Immunoglobulin G for the Treatment of Chronic Pain: Report of an Expert Workshop

Authors


  • Disclosures: ST, FM, GZ, and SJ received funding from Grifols to attend scientific meetings. The Institution of ST and FM received money from Pfizer for educational activities on neuropathic pain and received the EFIC Grünenthal Grant 2010. KB received grants from Grifols, the Stockholm County (ALF), and the Karolinska Institutet, Sverige. XJC, LW, and PJS have no relevant financial interests or conflicts related to this manuscript. SJ received support for travel from Kedrion and received unconditioned grant support from Grifols to conduct clinical studies. SJ served as speaker for CLS-Behring. AJC received funding from the Bayer/Talecris/Canadian Blood Services/Héma-Québec Partnership Fund, Canada. GS serves on scientific advisory boards for Kanae Science Foundation for the Promotion of Medical Science, Naito Science Foundation, and is funded by the Ministry of Education, Culture, Sports, Science, and Technology of Japan; the Ministry of Welfare, Health, and Labor of Japan; and the Japan Science and Technology Agency, Core Research for Evolutional Science and Technology. HK received research support from the Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan, a grant from the Ministry of Health, Welfare, and Labor of Japan, and the Kimi Imai Memorial Foundation for Research of Incurable Neuromuscular Diseases. AV and the University of Oxford hold patents and receive royalties and payments for antibody assays. AG received research support, travel support, speaker honoraria, and consultancy fees from Axsone, CSL-Behring, BPL, Biotest, Talecris, Baxter, Grifols, and Pfizer.
  • Funding: The Expert Workshop (Liverpool, UK, October 2012), upon which the present manuscript was based, was supported by The Pain Relief Foundation, Liverpool The Great-Britain Sasakawa Foundation Awards Programme; Baxter; BPL; Biotest; CSL-Behring; and Grifols.
  • Contributorship Statement: ST and AG designed the article, collected and interpreted the data, and drafted and revised the manuscript. KB, XJC, SJ, AJC, HK, PJS, and AV collected and interpreted the data, drafted parts of the manuscript, and revised it for important intellectual content. FM, GS, LW, and GZ collected and interpreted the data and revised the manuscript for important intellectual content. All authors approved the final version of the article. ST and AG take full responsibility for the content of this article.

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.

Design

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.

Ancillary