Thermal Thresholds and Catastrophizing in Individuals with Chronic Pain after Whiplash Injury

2006 ◽  
Vol 8 (2) ◽  
pp. 138-146 ◽  
Author(s):  
Ragnhild Raak ◽  
Mia Wallin
Keyword(s):  
Pain Catastrophizing ◽  
Thermal Sensitivity ◽  
Trapezius Muscle ◽  
Thenar Eminence ◽  
Heat Pain ◽  
Cold Pain ◽  
Pain Thresholds ◽  
Thermal Thresholds ◽  
Thermal Pain ◽  
Background Pain

Thermal sensitivity, thermal pain thresholds, and catastrophizing were examined in individuals with whiplash associated disorders (WAD) and in healthy pain-free participants. Quantitative sensory testing (QST) was used to measure skin sensitivity to cold and warmth and cold and heat pain thresholds over both the thenar eminence and the trapezius muscle (TrM) in 17 participants with WAD (age 50.8± 11.3 years) and 18 healthy participants (age 44.8± 10.2 years). The Pain Catastrophizing Scale (PCS) was used to determine pain coping strategies, and visual analogue scales were used for self-assessment of current background pain in individuals in the WAD group as well as experienced pain intensity and unpleasantness after QST and sleep quality in all participants. There were significant differences in warmth threshold and cold and heat pain thresholds of the TrM site between the WAD and pain-free groups. Significant differences between the two groups were also found for the catastrophizing dimension of helplessness in the PCS and in self-assessed quality of sleep. A correlational analysis showed that current background pain is significantly correlated with both cold discrimination and cold pain threshold in the skin over the TrM in individuals with WAD. These findings imply that thermal sensitivity is an important factor to consider in providing nursing care to individuals with WAD. Because biopsychosocial factors also influence the experience of pain in individuals with WAD, the role of nurses includes not only the description of the pain phenomenon but also the identification of relieving and aggravating factors.

Thermoreception and nociception of the skin: a classic paper of Bessou and Perl and analyses of thermal sensitivity during a student laboratory exercise

2010 ◽  
Vol 34 (2) ◽  
pp. 25-34 ◽  
Author(s):  
Johann P. Kuhtz-Buschbeck ◽  
Wiebke Andresen ◽  
Stephan Göbel ◽  
René Gilster ◽  
Carsten Stick
Keyword(s):  
Thermal Sensitivity ◽  
Nerve Fibers ◽  
Heat Pain ◽  
Cold Pain ◽  
Pain Thresholds ◽  
Nociceptive Neurons ◽  
Laboratory Exercise ◽  
Thermal Pain ◽  
C Fibers ◽  
Thermal Detection

About four decades ago, Perl and collaborators were the first ones who unambiguously identified specifically nociceptive neurons in the periphery. In their classic work, they recorded action potentials from single C-fibers of a cutaneous nerve in cats while applying carefully graded stimuli to the skin (Bessou P, Perl ER. Response of cutaneous sensory units with unmyelinated fibers to noxious stimuli. J Neurophysiol 32: 1025–1043, 1969). They discovered polymodal nociceptors, which responded to mechanical, thermal, and chemical stimuli in the noxious range, and differentiated them from low-threshold thermoreceptors. Their classic findings form the basis of the present method that undergraduate medical students experience during laboratory exercises of sensory physiology, namely, quantitative testing of the thermal detection and pain thresholds. This diagnostic method examines the function of thin afferent nerve fibers. We collected data from nearly 300 students that showed that 1) women are more sensitive to thermal detection and thermal pain at the thenar than men, 2) habituation shifts thermal pain thresholds during repetititve testing, 3) the cold pain threshold is rather variable and lower when tested after heat pain than in the reverse case (order effect), and 4) ratings of pain intensity on a visual analog scale are correlated with the threshold temperature for heat pain but not for cold pain. Median group results could be reproduced in a retest. Quantitative sensory testing of thermal thresholds is feasible and instructive in the setting of a laboratory exercise and is appreciated by the students as a relevant and interesting technique.

