Effects of noxious cooling of the skin on pain perception in man

By means of somatosensory evoked brain potentials following painful CO2 laser stimulation (pain SEPs) and a pain visual analogue scale (VAS), we investigated changes in pain perception caused by noxious cooling of the skin in normal subjects. Pain SEPs were recorded from scalp electrodes following laser stimulation applied to the leg under various conditions as follows: (1) control (without any interference); (2) 46 degrees C foot (dipping the foot ipsilateral to the stimulated leg in hot water at 46 degrees C); (3) 0 degrees C foot (dipping the foot ipsilateral to the stimulated leg in ice water at 0 degrees C); and (4) 0 degrees C hand (dipping the hand contralateral to the stimulated leg in ice water at 0 degrees C). Marked decreases in amplitude of pain SEPs and VAS were observed under all conditions as compared with the control (P < 0.001); the degree of pain relief was significantly correlated with changes in pain SEPs. These changes were greatest in the '0 degrees C hand' condition, followed in decreasing order by '0 degrees C foot' and '46 degrees C foot', and there was a significant difference between '0 degrees C hand' and the '46 degrees C foot' condition. We considered that the decrease in pain is due to the diffuse noxious inhibitory control (DNIC). The reason why the degree of pain relief in '0 degrees C foot' condition was less than that in '0 degrees C hand' condition is unclear, but some particular spatial summation of two kinds of nociceptive impulses mediated by the same pathway might take place.