• Andreas Goebel, Andrew Baranowski, Konrad Maurer, Artemis Ghiai, Candy McCabe, and Gareth Ambler.
• University of Liverpool, Clinical Sciences Building, University Hospital Aintree, Liverpool L9 7AL, United Kingdom.
• Ann. Intern. Med. 2010 Feb 2; 152 (3): 152-8.

BackgroundTreatment of long-standing complex regional pain syndrome (CRPS) is empirical and often of limited efficacy. Preliminary data suggest that the immune system is involved in sustaining this condition and that treatment with low-dose intravenous immunoglobulin (IVIG) may substantially reduce pain in some patients.ObjectiveTo evaluate the efficacy of IVIG in patients with longstanding CRPS under randomized, controlled conditions.DesignA randomized, double-blind, placebo-controlled crossover trial. (National Research Registry number: N0263177713; International Standard Randomised Controlled Trial Number Registry: 63918259)SettingUniversity College London Hospitals Pain Management Centre.PatientsPersons who had pain intensity greater than 4 on an 11-point (0 to 10) numerical rating scale and had CRPS for 6 to 30 months that was refractory to standard treatment.InterventionIVIG, 0.5 g/kg, and normal saline in separate treatments, divided by a washout period of at least 28 days.MeasurementsThe primary outcome was pain intensity 6 to 19 days after the initial treatment and the crossover treatment.Results13 eligible participants were randomly assigned between November 2005 and May 2008; 12 completed the trial. The average pain intensity was 1.55 units lower after IVIG treatment than after saline (95% CI, 1.29 to 1.82; P < 0.001). In 3 patients, pain intensity after IVIG was less than after saline by 50% or more. No serious adverse reactions were reported.LimitationThe trial was small, and recruitment bias and chance variation could have influenced results and their interpretation.ConclusionIVIG, 0.5 g/kg, can reduce pain in refractory CRPS. Studies are required to determine the best immunoglobulin dose, the duration of effect, and when repeated treatments are needed.Primary Funding SourceAssociation of Anaesthetists of Great Britain and Ireland, University College London Hospitals Charity, and CSL-Behring.

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