Chronic pain may be an autoimmune problem

Dr. Anne Louise Oaklander, a neurologist at Massachusetts General Hospital, may have figured out the cause of many people’s unexplained pain: an over-active immune system. One of her patients, Leslie Levine, had to quit her job as Harvard University’s chief patent attorney because “I was in such pain and could hardly walk. It was like my legs were dipped in boiling oil 24/7.” Oaklander treated Levine with intravenous immunoglobulin (IVIg), and Levine’s pain disappeared within five days.

The IVIg treatment works, Oaklander says, because it “bamboozles the immune system,” overwhelming it with harmless proteins to distract it from attacking the nerves. If the condition goes untreated, continued attacks can leave permanent damage. On the other hand, Oaklander has found that about 16 percent of the patients were able to be weaned off of IVIg without their symptoms returning.

The painful condition is a small-fiber neuropathy and is rather common, especially among people who have diabetes or have suffered the effects of chemotherapy or other toxins. (The condition can also include numbness and itching.) But there are plenty of people with small fiber neuropathy for whom doctors cannot find a cause and which may in fact be an over-active immune system. (The same tiny nerves also line the gut, so people with this condition can also have gastrointestinal symptoms, such as nausea or vomiting when they try to eat.)

So far, there have been no large-scale clinical trials for the treatment. Because of this, other doctors are reluctant to try the therapy. Moreover, the treatment costs $10,000 per monthly dose (each dose contains purified proteins from 5,000 to 8,000 blood donors who have been screened for infectious disease). Of course, insurance companies are reluctant to pay, although after four years they began paying for Ms. Levine’s treatment when they discovered it was cheaper than paying for her hospital stays that resulted from the side effects of steroids—a treatment she’d resorted to when insurance wouldn’t cover the IVIg.

If insurance won’t pay for IVIg, there are always opioid painkillers. On second thought…..

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