The Hand-Withdrawal-Method - An adapted and simplified method of limits for behavioral heat pain assessment

Published:December 26, 2022DOI:


      • A simplified method-of-limits for thermal threshold testing was developed.
      • First validation in adults shows high equivalence with the standard method-of-limits.
      • No significant differences between the 2 methods were found for any outcome.
      • The simplified procedure is safe and might increase comfort.
      • This procedure is promising for safe heat pain assessment, eg, in young children.


      The method-of-limits (MLI) is an established psychophysical procedure, for example for determining thermal thresholds. The standard MLI relies on fixating the thermode at the stimulation site by means of a strap and requires the participant to terminate the increase in heat by pressing a button. This, however, raises concerns regarding safety and task complexity in specific populations, such as cognitively impaired individuals, people with high fear of pain or young children (< 6 years). In this study, we aimed at developing a simplified version of the commonly used MLI for testing heat pain threshold (HPT) and tolerance (HPTol), and at validating it as a first step in healthy adults. Heating is terminated by withdrawing the hand from the heat probe, thereby ensuring maximum control and safety. For validation, HPTs and HPTols were assessed with the novel “hand-withdrawal-method” (HWM) and compared to the standard MLI, using a within-subject design. Additionally, as one potential research area in which the HWM may be used, we explored expectancy-induced placebo hypoalgesic effects by comparing results of standard MLI with those of HWM. Our data confirm good concordance between the 2 methods. For none of the outcomes significant differences between the 2 methods were found.


      In the present study in healthy adults, an adapted simplified and safe method of limits was demonstrated to be equivalent to the standard method-of-limits. This novel behavioral “hand-withdrawal-method” seems promising for future investigations of pain sensitivity and placebo effects, especially for specific populations such as young children.

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