Andreas Goebel is a Senior Lecturer at the University of Liverpool, and Consultant in Pain Medicine at the Liverpool Walton Centre Hospital, one of the largest pain teams in the UK.
A small but significant randomized, double-blind, placebo-controlled crossover trial has shown that treating the immune system of patients with CRPS/RSD can significantly relieve pain.
The study, published in the February 2010 issue of the journal Annals of Internal Medicine, found that a single, low dose infusion of intravenous immunoglobulin (IVIG) significantly reduced pain in just under 50 percent of patients treated, with few adverse effects
In unresolved CRPS of more than a year (nCRPS) they question whether there is an inflammatory or autoimmune condition. They think that nCRPS is an inflammatory or autoimmune condition, at least in some cases. In separate laboratory studies, the researchers and others have since discovered that many patients with nCRPS have antibodies directed against their own nerves (=’autoantibodies’) suggesting that CRPS could be ‘autoimmune’.
Research has shown that the affected limb's representation in the brain changes with nCRPS. Because of the described changes in the brain and the success of ‘brain training’, ( Lorimer Moseley, mirror therapy, Professor Minh Zhuo links ) people have started to think that whatever biological cause initially elicits CRPS is perhaps not so important later – that nCRPS is essentially sustained by the brain. However Dr Goebel's research suggests that this may not be the case. I don't quite agree with this. I don't think this conclusion follows logically on. However I have no training or knowledge other than my own observation.
Dr Goebel says,
"there is something odd about our patients’ responses to IVIG: most patients respond to unusually low doses (0.5g/kg), and they respond much quicker than people suffering from other IVIG-responsive conditions. Equally unusual is that our patients very likely do not respond to treatment with steroids, the panacea of things going wrong with the immune system. I would not be surprised if the way by which the immune system causes CRPS is different from that by which is causes other conditions."
He asks if brain retraining can override the immunological processes in some patients. Moseley's research suggests this is so.
These are now my ovservations for what they are worth. Because I have had CRPS and have had remission twice after more than 10 years of constant whole body pain and symptoms I have made observations along the way.
- It has been shown that CRPS can be prevented in some cases by taking small doses of vitamin c from the time of initiating event for a period described in research.
- Studies in Holland have centered around free radical scavengers as treatment for CRPS. There are many ongoing studies with DMSO, NAC in Holland.
- Whether it is a pre existing inflammation or an inflammatory response we know that something associated with this triggers CRPS.
- Dr Andreas Goebel's research suggests that treating the immune system can reduce pain. This fits neatly with Dutch research.
- Mirror Therapy has worked for me to reduce both pain and symptoms of CRPS and also other pain
- From my observation of my own response brain retraining reduces pain and symptoms of CRPS (and other pain)
- It appears to me that much of what we do, think etc can be shown by fMRI to change the brain. No matter what method you use (brain retraining techniques, medication, vitamins, surgery that reduce local symptoms etc) a change is produced in the body. This change produces (as I understand it) a change in the brain. Isn't it true that as change affects the brain, then at the time of an inciting event that the brain would change. I believe it is time we stopped measuring the change and just conclude that change in the brain is a fact. This is an exciting development in my opinion as it would seem that we are able to effect beneficial changes to our well being by doing, thinking etc things that we now know to produce beneficial brain changes. This change can also be produced, I think, by many means, such as physical exercises, thought training, meditation, taking medicine, immuno suppressants, vitamins etc. I suspect anything that elicits a body response may be shown to change the brain.
I have no qualifications and no training in this area so I'm aware what I've written here is quite simplistic. However it appears to me that, in general, the least invasive, least likely to cause side effects method of treatment would be the most desirable or the method proven to produce greatest benefit for least cost, financially and physically. I hope now and into the future these dedicated researchers get adequate funding to keep asking questions and searching for answers.