Body regional heat pain thresholds using the method of limit and level: a comparative study

  • Sungjin Park
  • Sang-Hyun Roh
  • Joo-Young LeeEmail author
Original Article



The purpose of this study was to compare cutaneous heat pain thresholds using the method of limit and level.


Sixteen young males (23.2 ± 3.2 year, 174.9 ± 4.9 cm, and 70.1 ± 8.6 kg) participated in this study. The thermode temperature increased at a constant rate of 0.1 °C s−1 from 33 °C for the method of limit, whereas the method of level consisted of 3 s heat pulses increasing from 44 °C to 50 °C in 100 s separated by 5 s intervals. All measurements were conducted on 14 body regions (the forehead, neck, chest, abdomen, upper back, upper arm, forearm, waist, hand, palm, thigh, calf, foot, and sole) in 28 °C, 35% relative humidity.


The results are as follows. Heat pain thresholds were on average 3.2 ± 2.1 °C higher for the method of level than for the method of limit (P < 0.05). Second, the correlation coefficient between values by two methods was 0.819 (P < 0.01). Third, lower body regions (thigh, calf, and sole) had higher heat pain thresholds than upper body regions (chest) by the method of level only (P < 0.05). Fourth, body regional subcutaneous fat thickness showed no relationship with heat pain thresholds except the upper arm.


These results indicated that cutaneous heat pain thresholds vary based on the type of heat stimuli and body regions. The method of limit could be applied for predicting accumulated thermal pain starting from moderate heat, whereas the method of level may be applicable for predicting acute heat pain to flames or high heat.


Heat pain thresholds Method of limit Method of level Subcutaneous fat thickness Body regional difference Burn 



American Society for Testing and Materials


International Organization for Standardization


Substantia gelatinosa


Rectal temperature


Skin temperature


Thermal comfort


Transient receptor potential (TRP)


Thermal sensation



This research was supported by Nano·Material Technology Development Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (No. 2016M3A7B4910) and by the Fire Fighting Safety and 119 Rescue Technology Research and Development Program funded by the Ministry of Public Safety and Security (‘MPSS-Fire Fighting Safety-2015-76’). We thank the subjects for their participation and Jung-Mi Ha, Wojin Joe, and Andrew Gorski for their technical supports.

Author contributions

Its publication has been approved by all co-authors. All authors have contributed to the planning, preparation, data collection, analysis, and the writing of this manuscript, such that their contributions satisfy all the requirements of authorship.

Complaince with ethical standards

Conflict of interest

There are no conflicts of interest.


