Spatial summation and spatial discrimination of cold pain: Effect of spatial configuration and skin type

Spatial summation (SS) and spatial discrimination (SD) are essential for pain perception. In the cold-pain sensation, these processes have hardly been studied. Our aim was to study the SS and SD of cold pain, as well as the SS of cold-pain threshold (CPT) in hairy and glabrous skin. Two discrete stimuli (9 cm2 each) were applied to the forearm with separation distances of 0-40 cm and in addition, a single stimulus on each forearm. For each configuration, the CPT, suprathreshold cold-pain ratings, and the reported number of activated stimuli (SD) were obtained. In another experiment, SS of CPT was tested in the hairy and glabrous skin of the hand using small (2.25 cm2) and large (9 cm2) probe sizes. The SS of CPT and of cold pain existed over separation distances of up to 30-40 cm, at which point SD became better than chance. When the 2 forearms were stimulated, SS was abolished and cold pain was inhibited. CPT was significantly higher in hairy than glabrous skin, but the amount of SS of CPT was similar in the 2 skin types. Noxious cold-evoked thermal qualities were more common in the glabrous than the hairy skin. In conclusion: (1) SS and SD of cold pain are reciprocal; (2) whereas cold pain can summate over large distances, the SD of cold pain is poor; (3) SS of cold pain does not exist between contralateral body sides, however, inhibition occurs; (4) SS is independent of skin type and sensitivity to cold pain; (5) differences in pain quality between hairy and glabrous skin may reflect innervation differences.