Intravenous Immunoglobulin Treatment of the Complex Regional Pain Syndrome

Göebel, Andreas; Baranowski, A.; Maurer, K.; Ghiai, Artemis; McCabe, Candy; Ambler, Gareth

doi:10.7326/0003-4819-152-3-201002020-00006

Cited by 168 publications

(108 citation statements)

References 32 publications

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“…Among 6 patients with long-standing CRPS, some benefited from therapeutic plasma exchange [69]. One open-label study in 11 patients with CRPS and 1 well-designed, RCT in 12 patients reported modest efficacy of IVIg, 1 g/kg [70,71]. Given the desperate situation of patients with refractory CRPS, some of whom resort to limb amputation to try and reduce their pain, larger trials of IVIg and other immunomodulatory therapies seem indicated.…”

Section: Complex Regional Pain Syndromementioning

confidence: 99%

Immunotherapy Prospects for Painful Small-fiber Sensory Neuropathies and Ganglionopathies

Oaklander

2016

Neurotherapeutics

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The best-known peripheral neuropathies are those affecting the large, myelinated motor and sensory fibers. These have well-established immunological causes and therapies. Far less is known about the somatic and autonomic "small fibers"; the unmyelinated C-fibers, thinly myelinated A-deltas, and postganglionic sympathetics. The small fibers sense pain and itch, innervate internal organs and tissues, and modulate the inflammatory and immune responses. Symptoms of small-fiber neuropathy include chronic pain and itch, sensory impairment, edema, and skin color, temperature, and sweating changes. Small-fiber polyneuropathy (SFPN) also causes cardiovascular, gastrointestinal, and urological symptoms, the neurologic origin of which often remains unrecognized. Routine electrodiagnostic study does not detect SFPN, so skin biopsies immunolabeled to reveal axons are recommended for diagnostic confirmation. Preliminary evidence suggests that dysimmunity causes some cases of small-fiber neuropathy. Several autoimmune diseases, including Sjögren and celiac, are associated with painful small-fiber ganglionopathy and distal axonopathy, and some patients with "idiopathic" SFPN have evidence of organ-specific dysimmunity, including serological markers. Dysimmune SFPN first came into focus in children and teenagers as they lack other risk factors, for example diabetes or toxic exposures. In them, the rudimentary evidence suggests humoral rather than cellular mechanisms and complement consumption. Preliminary evidence supports efficacy of corticosteroids and immunoglobulins in carefully selected children and adult patients. This paper reviews the evidence of immune causality and the limited data regarding immunotherapy for small-fiberpredominant ganglionitis, regional neuropathy (complex regional pain syndrome), and distal SFPN. These demonstrate the need to develop case definitions and outcome metrics to improve diagnosis, enable prospective trials, and dissect the mechanisms of small-fiber neuropathy.

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Section: Complex Regional Pain Syndromementioning

confidence: 99%

Immunotherapy Prospects for Painful Small-fiber Sensory Neuropathies and Ganglionopathies

Oaklander

2016

Neurotherapeutics

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“…Case study data suggests anti-TNF therapy may have a role in CRPS (Ozgül et al 2011) but controlled trial data is still awaited. Goebel et al (2010) have demonstrated a significant reduction in pain for 5 out of 12 people with CRPS treated with low-dose intravenous immunoglobulin in a randomised controlled trial. This pain relief lasted for five weeks on average.…”

Section: Pharmacologicalmentioning

confidence: 98%

“…These changes in cytokine activity are not associated with disease duration or other clinical signs but appear to be related specifically to the degree of mechanical hyperalagesia, rather than pain per se, as they remain high even when the pain disappears (Wesseldijk et al 2008). Autoantibodies in some patients with CRPS have been reported by a number of groups (Blaes et al 2004;Goebel et al 2010;Kohr et al 2011) but it is not yet clear whether the autoantibodies are pathogenic or potentially protective against future reinfection.…”

Section: Introductionmentioning

confidence: 99%

Imaging and Clinical Evidence of Sensorimotor Problems in CRPS: Utilizing Novel Treatment Approaches

Bailey

Nelson

Lewis

et al. 2012

J Neuroimmune Pharmacol

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“…IVIG with steroids has been successful in one third of patients with CRPS. 18 Both thalidomide and lenalidomide have also shown some benefit in the treatment of CRPS. 19,20 Converging evidence supports the development of a sterile inflammatory response at the site of injury in CRPS patients.…”

Section: Case Reportmentioning

confidence: 99%

Gardner-Diamond syndrome associated with complex regional pain syndrome

Edinger¹,

Schwartzman²

2013

J Dermatol Case Rep

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Background: Gardner-Diamond syndrome (GDS) is also known as psychogenic purpura, autoerythrocyte sensitization syndrome and painful bruising syndrome.Main observation: This is a case report of 27-year-old woman who presented with unexplained bruising and intramuscular hematomas after a seven year history of complex regional pain syndrome. Her evaluation consisted of hematological studies, skin and muscle biopsy; it failed to reveal an underlying coagulopathy, vasculitis or other demonstrable cause. In the absence of any other etiology, she was diagnosed as Gardner-Diamond syndrome. Conclusion:This patient is unique because of intramuscular hematomas and the association of Complex regional pain syndrome with Gardner-Diamond syndro-

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Intravenous Immunoglobulin Treatment of the Complex Regional Pain Syndrome

Abstract: Association of Anaesthetists of Great Britain and Ireland, University College London Hospitals Charity, and CSL-Behring.

Cited by 168 publications

References 32 publications

Immunotherapy Prospects for Painful Small-fiber Sensory Neuropathies and Ganglionopathies

Immunotherapy Prospects for Painful Small-fiber Sensory Neuropathies and Ganglionopathies

Imaging and Clinical Evidence of Sensorimotor Problems in CRPS: Utilizing Novel Treatment Approaches

Gardner-Diamond syndrome associated with complex regional pain syndrome

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