Psychophysics of phasic and tonic heat pain stimuli by quantitative sensory testing in healthy subjects

The increased use of quantitative sensory testing in the study of pain raises the need to characterize various aspects of psychophysical response to noxious stimulation in healthy subjects. The present study aims to address several issues regarding the use of heat pain stimuli: (a) Are pain scores for short-term repeated phasic stimuli consistent? (b) Does an exposure to tonic heat pain stimulus cause sensitization and change the scores for subsequent phasic stimuli? and (c) Are pain scores for phasic and tonic heat pain correlated? To address these questions, a series of four phasic heat pain stimuli of 47 degrees C were given to the forearms of 70 healthy volunteers, over the course of an hour. Pain scores by Visual Analog Scale (VAS) were obtained for each stimulus. In 50 subjects, a tonic heat pain of 70s duration at 47.5 degrees C was given between the first and second phasic stimuli. Pain scores were obtained at four points along this tonic stimulus. Repeated measures ANOVA and a sensitive post hoc analysis indicated that, while the pain perception was reduced on the second, nearly immediate trial, subsequent VAS scores of pain perception were not different from the first (#1: 35.2+/-19.2; #2: 31.4+/-20.2, #3: 33.0+/-21.6; and #4: 33.2+/-20.1, respectively), with strong correlation among the phasic tests. The average tonic pain score was 53.7+/-23.1. Administration of tonic pain stimuli did not result in different VAS scores of subsequent phasic pain stimuli, compared to those subjects who did not receive tonic pain stimuli. Tonic and phasic pain were positively correlated (e.g., r=0.45,p<0.001 for the first phasic stimuli). However, no relation was found between the level of perceived pain, either for phasic or for tonic stimuli, and presence or absence of temporal summation during the tonic pain.

(i) phasic pain scores assessments at 30' and 60' after baseline is consistent; (ii) tonic heat pain, despite relatively high VAS scores, does not cause a change in the scoring of subsequent phasic stimuli; and (iii) phasic and tonic pain scores correlate with each other. Thus, the normal pattern of pain perception is stable and not altered by single tonic pain stimulation.