Repeatability of cold pain and heat pain thresholds: The application of sensory testing in migraine research

Cephalalgia ◽  
2010 ◽  
Vol 30 (8) ◽  
pp. 904-909 ◽  
Author(s):  
Trond Sand ◽  
Kristian Bernhard Nilsen ◽  
Knut Hagen ◽  
Lars Jacob Stovner
Keyword(s):  
Pain Threshold ◽  
Heat Pain ◽  
Cold Pain ◽  
Pain Thresholds ◽  
Thermal Pain ◽  
Normal Limits ◽  
Normal Test ◽  
Heat Pain Threshold ◽  
The Face ◽  
Repeatability Limit

Normal heat pain threshold (HPT) and cold pain threshold (CPT) repeatability should be estimated in order to identify thermal allodynia in longitudinal studies, but such data are scarce in the literature. The aim of our study was to estimate normal HPT and CPT repeatability in the face, forehead, neck and hand. In addition, we reviewed briefly normative studies of thermal pain thresholds relevant for headache research. Thermal pain thresholds were measured on three different days in 31 healthy headache-free subjects. Coefficients of repeatability and normal limits were calculated. HPT and CPT were lowest in the face. Pooled across regions, the lower repeatability limit for the test/retest ratio was 63% for HPT and 55% for CPT. The upper normal CPT limit varied between 24.5°C and 29.7°C. Lower HPT limits ranged between 35.5°C and 40.8°C. Quantitative sensory methods provide useful information about headache and pain pathophysiology, and it is important to estimate the normal test/retest repeatability range in follow-up studies.

scholarly journals The Added Value of Sensitivity to Nonnoxious Stimuli to Predict an Individual’s Sensitivity to Pain

2021 ◽  
Vol 24 (6) ◽  
pp. E783-E794
Keyword(s):  
Postoperative Pain ◽  
Healthy Volunteers ◽  
Pain Score ◽  
Pain Sensitivity ◽  
Pain Catastrophizing ◽  
Light Sensitivity ◽  
Heat Pain ◽  
Cold Pain ◽  
Eye Color ◽  
Anxiety Depression

BACKGROUND: Simple tools are needed to predict postoperative pain. Questionnaire-based tools such as the Pain Sensitivity Questionnaire (PSQ) are validated for this purpose, but prediction could be improved by incorporating other parameters. OBJECTIVES: To explore the potency of sensitivity to nonpainful stimuli and biometric data to improve prediction of pain. STUDY DESIGN: Transversal exploratory study. SETTING: Single clinical investigation center. METHODS. Eighty-five healthy volunteers of both genders underwent a multimodal exploration including biometry, questionnaire-based assessment of anxiety, depression, pain catastrophizing, sensitivity to smell, and the PSQ, followed by a psychophysical assessment of unpleasantness thresholds for light and sound, and sensitivity to mechanical, heat, and cold pain. These last 3 parameters were used to calculate a composite pain score. After a multi-step selection, multivariable analyses identified the explanative factors of experimental pain sensitivity, by including biometric, questionnaire-based, and psychophysical nonnociceptive sensitivity parameters, with the aim of having each domain represented. RESULTS: Female gender predicted mechanical pain, a younger age and dark eyes predicted cold pain, and the PSQ predicted heat pain. Sensitivity to unpleasantness of sound predicted mechanical and heat pain, and sensitivity to unpleasantness of light predicted cold pain. Sensitivity to smell was unrelated. The predictors of the composite pain score were the PSQ, the light unpleasantness threshold, and an interaction between gender and eye color, the score being lower in light-eyed men and higher in all women. The final multivariable multi-domain model was more predictive of pain than the PSQ alone (R2 = 0.301 vs 0.122, respectively). LIMITATIONS: Sensitivity to smell was only assessed by a short questionnaire and could lack relevance. Healthy volunteers were unlikely to elicit psychological risk factors such as anxiety, depression, or catastrophizing. These results have not been validated in a clinical setting (e.g., perioperative). CONCLUSION: The predictive potential of the PSQ can be improved by including information about gender, eye color, and light sensitivity. However, there is still a need for a technique suitable for routine clinical use to assess light sensitivity. KEY WORDS: Personalized medicine, postoperative pain, senses, prediction, photophobia, hyperacusis, eye color, hypervigilance, sensory over-responsivity

