Comparison of the cold pressor test and contact thermode-delivered cold stimuli for the assessment of cold pain sensitivity

Abstract

Sensitivity to suprathreshold cold pain stimuli constitutes an important part of comprehensive pain sensitivity testing and can be assessed by the cold pressor test or by using a contact thermode-based testing device. One major difference between the 2 methods is the size of the surface area stimulated, which is thought to affect both recruitment of endogenous pain control mechanisms and vasomotor reactions. It is therefore not clear if the 2 methods can be used interchangeably for the assessment of cold pain. Here we applied 60-second-long stimuli at approximately 3 degrees C to the hands of 47 subjects by both methods. Pain intensity ratings (on a scale from 0 to 10) were significantly higher in the cold pressor test than in the thermode cold test (6.3 +/- 1.8 vs 3.9 +/- 2), associated with a higher rate of dropouts within the 60 seconds (64 vs 11%). Nonetheless, pain intensity ratings obtained with both methods were highly correlated (r = .70). However, the thermode cold test shared a larger amount of variance with 1 or more of the other pain intensity rating tests (phasic and tonic heat, pinprick) than the cold pressor test (53% vs 30%) while the cold pressor test contained a larger proportion of unique variance (39 vs 26%).

Perspective: This article compares 2 methods of cold pain assessment in humans and analyzes their relationship to heat and pinprick pain. It could help researchers select the appropriate cold pain test for their study. It may also promote our understanding of commonalities and differences between different pain modalities.