New Hope for CRPS Patients
There is growing interest in the use of immunomodulators for the treatment of complex regional pain syndrome (CRPS), reported researchers from the Walton Centre NHS Foundation Trust, in Liverpool, England.1
Although the etiology of CRPS is unknown, there is evidence of immune activation in the affected limb, the peripheral blood, and cerebrospinal fluid. The researchers, led by Andreas Goebel, MD, PhD, have hypothesized that modulating the immune system may alleviate CRPS. In fact, a previous study has found that low-dose intravenous immunoglobulin (IVIG, 0.5 g/kg) reduced pain intensity by ≥30% in approximately 50% of CRPS patients.2
The researchers wanted to see if repeated subcutaneous administration of immunoglobulin (SCIG)—which could be performed at home—was as effective as IVIG. Three patients (2 women) who had previously responded to IVIG were recruited for the prospective study. Each patient received a single dose of IVIG (1 g/kg in Patient 1; 0.5 g/kg in Patients 2 and 3). Patient 1 and 3 achieved >45% pain reduction, and were continued on the study, which included self-administering SCIG weekly at home. For Patient 1, the initial SCIG was 1 g/kg/month; reduced to 0.5 g/kg/month at 6 months; and 0.25 g/kg/month at 9 months until 12 months. Patient 3 started at 0.5 g/kg/month for 3.5 months. The patients evaluated their pain and sleep quality daily, and quality of life and function monthly over the course of the study.
The results of the study found that both Patient 1 and 3 reported sustained and stable pain reduction of >70% over their study periods, and also reported improved quality of life and function. The authors concluded that low-dose SCIG, administered at home, may be a viable option for current IVIG responders.
- Poole H, Frank B, Maciver K, et al. Managing pain in CRPS: a case series examining the effects of repeated dose subcutaneous immunoglobulin. J Pain. 2012;13(4):S28 (abstract #209).
- Goebel A, Baranowski A, Maurer K, et al. Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial. Ann Intern Med. 2010;152(3):152-158.
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