Temporal summation of pain (TSP) is a promising tool for measuring the pain modulation processes in healthy subjects and patients with chronic pain. We tried to find optimal stimulation parameters in order to elicit a robust reproducible TSP phenomenon. Twenty healthy volunteers (15 women and 5 men) completed four sessions/conditions of pulsating heat pain stimulation, applied to the left forearm with a frequency of 0.33–0.4 sec–1 using a contact heat-evoked potential stimulator. The stimulation temperature (step +0.5°C or +1.0°C up to the pain threshold, pain tolerance), pulse duration (500, 800, or 1000 msec), and number of stimuli (60 or 90) were varied. The participants rated the pain intensity at the first and every 10th heat pulse, using a numeric rating scale (NRS) 0–100. The TSP was calculated as the difference between the lowest rating and the rating of the last stimulus and was compared between conditions. The optimal condition (19 out of 20 participants responded with TSP) showed temperature at pain tolerance, pulse duration of 800 msec, and 90 stimuli. In addition, this condition showed weaker side effects (painful discomfort) than those with less (60) but longer (1000 msec) stimuli presented 1.0 degree above the pain threshold. The protocol with a relatively high stimulus repetition and a moderate pulse duration seems to be the optimal protocol to reproduce TSP. Heat stimulation with longer pulse durations and higher stimulation temperatures was less feasible.
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References
D. D. Price, “Characteristics of second pain and flexion reflexes indicative of prolonged central summation,” Exp. Neurol., 37, 371–391 (1992)
L. Arendt-Nielsen, “Central sensitization in humans: assessment and pharmacology,” Handb. Exp. Pharmacol., 227, 79–102 (2015).
J. J. Barrel and D. D. Price, “The perception of first and second pain as a function of psychological set,” Percept. Psychophys., 17, 163–166 (1975).
S. Lautenbacher, S. Roscher, and F. F. Strian, “Tonic pain evoked by pulsating heat: temporal summation mechanisms and perceptual qualities,” Somatosens. Mot. Res., 12, 59–70 (1995).
W. Maixner, R. Fillingim, A. Sigurdsson, et al., “Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain: evidence for altered temporal summation of pain,” Pain, 76, 71–81 (1998).
A. E. Olesen, T. Andresen, C. Staahl, and A. M. Drewes, “Human experimental pain models for assessing the therapeutic efficacy of analgesic drugs,” Pharmacol. Rev., 64, 722–779 (2012).
D. D. Price, L. W. Hu, R. Dubner, and R. H. Gracely, “Peripheral suppression of first pain and central summation of second pain evoked by noxious heat pulses,” Pain, 3, 57–68 (1977).
C. Staahl and A. M. Drewes, “Experimental human pain models: a review of standardised methods for preclinical testing of analgesics,” Basic Clin. Pharmacol. Toxicol., 95, 97–111 (2004).
L. M. Mendell and P. D. Wall, “Responses of single dorsal cells to peripheral cutaneous unmyelinated fibers,” Nature, 206, 97–99 (1965).
R. Staud, D. D. Price, and R. B. Fillingim, “Advanced contineous-contact heat pulse design for efficient temporal summation of second pain (windup),” J. Pain, 7, 575–582 (2006).
R. Staud, M. E. Robinson, and D. D. Price, “Temporal summation of second pain and its maintenance are useful for characterizing widespread central sensitization of fibromyalgia patients,” J. Pain, 8, 893–901 (2007).
J. Schouenborg, “Functional and topographical properties of field potentials evoked in rat dorsal horn by cutaneous C-fiber stimulation,” J. Physiol., 356, 169–192 (1984).
J. F. Herrero, J. M. A. Laird, and L. A. Lopez-Garcia, “Wind-up of spinal cord neurons and pain sensation: much ado about something?,” Prog. Neurobiol., 61, 169–203 (2000).
R. Staud, “Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions,” Expert. Rev. Neurother., 12, 577–585 (2012).
R. J. Anderson, J. G. Craggs, L. E. Bialosky, et al., “Temporal summation of second pain: variability in responses to a fixed protocol,” Eur. J. Pain, 17, 67–74 (2013).
R. R. Edwards and R. B. Fillingim, “Effects of age on temporal summation and habituation of thermal pain: Clinical relevance in healthy older and younger adults,” J. Pain, 2, 307–317 (2001).
M. Granot, Y. Granovsky, E. Sprecher, et al., “Contact heat-evoked temporal summation: Tonic versus repetitive-phasic stimulation,” Pain, 122, 295–305 (2006).
C. J. Vierck, R. L. Cannon, G. Fry, et al., “Characteristics of temporal summation of second pain sensations elicited by brief contact of glabrous skin by a preheated thermode,” J. Neurophysiol., 78, 992–1002 (1997).
R. Dubner and M. A. Ruda, “Activity-dependent neuronal plasticity following tissue injury and inflammation,” Trends Neurosci., 15, 96–103 (1992).
W. Greffrath, U. Baumgärtner, and R. D. Treede, “Peripheral and central components of habituation of heat pain perception and evoked potentials in humans,” Pain, 132, 301–311 (2007).
D. D. Price and R. Dubner, “Mechanisms of first and second pain in the peripheral and central nervous systems,” J. Invest. Dermatol., 69, 167–171 (1977).
S. Lautenbacher, M. Kunz, P. Strate, et al., “Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain,” Pain, 115, 410–418 (2005).
R. B. Fillingim, W. Maixner, S. Kincaid, and S. Silva, “Sex differences in temporal summation but not sensory-discriminative processing of thermal pain,” Pain, 75, 121–127 (1998).
E. Sarlani and J. D. Greenspan, “Gender differences in temporal summation of mechanically evoked pain,” Pain, 97, 163–169 (2002).
H. Janner, C. Klausenitz, N. Gürtler, et al., “Effects of electrical transcutaneous vagus nerve stimulation on the perceived intensity of repetitive painful heat stimuli: a blinded placebo- and sham-controlled randomized crossover investigation,” Anesth. Analg., 126, 2085–2092 (2018).
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Usichenko, T.I., Möller, N., Janner, H. et al. Measurements of Temporal Summation of Heat Pain: a Pilot Investigation in Healthy Humans. Neurophysiology 50, 415–423 (2018). https://doi.org/10.1007/s11062-019-09773-0
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DOI: https://doi.org/10.1007/s11062-019-09773-0