Highlights
- •The study provides a comparison of temporal summation stimulation techniques.
- •Results suggest constant contact ramping protocols underestimate temporal summation.
- •Models using temporal summation should consider intermittent tapping techniques.
Abstract
Temporal summation of second pain (TSSP) is a psychophysical indication of a central
pain encoding mechanism, potentially enhanced in pathological pain conditions. Low-frequency
repetitive stimulation of unmyelinated (C) nociceptors results in a progressive increase
of pain intensity when thermal stimulation intensity remains constant. However, when
using different methods of nociceptive delivery to the skin, regularity as well as
rate of pain enhancement with repetition varies between experiments. Specifically,
repetitive ramping up and down from a neutral to a painful temperature has produced
weak and inconsistent pain summation. In contrast, repetitive contact of the skin
with a preheated probe has generated substantial pain summation. In the present study,
TSSP by the intermittent contact with a preheated thermode and constant contact, ramp
and hold methods were compared during 10 iterations of stimulation of glabrous skin
of the hand or hairy forearm skin, with an onset to onset interval of 3.3 seconds
and stimulus interval of .8 seconds. Significantly greater TSSP was observed for intermittent
contact stimulation at both sites (P < .001). Differential activation of myelinated and unmyelinated nociceptors by ramping
and tapping may account for different rates of temporal summation of heat pain.
Perspective
This article presents direct evidence suggesting the constant contact, ramp and hold
stimulus may underestimate the level of TSSP. This evidence suggests the re-evaluation
of stimulation techniques used for temporal summation tests, especially within clinical
models.
Key words
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Article info
Publication history
Published online: August 08, 2017
Accepted:
July 30,
2017
Received in revised form:
July 11,
2017
Received:
May 16,
2017
Footnotes
This research was supported by the National Institutes of Health (R01AG039659, 1T32AG049673). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
Dr. Fillingim has received consulting fees, speaking fees, and/or honoraria from WebMD and Algynomics (less than $10,000 each) and owns stock or stock options in Algynomics. Dr. Staud has received consulting fees, speaking fees, and/or honoraria from Pfizer (less than $10,000). Dr. Vierck owns stock in Neuroanalytics Corporation. The remaining authors have no conflicts of interest to declare.
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© 2017 by the American Pain Society
