Spatial summation for pain perception: interaction of inhibitory and excitatory mechanisms.

To study the relation between size of the surface stimulated and perceived pain intensity (spatial summation effect), subjects sequentially immersed predetermined segments of the surface of their arm, between the fingertips and the shoulder, in circulating nociceptive hot water. Immersion sessions were of three types: (i) increasing session (immersion beginning at fingertips and increasing to shoulder); (ii) decreasing session (immersion beginning at shoulder and decreasing to fingertips); and (iii) whole arm+increasing session (preliminary immersion of the whole arm up to shoulder, followed by an increasing session from fingertips to shoulder). Results showed a positive spatial summation effect (pain perception positively correlated to the size of the surface stimulated) during both the decreasing session and the whole arm+increasing session. However, no spatial summation effect was found during the increasing session (fingertips to shoulder). In addition, pain perceived for a surface area was less intense during the decreasing session compared to the increasing session. One possible explanation for the lack of a spatial summation effect during the increasing session is that inhibitory mechanisms are gradually recruited at the same time as excitatory afferences, thus 'cancelling out' any measurable spatial summation effect. The results obtained during the decreasing session and the whole arm+increasing session may be explained by inhibitory mechanisms being fully recruited at the beginning of the session with the immersion of the largest surface area (whole arm). The results are a shift of the pain perception curve and a positive relation between the surface stimulated and pain perception.