Influence of age on thermal thresholds, thermal pain thresholds, and reaction time

2010 ◽  
Vol 17 (6) ◽  
pp. 722-726 ◽  
Author(s):  
Han-Wei Huang ◽  
Wen-Chi Wang ◽  
Chou-Ching K. Lin
Keyword(s):  
Reaction Time ◽  
Pain Thresholds ◽  
Thermal Thresholds ◽  
Thermal Pain

scholarly journals Low mechano-afferent fibers reduce thermal pain but not pain intensity in CRPS

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathrin Habig ◽  
Gothje Lautenschläger ◽  
Hagen Maxeiner ◽  
Frank Birklein ◽  
Heidrun H. Krämer ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Pain Threshold ◽  
Glabrous Skin ◽  
Healthy Controls ◽  
Cold Pain ◽  
Pain Thresholds ◽  
Thermal Pain ◽  
C Fibers ◽  
Ct Afferents ◽  
Heat Pain Threshold

Abstract Background Human hairy (not glabrous skin) is equipped with a subgroup of C-fibers, the C-tactile (CT) fibers. Those do not mediate pain but affective aspects of touch. CT-fiber-activation reduces experimental pain if they are intact. In this pilot study we investigated pain modulating capacities of CT-afferents in CRPS. Methods 10 CRPS-patients (mean age 33 years, SEM 3.3) and 11 healthy controls (mean age 43.2 years, SEM 3.9) participated. CT-targeted-touch (brush stroking, velocity: 3 cm/s) was applied on hairy and glabrous skin on the affected and contralateral limb. Patients rated pleasantness of CT-targeted-touch (anchors: 1 “not pleasant”—4 “very pleasant”) twice daily on 10 days. Pain intensity (NRS: 0 “no pain” – 10 “worst pain imaginable”) was assessed before, 0, 30, 60 and 120 min after each CT-stimulation. To assess sensory changes, quantitative-sensory-testing was performed at the beginning and the end of the trial period. Results CT-targeted-touch was felt more pleasant on the healthy compared to the affected limb on hairy (p < 0.001) and glabrous skin (p 0.002), independent of allodynia. In contrast to healthy controls patients felt no difference between stimulating glabrous and hairy skin on the affected limb. Thermal pain thresholds increased after CT-stimulation on the affected limb (cold-pain-threshold: p 0.016; heat-pain-threshold: p 0.033). Conclusions CT-stimulation normalizes thermal pain thresholds but has no effect on the overall pain in CRPS. Therefore, pain modulating properties of CT-fibers might be too weak to alter chronic pain in CRPS. Moreover, CT-fibers appear to lose their ability to mediate pleasant aspects of touch in CRPS.

scholarly journals Effects of Acute Exercise on Cutaneous Thermal Sensation

2020 ◽  
Vol 17 (7) ◽  
pp. 2491
Author(s):  
Samuel D. Thomas ◽  
Howard H. Carter ◽  
Helen Jones ◽  
Dick H.J. Thijssen ◽  
David A. Low
Keyword(s):  
Acute Exercise ◽  
Thermal Sensation ◽  
Thermal Sensitivity ◽  
Young Male ◽  
Sensory Function ◽  
Heat Sensitivity ◽  
Heat Pain ◽  
Local Skin ◽  
Pain Thresholds ◽  
Main Effect

