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Heat pain detection threshold is associated with the area of secondary hyperalgesia following brief thermal sensitization: a study of healthy male volunteers

Authors Hansen MS, Wetterslev J, Pipper CB, Asghar MS, Dahl JB

Received 31 August 2016

Accepted for publication 7 November 2016

Published 27 January 2017 Volume 2017:10 Pages 265—274

DOI https://doi.org/10.2147/JPR.S121189

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Michael Schatman

Morten Sejer Hansen,1 Jørn Wetterslev,2 Christian Bressen Pipper,3 Mohammad Sohail Asghar,1 Jørgen Berg Dahl4

1Department of Anesthesiology, 4231, Centre of Head and Orthopedics, Rigshospitalet, 2Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, 3Section of Biostatistics, Faculty of Health, Copenhagen University, Copenhagen, 4Department of Anesthesiology, Department Z, Bispebjerg Hospital, Copenhagen, Denmark

Introduction: The area of secondary hyperalgesia following brief thermal sensitization (BTS) of the skin and heat pain detection thresholds (HPDT) may both have predictive abilities in regards to pain sensitivity and clinical pain states. The association between HPDT and secondary hyperalgesia, however, remains unsettled, and the dissimilarities in physiologic properties suggest that they may represent 2 distinctively different pain entities. The aim of this study was to investigate the association between HPDT and BTS-induced secondary hyperalgesia.
Methods: A sample of 121 healthy male participants was included and tested on 2 separate study days with BTS (45°C, 3 minutes), HPDT, and pain during thermal stimulation (45°C, 1 minute). Areas of secondary hyperalgesia were quantified after monofilament pinprick stimulation. The pain catastrophizing scale (PCS) and hospital anxiety and depression scale (HADS) were also applied.
Results: A significant association between HPDT and the size of the area of secondary hyperalgesia (p<0.0001) was found. The expected change in area of secondary hyperalgesia due to a 1-degree increase in HPDT was estimated to be −27.38 cm2, 95% confidence interval (CI) of −37.77 to −16.98 cm2, with an R2 of 0.19. Likewise, a significant association between HADS-depression subscore and area of secondary hyperalgesia (p=0.046) was found, with an estimated expected change in secondary hyperalgesia to a 1-point increase in HADS-depression subscore of 11 cm2, 95% CI (0.19–21.82), and with R2 of 0.03. We found no significant associations between secondary hyperalgesia area and PCS score or pain during thermal stimulation.
Conclusion:
HPDT and the area of secondary hyperalgesia after BTS are significantly associated; however, with an R2 of only 19%, HPDT only offers a modest explanation of the inter-participant variation in the size of the secondary hyperalgesia area elicited by BTS.

Keywords: pain, central nervous system sensitization, hyperalgesia, pain threshold, healthy volunteers, catastrophization, secondary hyperalgesia, central sensitization

Corrigendum for this paper has been published

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