastname: Koike
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Späth
authors.forename: Angela
authors.initials: A
authors.lastname: Vincent
authors.forename: Andreas
authors.initials: A
authors.lastname: Goebel
mesh_terms: D059350:Chronic Pain / Q000188:drug therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*
chemical_list: D007074:Immunoglobulin G
keywords: Immune system; Immunoglobulin; Immunotherapy; Pain; Pathophysiology; Therapy