• Jens Fust, Maria Lalouni, Viktor Vadenmark Lundqvist, Emil Wärnberg, and Karin B Jensen.
• Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
• Pain Rep. 2021 Jan 1; 6 (1): e914.

IntroductionOffset analgesia (OA), a large reduction in pain after a brief increase in intensity of an otherwise stable painful stimulus, has been established by a large body of research. But the opposite effect, onset hyperalgesia (OH), a disproportional hyperalgesic response after a briefly decreased intensity of a painful stimulus, has only been investigated in one previous study.ObjectivesThe aim of this study was to induce OA and OH in healthy participants and explore the effects of different stimulus ranges (increase/decrease of temperature) on OA and OH.MethodsA total of 62 participants were tested in 2 identical experiments. Offset analgesia and OH conditions included 2 different temperature deviations (±1°C/±2°C) from initial temperature and were compared with a constant temperature (control).ResultsOffset analgesia was successfully elicited in OA1°C in experiment 1, and in OA1°C and OA2°C in experiment 2. Results indicate a continuous stimulus-response relationship between the stimulus range and the resulting hypoalgesic response. Onset hyperalgesia was only elicited in OH2°C in experiment 1. Exploratory analysis showed that the lack of OH response in experiment 2 could be explained by sex differences, and that OA and OH responses were only weakly correlated.ConclusionsThe asymmetry between pain responses after a brief temperature increase and decrease suggests that different mechanisms are involved in the pain responses to increasing and decreasing temperature. This asymmetry may also be explained by high temperatures in OA condition (+1°C/+2°C above baseline) that could be seen as salient "learning signals," which augment the response to following changes in temperature.Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

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