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On AY, Latifoglou E, Çınar E, Tanıgör G. Prevalence and Severity of Central Sensitization in Post-Polio Syndrome: Associations with Clinical Measures and Quality of Life. Ann Indian Acad Neurol 2024; 27:282-288. [PMID: 38907687 PMCID: PMC11232829 DOI: 10.4103/aian.aian_1040_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/23/2024] [Accepted: 06/02/2024] [Indexed: 06/24/2024] Open
Abstract
OBJECTIVES To investigate the presence and severity of central sensitization (CS) and its associations with clinical measures and quality of life (QoL) in individuals with a history of paralytic poliomyelitis with and without post-polio syndrome (PPS). METHODS In this cross-sectional study, we included 98 individuals with a history of poliomyelitis, in whom 82 (83.6%) met the criteria of PPS. We used CS Inventory (CSI) to evaluate the presence and severity of CS. We evaluated the severity of fatigue, pain, polio-related impairments, and QoL using a Numerical Rating Scale in addition to Fatigue Severity Scale, Self-reported Impairments in Persons with late effects of Polio rating scale (SIPP), and Nottingham Health Profile (NHP). RESULTS CS was present in 52.4% of patients with PPS, of which 63% are classified as severe to extreme. Those with CS reported more severe symptoms, more polio-related impairments, and worse QoL than those without CS. Severity of CS showed significant positive correlations with severity of fatigue, pain, SIPP, and NHP scales in those with PPS. CSI did not indicate CS in any of those without PPS. CONCLUSION CS was present in more than half of the individuals with PPS and correlated with more severe pain, fatigue, and more polio-related impairments, in addition to poorer QoL. These findings suggest that CS may contribute to the clinical picture in a subgroup of individuals with PPS. Thus, identification and appropriate management of CS patients may potentially help alleviate their symptoms and improve their QoL.
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Affiliation(s)
- Arzu Y On
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Emre Latifoglou
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ece Çınar
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Göksel Tanıgör
- Department of Internal Sciences, Faculty of Medicine, İzmir University of Economics, İzmir, Turkey
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Laffont I, Duflos C, Hirtz C, Bakhti K, Gelis A, Palayer C, Macioce V, Soler M, Pradalier F, Galtier F, Jentzer A, Lozano C, Vincent T, Morales RJ. Post-polio syndrome is not a dysimmune condition. Eur J Phys Rehabil Med 2024; 60:270-279. [PMID: 38252127 PMCID: PMC11112507 DOI: 10.23736/s1973-9087.23.08158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Poliomyelitis is a global disabling disease affecting 12-20 million of people. Post poliomyelitis syndrome (PPS) may affect up to 80% of polio survivors: increased muscle weakness, pain, fatigue, functional decline. It relies on aging of an impaired neuro-muscular system with ongoing denervation processes. A late involvement of humoral or cellular pro-inflammatory phenomena is also suspected. AIM To assess the dysimmune hypothesis of PPS by comparing lymphocyte subpopulations and humoral immune factors between PPS patients and controls. DESIGN Cross-sectional study. SETTING Montpellier University Hospital. POPULATION Forty-seven PPS and 27 healthy controls. METHODS PPS patients and controls were compared on their lymphocyte subpopulations and humoral immune factors (IL-1β, IL-6, IL-8, IL-17, IL-21, IL-22, IL-23, IFN-γ, TNF-α, GM-CSF, RANTES, MCP1, MIP-3a, IL-10, TGF-β, IL4, IL13). Patients were further compared according to their dominant clinical symptoms. Sample size guaranteed a power >90% for all comparisons. RESULTS PPS patients and controls were comparable in gender, age and corpulence. Most patients had lower limb motor sequelae (N.=45, 95.7%), a minority had upper limb motor impairment (N.=16, 34.0%). Forty-five were able to walk (94%), 35/45 with technical aids. The median of the two-minute walking test was 110 meters (interquartile range 55; 132). Eighteen (38%) required help in their daily life. Their quality of life was low (SF36). All described an increased muscular weakness, 40 (85%) a general fatigue, and 39 (83%) muscular or joint pain. Blood count, serum electrolytes, T and B lymphocyte subpopulations and cytokines were comparable between patients and controls, except for creatine phospho kinase that was significantly higher in PPS patients. None of these variables differed between the 20/47 patients whose late main symptoms were pain or fatigue, and other patients. CONCLUSIONS Our results suggest that PPS is not a dysimmune disease. CLINICAL REHABILITATION IMPACT Our results do not sustain immunotherapy for PPS. Our work suggest that PPS may be mostly linked to physiological age-related phenomena in a disabled neuromuscular condition. Thus, our results emphasize the role of prevention and elimination of aggravating factors to avoid late functional worsening, and the importance of rehabilitation programs that should be adapted to patients' specific conditions.