The aim of this study was to assess the effect of exercise intensity on the thermal sensory function of active and inactive limbs. In a randomised and counterbalanced manner, 13 healthy young male participants (25 ± 6 years, 1.8 ± 0.1 m, 77 ± 6 kg) conducted: (1) 30-min low-intensity (50% heart rate maximum, HRmax; LOW) and (2) 30-min high-intensity (80% HRmax; HIGH) cycling exercises, and (3) 30 min of seated rest (CONTROL). Before, immediately after, and 1 h after, each intervention, thermal sensory functions of the non-dominant dorsal forearm and posterior calf were examined by increasing local skin temperature (1 °C/s) to assess perceptual heat sensitivity and pain thresholds. Relative to pre-exercise, forearm heat sensitivity thresholds were increased immediately and 1 hr after HIGH, but there were no changes after LOW exercise or during CONTROL (main effect of trial; p = 0.017). Relative to pre-exercise, calf heat sensitivity thresholds were not changed after LOW or HIGH exercise or during CONTROL (main effect of trial; p = 0.629). There were no changes in calf (main effect of trial; p = 0.528) or forearm (main effect of trial; p = 0.088) heat pain thresholds after exercise in either LOW or HIGH or CONTROL. These results suggest that cutaneous thermal sensitivity function of an inactive limb is only reduced after higher intensity exercise but is not changed in a previously active limb after exercise. Exercise does not affect heat pain sensitivity in either active or inactive limbs.

scholarly journals Thermal Pain in Complex Regional Pain Syndrome Type I

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. 71-79
Author(s):  
John R. Grothusen
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Quantitative Sensory Testing ◽  
Thermal Hyperalgesia ◽  
Pain Syndrome ◽  
Heat Pain ◽  
Syndrome Type ◽  
Sensory Testing ◽  
Cold Pain ◽  
Thermal Pain ◽  
Heat Hyperalgesia

Background: Quantitative sensory testing (QST), with thermal threshold determinations, is a routine part of the comprehensive clinical workup of patients suffering from chronic pain, especially those with Complex Regional Pain Syndrome seen at our outpatient pain clinic. This is done to quantitatively assess each patient’s small fiber and sensory function in a controlled manner. Most patients have normal sensory detection thresholds, but there are large differences in thermal pain thresholds. Some patients display no thermal hyperalgesia, while other patients display severe thermal hyperalgesia when tested in all 4 limbs. Objectives: To ascertain the prevalence of thermal hyperalgesia in patients with complex regional pain syndrome type 1 (CRPS-I). Study Design: This was a retrospective review of the results of QST performed on 105 patients as part of their clinical workup. Setting: The outpatient clinic of the Department of Neurology at Drexel University College of Medicine. Methods: All patients had a diagnosis of CRPS-I. Thermal quantitative sensory testing, including cool detection, warm detection, cold pain, and heat pain, was performed on 8 distal sites on each patient as part of a comprehensive clinical examination. Results: With regards to thermal hyperalgesia, patients with CPRS-I appear to fall into distinct groups. One subgroup displays evidence of generalized cold and heat hyperalgesia, one subgroup displays evidence of generalized cold hyperalgesia only, one displays evidence of heat hyperalgesia only, and one subgroup does not display evidence of cold or heat hyperalgesia. Limitations: This study is based on retrospective information on a relatively small (105 patient records) number of patients. Since only patients with CRPS-I were included, the results are only applicable to this group. Conclusions: Thermal QST provides useful information about the sensory phenotype of individual patients. Subgrouping based on thermal hyperalgesia may be useful for future studies regarding prognosis, treatment selection, and efficacy. Key words: Complex regional pain syndrome, CRPS, quantitative sensory testing, QST, cold pain, heat pain, thermal hyperalgesia

