The aim of this study was to investigate the role of local acidosis in the
generation of pain in complex regional pain syndrome (CRPS). We investigate
d ten patients with CRPS of the upper extremity with a mean duration of the
disease of 43 weeks (range 4-280 weeks) and ten control subjects for sensi
tivity to infusion of fluids with low pH (pH 6.1). Another group of five CR
PS patients and three healthy controls was investigated using the same prot
ocol but neutral infusion fluid (pH 7.4). A motorized syringe pump was inst
alled for a constant infusion of synthetic interstitial fluid (SIF, either
acidified (pH 6.1) or neutral) into the skin at the back of the hands and,
thereafter, into the interosseus I muscle on both sides. A flow rate of 30
ml/h was chosen for intradermal and 7.5 ml/h for intramuscular infusion ove
r a period of 10 min. The magnitude of pain was rated on an electronic visu
al analogue scale. Patients were requested to give their ratings every 10 s
during the whole stimulation period. The ratings were normalized as fracti
ons of individual grand mean values. We found significantly increased pain
perception during infusion of acidified SIF on the affected side in CRPS pa
tients. Low pH fluid into the skin was significantly more painful between 4
and 6 min (ipsi 1.27 normalized rating (NR) (0.19-1.94), contra 0.31 NR (0
.03-0.51), P < 0.02) and between 8 and 10 min (ipsi 1.38 NR (0.19-1.94), co
ntra 0.08 NR (0-0.27), P < 0.03) on the affected side, while analysis over
the whole stimulation period just failed to reach statistical significance
(ipsi 281 area under the curve (AUC) (187-834), contra 87 AUC (28-293), P =
0.059). Low pH infusion into the muscle was significantly more painful on
the affected side during the whole infusion time (ipsi 861 AUC (308-1377),
contra 190 AUC (96-528), P < 0.01). The quality of the deep pain during inf
usion into the muscle was described by the patients as very similar to the
CRPS-related pain. In controls we found no side differences of pain intensi
ty during low pH stimulation. Neutral SIF evoked no pain at all, neither in
CRPS patients (ipsi O AUG, contra 0 AUG) nor in healthy controls. Our resu
lts suggest that hyperalgesia to protons is present in patients with CRPS.
Further, we could demonstrate that pain is not only restricted to the skin
but is also generated in deep somatic tissue of the affected limb. (C) 2000
International Association for the Study of Pain. Published by Elsevier Sci
ence B.V. All rights reserved.