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Affiliation(s)
- Isabelle Laffont
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France -
- Euromov-Digital Health in Motion, Montpellier University, Montpellier, France -
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Christophe Hirtz
- Institute for Regenerative Medicine and Biotherapy, INSERM 1183, Montpellier University, Montpellier, France
| | - Karima Bakhti
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
- Euromov-Digital Health in Motion, Montpellier University, Montpellier, France
| | - Anthony Gelis
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
- Department of Physical and Rehabilitation Medicine, Propara, Montpellier, France
| | - Claire Palayer
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Marion Soler
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Fanny Pradalier
- Department of Physical and Rehabilitation Medicine, Nimes University Hospital, Montpellier University, Nimes, France
| | - Florence Galtier
- Inserm CIC 1411, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Alexandre Jentzer
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Claire Lozano
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Thierry Vincent
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Raul J Morales
- Department of Neurology, Montpellier University Hospital, Montpellier University, Montpellier, France
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
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3
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Li Hi Shing S, Chipika RH, Finegan E, Murray D, Hardiman O, Bede P. Post-polio Syndrome: More Than Just a Lower Motor Neuron Disease. Front Neurol 2019; 10:773. [PMID: 31379723 PMCID: PMC6646725 DOI: 10.3389/fneur.2019.00773] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
Post-polio syndrome (PPS) is a neurological condition that affects polio survivors decades after their initial infection. Despite its high prevalence, the etiology of PPS remains elusive, mechanisms of progression are poorly understood, and the condition is notoriously under-researched. While motor dysfunction is a hallmark feature of the condition, generalized fatigue, sleep disturbance, decreased endurance, neuropsychological deficits, sensory symptoms, and chronic pain are also often reported and have considerable quality of life implications in PPS. The non-motor aspects of PPS are particularly challenging to evaluate, quantify, and treat. Generalized fatigue is one of the most distressing symptoms of PPS and is likely to be multifactorial due to weight-gain, respiratory compromise, poor sleep, and polypharmacy. No validated diagnostic, monitoring, or prognostic markers have been developed in PPS to date and the mainstay of therapy centers on symptomatic relief and individualized rehabilitation strategies such as energy conservation and muscle strengthening exercise regimes. Despite a number of large clinical trials in PPS, no effective disease-modifying pharmacological treatments are currently available.
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Affiliation(s)
- Stacey Li Hi Shing
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Eoin Finegan
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Murray
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Lo JK, Robinson LR. Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis. Muscle Nerve 2018; 58:760-769. [PMID: 29752826 DOI: 10.1002/mus.26167] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
Post-polio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids, and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. Muscle Nerve 58:760-769, 2018.
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Affiliation(s)
- Julian K Lo
- Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Lawrence R Robinson
- Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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Lo JK, Robinson LR. Postpolio syndrome and the late effects of poliomyelitis. Part 1. pathogenesis, biomechanical considerations, diagnosis, and investigations. Muscle Nerve 2018; 58:751-759. [DOI: 10.1002/mus.26168] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Julian K. Lo
- Sunnybrook Health Sciences Centre; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto; 2075 Bayview Avenue, Toronto Ontario Canada
| | - Lawrence R. Robinson
- Sunnybrook Health Sciences Centre; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto; 2075 Bayview Avenue, Toronto Ontario Canada
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Post-polio Syndrome. Neuromuscul Disord 2018. [DOI: 10.1007/978-981-10-5361-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Post-Polio Syndrome, Implications for Geriatric Care. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Perez EE, Orange JS, Bonilla F, Chinen J, Chinn IK, Dorsey M, El-Gamal Y, Harville TO, Hossny E, Mazer B, Nelson R, Secord E, Jordan SC, Stiehm ER, Vo AA, Ballow M. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol 2016; 139:S1-S46. [PMID: 28041678 DOI: 10.1016/j.jaci.2016.09.023] [Citation(s) in RCA: 376] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 09/12/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
Abstract
Human immunoglobulin preparations for intravenous or subcutaneous administration are the cornerstone of treatment in patients with primary immunodeficiency diseases affecting the humoral immune system. Intravenous preparations have a number of important uses in the treatment of other diseases in humans as well, some for which acceptable treatment alternatives do not exist. We provide an update of the evidence-based guideline on immunoglobulin therapy, last published in 2006. Given the potential risks and inherent scarcity of human immunoglobulin, careful consideration of its indications and administration is warranted.