P059 Repeatability of cold pain and heat pain thresholds in healthy subjects

2008 ◽  
Vol 119 ◽  
pp. S86-S87
Author(s):  
Trond Sand ◽  
Nikita Zhitniy ◽  
Kristian Nilsen ◽  
Knut Hagen ◽  
Lars Stovner
Keyword(s):  
Healthy Subjects ◽  
Heat Pain ◽  
Cold Pain ◽  
Pain Thresholds

scholarly journals Episodic and chronic migraineurs are hypersensitive to thermal stimuli between migraine attacks

Cephalalgia ◽  
2010 ◽  
Vol 31 (1) ◽  
pp. 6-12 ◽  
Author(s):  
Todd J Schwedt ◽  
Melissa J Krauss ◽  
Karen Frey ◽  
Robert W Gereau
Keyword(s):  
Quantitative Sensory Testing ◽  
Pain Tolerance ◽  
Sensory Testing ◽  
Cold Pain ◽  
Pain Thresholds ◽  
Thermal Pain ◽  
Mechanical Pain Thresholds ◽  
Thermal Stimuli ◽  
Episodic Migraineurs ◽  
Chronic Migraineurs

Objective: To determine if migraineurs have evidence of interictal cutaneous sensitisation. Subjects and methods: Thermal and mechanical pain thresholds in 20 episodic migraineurs, 20 chronic migraineurs, and 20 non-migraine control subjects were compared. Quantitative sensory testing was conducted when subjects had been migraine-free for at least 48 h. Heat, cold and mechanical pain thresholds, and heat and cold pain tolerance thresholds were measured. Results: Thermal pain thresholds and thermal pain tolerance thresholds differed significantly by headache group ( P = 0.001). During the interictal period, episodic and chronic migraineurs were more sensitive to thermal stimulation than non-migraine controls. Conclusions: Interictal sensitisation may predispose the migraineur to development of headaches, may be a marker of migraine activity, and a target for treatment.

scholarly journals Does pain sensitivity change by migraine phase? A blinded longitudinal study

Cephalalgia ◽  
2016 ◽  
Vol 37 (14) ◽  
pp. 1337-1349 ◽  
Author(s):  
Martin Uglem ◽  
Petter Moe Omland ◽  
Kristian Bernhard Nilsen ◽  
Erling Tronvik ◽  
Lars Jacob Stovner ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Pain Perception ◽  
Prodromal Phase ◽  
Cold Pain ◽  
Pain Thresholds ◽  
Thermal Pain ◽  
Migraine Headaches ◽  
Pain Scores ◽  
Sensitivity Change ◽  
Heat Hyperalgesia

Objective Studies suggest that pain thresholds may be altered before and during migraine headaches, but it is still debated if a central or peripheral dysfunction is responsible for the onset of pain in migraine. The present blinded longitudinal study explores alterations in thermal pain thresholds and suprathreshold heat pain scores before, during, and after headache. Methods We measured pain thresholds to cold and heat, and pain scores to 30 seconds of suprathreshold heat four times in 49 migraineurs and once in 31 controls. Sessions in migraineurs were categorized by migraine diaries as interictal, preictal (≤one day before attack), ictal or postictal (≤one day after attack). Results Trigeminal cold pain thresholds were decreased ( p = 0.014) and pain scores increased ( p = 0.031) in the ictal compared to the interictal phase. Initial pain scores were decreased ( p < 0.029), and the temporal profile showed less adaptation ( p < 0.020) in the preictal compared to the interictal phase. Hand cold pain thresholds were decreased in interictal migraineurs compared to controls ( p < 0.019). Conclusion Preictal heat hypoalgesia and reduced adaptation was followed by ictal trigeminal cold suballodynia and heat hyperalgesia. Our results support that cyclic alterations of pain perception occur late in the prodromal phase before headache. Further longitudinal investigation of how pain physiology changes within the migraine cycle is important to gain a more complete understanding of the pathogenic mechanisms behind the migraine attack.

Sign in / Sign up

Export Citation Format

Share Document