  1. Arendt-Nielsen L (1998) Experimental pain research-experimental and clinical aspects (reviews). J Jpn Soc Pain Clinic (JJSPC) 5(4):455–462Google Scholar
  2. ASTM C1055-03 (2003) Standard guide for heated system surface conditions that produce contact burn injuries. American Society of Test and Materials, West ConshohockenGoogle Scholar
  3. Bakkers M, Faber CG, Peters MJ, Reulen JP, Franssen H, Fischer TZ, Merkies IS (2013) Temperature threshold testing: a systemic review. J Peripheral Nerv Syst 18:7–18. CrossRefGoogle Scholar
  4. Belemonte C, Cervero F (1996) Neurobiology of nociceptors. Oxford University Press, OxfordCrossRefGoogle Scholar
  5. Burnett NC, Dallenbach KM (1927) The experience of heat. Am J Psychol 38(3):418–431CrossRefGoogle Scholar
  6. Campbell JN, LaMotte RH (1983) Latency to detection of first pain. Brain Res 266:203–208CrossRefGoogle Scholar
  7. Caterina MJ, Schumacher MA, Tominaga M, Rosen TA, Levine JD, Julius D (1997) The capsaicin receptor: a heat-activated ion channel in the pain pathway. Nature 389:816–824CrossRefGoogle Scholar
  8. Chery-Croze S (1983) Painful sensation induced by a thermal cutaneous stimulus. Pain 17(2):109–137CrossRefGoogle Scholar
  9. Cormack DH (1987) Ham’s histology. WB Saunders, Philadelphia, pp 450–474Google Scholar
  10. Defrin R, Givon R, Raz N, Urca G (2006a) Spatial summation and spatial discrimination of pain sensation. Pain 126(1–3):123–131. CrossRefGoogle Scholar
  11. Defrin R, Shachal-Shiffer M, Hadgadg M, Peretz C (2006b) Quantitative somatosensory testing of warm and heat-pain thresholds: the effect of body region and testing method. Clin J Pain 22(2):130–136CrossRefGoogle Scholar
  12. Dyck PJ, Zimmerman I, Gillen DA, Johnson D, Karnes JL, O’brien PC (1993) Cool, warm, and heat-pain detection thresholds testing methods and inferences about anatomic distribution of receptors. Neurology 43(8):1500–1508CrossRefGoogle Scholar
  13. Greenspan JD, Taylor DJ, McGillis SLB (1993) Body site variation of cool perception thresholds, with observations on paradoxical heat. Somatosens Mot Res 10(4):467–474CrossRefGoogle Scholar
  14. Hardy JD, Wolff HG, Goodell H (1952) Pricking pain thresholds in different body areas. Exp Biol Med 80(3):425–427CrossRefGoogle Scholar
  15. Harrison JLK, Davis KD (1999) Cold-evoked pain varies with skin type and cooling rate: a psychophysical study in humans. Pain 83:123–135CrossRefGoogle Scholar
  16. Hensel H (1981) Thermoreception and temperature regulation. Academic Press, LondonGoogle Scholar
  17. Hilz MJ, Glorius S, Beric A (1995) Thermal perception thresholds: influence of determination paradigm and reference temperature. J Neurol Sci 129:135–140CrossRefGoogle Scholar
  18. IASP (1994) Part III: pain terms, a current list with definitions and notes on usage. In: Merskey H, Bogduk N Classification of chronic pain, 2nd edn. IASP Press, Seattle, pp 209–214 IASP Task Force on TaxonomyGoogle Scholar
  19. ISO 13506 (2014) Protective clothing against heat and flame—test method for complete garments—prediction of burn injury using an instrumented manikin. International organization StandardizationGoogle Scholar
  20. Jones LA, Berris M (2002) The psychophysics of temperature perception and thermal-interface design. In: 10th Symposium on haptic interfaces for virtual environment and teleoperator systems, 2002. HAPTICS 2002. Proceedings, pp 137–142. IEEEGoogle Scholar
  21. Julius D (2013) TRP channels and pain. Annu Rev cell DeV Biol 29:355–384. CrossRefGoogle Scholar
  22. Julius D, Basbaum AI (2001) Molecular mechanisms of nociception. Nature 413(6852):203–210. doiCrossRefGoogle Scholar
  23. Kim YB, Jung D, Park J, Lee JY (2017) Sensitivity to cutaneous warm stimuli varies greatly in the human headGoogle Scholar
  24. Lee JY, Saat M, Chou C, Hashiguchi N, Wijayanto T, Wakabayashi H, Tochihara Y (2010) Cutaneous warm and cool sensation thresholds and the inter-threshold zone in Malaysian and Japanese males. J Therm Biol 35(2):70–76CrossRefGoogle Scholar
  25. Lee JY, Park J, Park H, Coca A, Kim JH, Taylor NAS, Son SY (2015) What do firefighters desire from the next generation of personal protective equipment? Outcomes from an international survey. Ind Health 53(5):434–444. CrossRefGoogle Scholar
  26. Levy D, Abraham R, Reid G (1989) A comparison of two methods for measuring thermal thresholds in diabetic neuropathy. J Neurol Neurosurg Psychiatry 52:1072–1077CrossRefGoogle Scholar
  27. Lowenstein L, Dallenbach KM (1930) The critical temperatures for heat and for burning heat. Am J Psychol 42:423–429. CrossRefGoogle Scholar
  28. Lynn B (1979) The heat sensitization of polymodal nociceptors in the rabbit and its independence of the local blood flow. J Physiol (Lond) 287:493–507CrossRefGoogle Scholar
