. Relationships between skin temperature and temporal summation of heat and cold pain. J Neurophysiol 90: 100 -109, 2003; 10.1152/jn.01066.2002. Temporal summation of heat pain during repetitive stimulation is dependent on C nociceptor activation of central N-methyl-D-aspartate (NMDA) receptor mechanisms. Moderate temporal summation is produced by sequential triangular ramps of stimulation that control skin temperature between heat pulses but do not elicit distinct first and second pain sensations. Dramatic summation of second pain is produced by repeated contact of the skin with a preheated thermode, but skin temperature between taps is not controlled by this procedure. Therefore relationships between recordings of skin temperature and psychophysical ratings of heat pain were evaluated during series of repeated skin contacts. Surface and subcutaneous recordings of skin temperatures revealed efficient thermoregulatory compensation for heat stimulation at interstimulus intervals (ISIs) ranging from 2 to 8 s. Temporal summation of heat pain was strongly influenced by the ISIs and cannot be explained by small increases in skin temperature between taps or by heat storage throughout a stimulus series. Repetitive brief contact with a precooled thermode was utilized to evaluate whether temporal summation of cold pain occurs, and if so, whether it is influenced by skin temperature. Surface and subcutaneous recordings of skin temperature revealed a sluggish thermoregulatory compensation for repetitive cold stimulation. In contrast to heat stimulation, skin temperature did not recover between cold stimuli throughout ISIs of 3-8 s. Psychophysically, repetitive cold stimulation produced an aching pain sensation that progressed gradually and radiated beyond the site of stimulation. The magnitude of aching pain was well related to skin temperature and thus appeared to be established primarily by peripheral factors.
I N T R O D U C T I O NTemporal summation of pain occurs reliably when pulses of heat or electrical stimulation are delivered repetitively at rates as slow as one pulse in 3 s. Enhanced discharge of nocireceptive central neurons ("windup") can be observed under these conditions (Mendell 1966;Tommerdahl et al. 1998). Temporal summation for psychophysical and neural responses to heat is dependent on activation of unmyelinated (C) nociceptors and is dependent in part on activation of central N-methyl-D-aspartate (NMDA) receptors (Dickenson 1990;Graven-Nielsen et al. 2000;Price et al. 1994). Most investigations of heat pain summation have utilized triangular ramps from a Peltier device in constant contact with the skin. This method has the advantage of returning the skin to a baseline temperature between each ramping heat stimulus. However, because of limitations on the ramp speeds of Peltier thermodes (especially during down ramps), distinct first and second pain sensations that are attributable respectively to activation of myelinated (A-delta) and C nociceptors are not produced. Possibly because of inhibitory influe...