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Affiliation(s)
- Elena E Perez
- Allergy Associates of the Palm Beaches, North Palm Beach, Fla.
| | - Jordan S Orange
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Francisco Bonilla
- Department of Pediatrics, Clinical Immunology Program, Children's Hospital Boston and Harvard Medical School, Boston, Mass
| | - Javier Chinen
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Ivan K Chinn
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Morna Dorsey
- Department of Pediatrics, Allergy, Immunology and BMT Division, Benioff Children's Hospital and University of California, San Francisco, Calif
| | - Yehia El-Gamal
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Terry O Harville
- Departments of Pathology and Laboratory Services and Pediatrics, University of Arkansas, Little Rock, Ark
| | - Elham Hossny
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Bruce Mazer
- Department of Pediatrics, Allergy and Immunology, Montreal Children's Hospital and McGill University, Montreal, Quebec, Canada
| | - Robert Nelson
- Department of Medicine and Pediatrics, Division of Hematology and Oncology and Stem Cell Transplantation, Riley Hospital, Indiana University School of Medicine and the IU Melvin and Bren Simon Cancer Center, Indianapolis, Ind
| | - Elizabeth Secord
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, Mich
| | - Stanley C Jordan
- Nephrology & Transplant Immunology, Kidney Transplant Program, David Geffen School of Medicine at UCLA and Cedars-Sinai Medical Center, Los Angeles, Calif
| | - E Richard Stiehm
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | - Ashley A Vo
- Transplant Immunotherapy Program, Comprehensive Transplant Center, Kidney Transplant Program, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Mark Ballow
- Department of Pediatrics, Division of Allergy & Immunology, University of South Florida, Morsani College of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla
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Werhagen L, Borg K. Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic. Neurol Sci 2016; 37:1597-601. [DOI: 10.1007/s10072-016-2629-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/03/2016] [Indexed: 11/28/2022]
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Baj A, Colombo M, Headley JL, McFarlane JR, Liethof MA, Toniolo A. Post-poliomyelitis syndrome as a possible viral disease. Int J Infect Dis 2015; 35:107-16. [PMID: 25939306 DOI: 10.1016/j.ijid.2015.04.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 12/27/2022] Open
Abstract
This review summarizes current concepts on post-polio syndrome (PPS), a condition that may arise in polio survivors after partial or complete functional recovery followed by a prolonged interval of stable neurological function. PPS affects 15-20 million people worldwide. Epidemiological data are reported, together with the pathogenic pathways that possibly lead to the progressive degeneration and loss of neuromuscular motor units. As a consequence of PPS, polio survivors experience new weakness, generalized fatigue, atrophy of previously unaffected muscles, and a physical decline that may culminate in the loss of independent life. Emphasis is given to the possible pathogenic role of persistent poliovirus infection and chronic inflammation. These factors could contribute to the neurological and physical decline in polio survivors. A perspective is then given on novel anti-poliovirus compounds and monoclonal antibodies that have been developed to contribute to the final phases of polio eradication. These agents could also be useful for the treatment or prevention of PPS. Some of these compounds/antibodies are in early clinical development. Finally, current clinical trials for PPS are reported. In this area, the intravenous infusion of normal human immunoglobulins appears both feasible and promising.
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Affiliation(s)
- Andreina Baj
- Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy
| | - Martina Colombo
- Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy
| | - Joan L Headley
- Post-Polio Health International, Saint Louis, Missouri, USA
| | | | - Mary-Ann Liethof
- Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy; Polio Australia Incorporated, Kew, Victoria, Australia
| | - Antonio Toniolo
- Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy.
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Huang YH, Chen HC, Huang KW, Chen PC, Hu CJ, Tsai CP, Tam KW, Kuan YC. Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis. BMC Neurol 2015; 15:39. [PMID: 25886512 PMCID: PMC4379590 DOI: 10.1186/s12883-015-0301-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/11/2015] [Indexed: 11/28/2022] Open
Abstract
Background Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial. Methods We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels. Results We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = −1.02, 95% confidence interval [CI] = −2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI −0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity. Conclusion The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.
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Affiliation(s)
- Yao-Hsien Huang
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Hung-Chou Chen
- Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Kuang-Wei Huang
- Department of Gastroenterology, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Gastroenterology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Po-Chih Chen
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
| | - Chaur-Jong Hu
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chin-Piao Tsai
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan. .,Center for Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Taipei Medical University-Shuang Ho Hospital, 291 Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
| | - Yi-Chun Kuan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan. .,Taipei Medical University-Shuang Ho Hospital, 291 Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
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Tamburin S, Borg K, Caro XJ, Jann S, Clark AJ, Magrinelli F, Sobue G, Werhagen L, Zanette G, Koike H, Späth PJ, Vincent A, Goebel A. Immunoglobulin g for the treatment of chronic pain: report of an expert workshop. PAIN MEDICINE 2014; 15:1072-82. [PMID: 24422915 DOI: 10.1111/pme.12319] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurological and Movement Sciences, University of Verona, Verona, Verona, Italy
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Bertolasi L, Frasson E, Turri M, Gajofatto A, Bordignon M, Zanolin E, Martini M, Pimazzoni F, Ferlisi M, Zanusso G, Rossi M, Monaco S. A randomized controlled trial of IV immunoglobulin in patients with postpolio syndrome. J Neurol Sci 2013; 330:94-9. [DOI: 10.1016/j.jns.2013.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 03/26/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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