Potassium-channel autoimmunity linked to chronic pain

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By Liam Davenport, medwireNews Reporter

A substantial proportion of patients with voltage-gated potassium channel (VGKC)-complex autoimmunity experience chronic idiopathic pain, although the specific antigenic complex associated with pain remains to be determined, conclude US scientists.

"Our findings add VGKC-complex autoimmune pain to the list of potentially treatable autoimmune channelopathies," the team says in Neurology, adding: "Most remarkably, 81% of patients receiving immunotherapy experienced pain symptom improvement not attributable to changes in standard analgesic medication or dosing, and allowing narcotics to be discontinued in some cases."

In an accompanying editorial, David Bennett, from King's College London, UK, and Angela Vincent, from John Radcliffe Hospital, in Oxford, UK, comment: "We may… be entering an exciting phase in which autoantibodies to neural antigens are recognized as having a role in the etiology of a number of hitherto poorly understood chronic pain states, opening new avenues for treatment."

The researchers, led by Christopher Klein, from the Mayo Clinic in Rochester, Minnesota, identified 1992 patients with VGKC-complex-immunoglobulin (Ig)G from 54,853 people who were tested between 2008 and 2010. Of 316 VGKC-complex-IgG-seropositive patients evaluated neurologically, 50% had pain not attributable to an alternative cause, which was isolated in 28% of patients and had accompanying neurologic manifestations in 72% of patients.

Symptoms were subacute in 95%, and became chronic in the majority of patients. Multiple medications were required by 70% of patients, with 30% of patients taking narcotics.

The most commonly affected area was the extremities, in 49% of patients. Total body pain was experienced by 27% of patients, which, prior to VGKC-complex-IgG detection, was diagnosed as psychogenic in 13% and fibromyalgia in 6.2%. Twelve percent of patients reported atypical head and face pain. Overall, pain was descriptively neuropathic or nociceptive, in 58% and 47% of the patients, respectively.

Normal peripheral function, as determined via neuropathy impairment scores and nerve conduction, was detected in 62% of 94 patients tested. Patients with pain were 25 times more likely than those without to have evidence of neuronal hyperexcitability, such as hyperhidrosis, quantitative heat-pain hyperalgesia, or electromyographic excitability.

Pain relief was achieved using immunotherapy in 13 of 16 patients. The presence of IgG antibodies binding the contactin-associated protein-2 antigen was significantly associated with pain, at 16% positivity among patients with pain versus 7% among patients without pain. By contrast, antibodies to the leucine-rich glioma-activated 1 protein were not linked to pain.

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Comments

  1. PJ PJ United States says:

    This article interests me, but the point escapes me. If I have chronic pain related to fibromyalgia and I also have low potassium levels being treated by taking prescription tablets daily, is this what I should be doing? I have several medical conditions being treated and try to keep a close eye on all of them as my father, a WWII Pharmacist's Mate First Class taught me to be as aware as I can be on all my ailments and treatments. I also have osteoarthritis and degenerative disc disease and essential tremors. So far I do not display any neuropathy which is wonderful. I do have another condition which I am not certain I can spell right now, hypogammaglobunemia, I hope that is close enough for you to know what I mean. Any ideas for that which might be helpful, I would appreciate. Thank you.  Oh and I am a young 61 year old, already considered disabled.

  2. dave dave United States says:

    Many substances are linked to chronic pain- biomedical research has done little to improve pain care and much of it is wasteful. Researchers are not held accountable for the adequacy or reliability of their studies- and most studies are faulted upon review.

  3. Jon Jon United States says:

    I fear the previous two comments have missed the whole point of this breakthrough research.

    This shows for the first time that Autoimmune Diseases which have VGKC autoantibodies cause dysfunction to the potassium ion channels of the pain receptors....causing a dysregulating effect in regards to pain felt.
    Previously these diseases were not seen as Chronic Pain givers by the medical literature....the patients always disagreed yet dismissed as complainers...and yet now at last they are vindicated.

    Diseases with VGKC Autoantibodies and thus affected are:
    Peripheral Nerve Hyperexcitability (and its variants)
    Autoimmune Neuromyotonia
    Limbic Encephalitis
    Morvans Syndrome

    Thankyou Liam for posting this news....it is truly fantastic for all these sufferers...that were once told it was all in their head.

  4. rick rick Australia says:

    I have been diagnosed with Auto Immune Neuromyotonia/Isaacs Syndrome suffering
    constant pain in many different parts of the body. Until this diagnosis I was told by
    some  Neurologists and Docotos that the pain  was in my head.
    The report has further vindicated this group of patients. Many of this group have been misunderstood for along time.

    Rick
    Australia.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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