  29. Lynn B, Perl ER (1977) A comparison of four tests for assessing the pain sensitivity of different subjects and test areas. Pain 3(4):353–365CrossRefGoogle Scholar
  30. Meh D, Denislic M (1994) Quantitative assessment of thermal and pain sensitivity. J Neurol Sci 127:164–169CrossRefGoogle Scholar
  31. Meyer RA, Ringkamp M, Campbell JN, Raja SN (1994) Peripheral mechanisms of cutaneous nociception. In: McMahon SB, Koltzenburg M (eds) Wall and Melzack’s textbook of pain. Elsevier, London, pp 3–34Google Scholar
  32. Nafe JP, Wagoner KS (1936) The Experiences of warmth, cold, and heat. The J Psychol 2(2):421–431. CrossRefGoogle Scholar
  33. Nielsen J, Arendt-Nielsen L (1997) Spatial summation of heat induced pain within and between dermatomes. Somatosens Mot Res 14(2):119–125CrossRefGoogle Scholar
  34. Nielsen J, Arendt-Nielsen L (1998) The influence of rate of temperature change and peak stimulus duration on pain intensity and quality. Somatosens Motor Res 15:220–229. CrossRefGoogle Scholar
  35. Pertovaara A, Kojo I (1985) Influence of the rate of temperature change on thermal thresholds in man. Exp Neurol 87:439–445CrossRefGoogle Scholar
  36. Pertovaara A, Thomas MJ, Kenneth CL (1988) Cutaneous pain and detection thresholds to short CO2 laser pulses in humans: evidence on afferent mechanisms and the influence of varying stimulus conditions. Pain 34(3):261–269CrossRefGoogle Scholar
  37. Pertovaara A, Kauppila T, Hämäläinen MM (1996) Influence of skin temperature on heat pain threshold in humans. Exp Brain Res 107(3):497–503CrossRefGoogle Scholar
  38. Price RC, Asenjo JF, Christou NV, Backman SB, Schweinhardt P (2013) The role of excess subcutaneous fat in pain and sensory sensitivity in obesity. Eur J Pain 17(9):1316–1326. CrossRefGoogle Scholar
  39. Raja SN, Meyer RA, Ringkamp M et al (1999) Peripheral neural mechanisms of nociception. In: Wall PD, Melzack R (eds) Textbook of pain. Churchill, London, pp 11–57Google Scholar
  40. Reulen JPH, Lansbergen MDI, Verstraete E, Spaans F (2003) Comparison of thermal thresholds tests to assess small nerve fiber function: limits vs. levels. Clin Neurophysiol 114(3):556–563CrossRefGoogle Scholar
  41. Taylor DJ, McGillis SL, Greenspan JD (1993) Body site variation of heat pain sensitivity. Somatosens Mot Res 10(4):455–465CrossRefGoogle Scholar
  42. Therm J, Biol 69:132–138.
  43. Tillman DB, Treede RD, Meyer RA, Campbell JN (1995) Response of C fiber nociceptors in the anaesthetized monkey to heat stimuli: estimates of receptor depth and threshold. J Physiol 485(3):753–765CrossRefGoogle Scholar
  44. Tominaga M (2007) The role of TRP channels inthermosensation. In: Liedtke WB, Heller S (eds) TRP ion channel function in sensory transduction and cellular signaling cascades. CRC Press/Taylor & Francis, Boca Raton, pp 271–286Google Scholar
  45. Van den Bosch GE, van Dijk M, Tibboel D, Valkenburg AJ (2017) Thermal quantitative sensory testing in healthy Dutch children and adolescents standardized test paradigm and Dutch reference values. BMC Pediatrics 17:77. CrossRefGoogle Scholar
  46. Verdugo R, Ochoa JL (1992) Quantitative somatosensory thermotest: a key method for functional evaluation of small calibre afferent channels. Brain 115(3):893–913CrossRefGoogle Scholar
  47. Xu F, Lu T (2011) Introduction to skin biothermomechnics and thermal pain. Science Press Beijing, Springer, New YorkCrossRefGoogle Scholar
  48. Yarnitsky D, Ochoa JL (1990) Studies of heat pain sensation in man: perception thresholds, rate of stimulus rise and reaction time. Pain 40(1):85–91CrossRefGoogle Scholar
  49. Yarnitsky D, Ochoa JL (1991) Differential effect of compressionischaemia block on warm sensation and heat-induced pain. Brain 114:907–913CrossRefGoogle Scholar
  50. Yarnitsky D, Simone DA, Dotson RM et al (1992) Single C nociceptor responses and psychophysical parameters of evoked pain: effect of rate of rise of heat stimuli in humans. J Physiol 450(1):581–592CrossRefGoogle Scholar
  51. Yarnitsky D, Sprecher E, Tamir A (1994) Variance of sensory threshold measurements: discrimination of feigners from trustworthy performers. J Neurol Sci 125:186CrossRefGoogle Scholar
  52. Yeomans DC, Proudfit HK (1996) Nociceptive responses to high and low rates of noxious cutaneous heating are mediated by different nociceptors in the rat: electrophysiological evidence. Pain 68(1):141–150. CrossRefGoogle Scholar
  53. Zahorska-Markiewicz B, Zych P, Kucio C (1988) Pain sensitivity in obesity. Acta Physiol Pol 39(3):183–187Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.COMFORT Laboratory, College of Human EcologySeoul National UniversitySeoulSouth Korea
  2. 2.Research Institute for Human EcologySeoulSouth Korea

Personalised recommendations