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

背景:慢性疼痛的治疗效果仍不理想。尽管现在治疗慢性疼痛的药物种类较多,但许多患者对疗效仍不满意或诉药物的副作用太大。越来越多的证据表明,免疫系统参与了伤害性和神经病理性慢性疼痛的病理过程。设计:在英国利物浦的专题会议上,专家们出示了免疫系统参与慢性疼痛的证据。近来的研究表明,静脉(IVIg)或皮下(SCIg)注射免疫调节药物——多价免疫球蛋白(Ig G)可缓解外周神经病理性疼痛和其他疼痛性疾病。专题会议讨论了IVIg和SCIg治疗的适应证、效价比及其副作用。结果:Ig G可缓解某些伤害性和神经病理性慢性疼痛,如糖尿病、干燥综合征、纤维肌痛症、复杂性区域疼痛综合征、小儿麻痹后遗症和继发于病理性自身抗体的疼痛。结论:Ig G对某些慢性疼痛具有一定的治疗前景。Ig G是一种相对安全的治疗方法,副作用少而轻,但价格较贵。今后有必要对Ig G治疗顽固性疼痛进行随机对照研究和预测性临床试验。

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,Sj（o）gren＇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.