Immunoglobulin responsive chronic pain

J Clin Immunol. 2010 May;30 Suppl 1:S103-8. doi: 10.1007/s10875-010-9403-8.

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Chronic Disease
  • Complex Regional Pain Syndromes / therapy
  • Cytokines / metabolism
  • Fibromyalgia / therapy
  • Humans
  • Hyperalgesia / etiology
  • Hyperalgesia / physiopathology
  • Hyperalgesia / therapy
  • Immunoglobulins, Intravenous / therapeutic use*
  • Mast Cells / metabolism
  • Models, Immunological
  • Models, Neurological
  • Neuralgia / therapy
  • Neuroglia / metabolism
  • Nociceptors / physiology
  • Pain / physiopathology
  • Pain Management*
  • Posterior Horn Cells / physiopathology
  • Postpoliomyelitis Syndrome / therapy
  • Randomized Controlled Trials as Topic
  • Sensory Receptor Cells / physiology
  • Spinal Cord / physiopathology

Substances

  • Cytokines
  • Immunoglobulins, Intravenous