All participants underwent quantitative sensory testing using thermal heat and a temporal summation of second pain protocol. The thermal stimuli were delivered by a computer-controlled Medoc Neurosensory Analyzer (TSA-2001, Ramat Yishai, Israel) via a 30*30mm Peltier thermode. The TSSP protocols used trains of thermal stimuli consisting of either 5 (Robinson et al., 2004 (
link)) or 10 (Alappattu et al., 2011 (
link); Bialosky et al., 2008 (
link); Bishop et al., 2011 (
link); George et al., 2006a (
link)) consecutive pulses of suprathreshold heat stimuli delivered to either the thenar surface of the palm (N = 195) (Bialosky et al., 2008 (
link); George et al., 2006a (
link); Robinson et al., 2004 (
link)) or the plantar surface of the foot (N = 117) (Alappattu et al., 2011 (
link); Bishop et al., 2011 (
link)). Each stimulus started at a baseline temperature of 39°C – 41°C, peaked at 51°C, then returned to baseline with a rise and decline rate of 10°C/s. The duration of each stimulus was approximately 1 second with a 3 second interval separating the peak of each stimulus (i.e., stimulus frequency = 0.33Hz). Participants were instructed to attend to the delayed pain sensation felt after each heat pulse (i.e., second pain), and verbally rate the intensity of this sensation using a numerical scale from 0 (no pain sensation) to 100 (most intense pain imaginable). Before the test, participants underwent one practice session to acclimate them to the thermal stimuli and pain rating system.
The 78 participants in the Robinson et al. (Robinson et al., 2004 (
link)) study received a train of 5 heat stimuli and rated pulses 1, 3, and 5, while the 234 participants in the other 4 studies received a train of 10 heat stimuli and rated every pulse. To standardize the evaluation of TSSP response across datasets, only the ratings from pulses 1, 3, and 5 were used in the analyses. It has been demonstrated that A-fiber mediated first pain is significantly diminished by the 4
th pulse, leaving only the experience of C-fiber mediated second pain thereafter (Price et al., 1977 (
link)). Additionally, peak temporal summation occurs in the first 4 stimuli in humans, and response saturates thereafter (Herrero et al., 2000 (
link)). Thus, the choice of limiting our analysis to the first 5 stimuli pulses is appropriate to evaluate TSSP response and allows for better consistency across the studies.
Anderson R.J., Craggs J.G., Bialosky J.E., Bishop M.D., George S.Z., Staud R, & Robinson M.E. (2012). Temporal Summation of Second Pain: Variability in Responses to a Fixed Protocol. European journal of pain (London, England), 17(1), 67-74.