• Alexandre S Quevedo, Carsten Dahl Mørch, Ole K Andersen, and Robert C Coghill.
• aDepartment of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC, USA bDepartamento de Cirurgia e Ortopedia, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil cCenter for Neuroplasticity and Pain (CNAP), SMI®, Dept. of Health Science and Technology, Aalborg University, Denmark, dDepartment of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, OH, USA.
• Pain. 2017 Jun 1; 158 (6): 1046-1052.

AbstractSpatial summation of pain (SSP) is the increase of perceived intensity that occurs as the stimulated area increases. Spatial summation of pain is subadditive in that increasing the stimulus area produces a disproportionately small increase in the perceived intensity of pain. A possible explanation for subadditive summation may be that convergent excitatory information is modulated by lateral inhibition. To test the hypothesis that lateral inhibition may limit SSP, we delivered different patterns of noxious thermal stimuli to the abdomens of 15 subjects using a computer-controlled CO2 laser. Lines (5 mm wide) of variable lengths (4, 8 cm) were compared with 2-point stimuli delivered at the same position/separation as the length of lines. When compared with one-point control stimuli, 2-point stimulus patterns produced statistically significant SSP, while no such summation was detected during line stimulus patterns. Direct comparison of pain intensity evoked by 2-point pattern stimuli with line pattern stimuli revealed that 2-point patterns were perceived as significantly more painful, despite the fact that the 2-point pattern stimulated far smaller areas of skin. Thus, the stimulation of the skin region between the endpoints of the lines appears to produce inhibition. These findings indicate that lateral inhibition limits SSP and is an intrinsic component of nociceptive information processing. Disruption of such lateral inhibition may contribute substantially to the radiation of some types of chronic pain.

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