Thermal perception thresholds: influence of determination paradigm and reference temperature

The use of different paradigms and initial skin and thermode reference temperatures in quantitative thermal testing does not allow strict comparison of results generated from different laboratories. We tested (a) whether the reproducibility of the method of limits is higher for measurement of isolated warm and cold thresholds (WT, CT) as compared to difference limen (DL) thresholds, i.e. values derived from alternating warm and cold stimulation, and (b) whether WT-, CT- and DL-thresholds depend on the value of baseline skin and thermode temperatures. In 20 healthy volunteers WT-, CT-, and DL-thresholds were determined at the volar wrist using a Somedic-Thermotest. In condition A the baseline thermode temperature was set at 30 degrees C, and in conditions B and C at 35 degrees C; in condition C the tested skin area was also warmed to 35 degrees C prior to the test. The randomized tests were repeated within 1-8 days. WT-, CT-, and DL-values were reproducible, but DL-values were more widely spread than WT and CT. CT variability was lowest in condition A, and WT variability in condition C. We conclude that DL determination should be abandoned, since CT and WT better differentiate normal from abnormal thresholds than the coarse DL-values. We recommend the use of the lower baseline thermode temperature (30 degrees C) and elimination of warming of the tested skin area prior to the test.