Medoc Thermodes

Fit to a T(hermode)

Medoc Thermodes

We are often asked by our customers: “what thermode should I use?” Our answer is usually: “it depends”.

This is one of the most common questions we are asked when a customer approaches us, intending to buy a thermal quantitative sensory testing (QST) device.

The thermode is the probe that is attached to the participants’ skin, that on command of the computer program changes its temperature to hot or cold.

There are several types of thermodes; which one fits you best, depends mostly on your intended use.

Let’s start with the basics:

Comparing and contrasting

The classic thermode size is the 30mm by 30mm contact surface thermode, or for short: the 30*30. This thermode size has been around for decades and has therefor gathered quite the following.

Most of the normative data that has been gathered with Medoc devices around the world, and specifically by the German Research Network on Neuropathic Pain, the DFNS, has been gathered with this 30*30 thermode[1],[2],[3]. If you intend to compare your QST results to normative values that have been collected from healthy participants, you may want to consider using the 30*30.

Another quite common thermode size is the 16*16. This thermode has been in use with researchers and clinicians who wish to stimulate smaller areas, like the face[4] or the tongue[5], or perform QST on children[6].

Need for speed

One of the most asked-about thermodes is the CHEPS thermode. This thermode is special, because its technology allows working at very high speeds, for both heat and cold stimulation.

These high speeds are especially important for researchers who want to use a fast thermal stimulation in order to record Contact Heat Evoked Potentials (CHEPs)[7],[8],[9] or Cold Evoked Potentials (CEPs)[10]. Others may be interested in an application called: phasic heat temporal summation, in which very fast noxious heat pulses are applied in order to test for the wind-up phenomenon[11],[12].

Visualizing pain

The above thermode types (30*30, 16*16, CHEPS) are also available in fMRI versions. fMRI thermodes are different from normal thermodes for having additional 10 meters cable length, allowing the device to be placed outside the magnetic chamber and only the thermode to pass through the waveguide, reducing noise artifacts and insuring safety. These thermodes have undergone thorough testing and validation in different MRI environments.

Thermal stimulation is used in many trials that examined psychology (including reward processing, mindfulness, and more)[13],[14] and pain neurophysiology[15],[16].

Not your run of the mill thermode..

Then there are the specialized thermodes. Some quantitative sensory testing has been conducted on the most uncommon places in the body, to elucidate specific issues.

Intra-oral testing is conducted with a small diameter Intraoral thermode for varying purposes like; tooth sensitivity[17],[18], pain disorders involving the mouth or the face[19]and thermal taster status.

Medoc’s Intravaginal thermode, formerly known as the Genito-sensory-analyzer (GSA) is utilized in studies which seek to assess somatosensory function and pain of the genital area in women[20],[21],[22] and men[23].

 

References: [1]Hafner, J., Lee, G., Joester, J., Lynch, M., Barnes, E. H., Wrigley, P. J., & Ng, K. (2015). Thermal quantitative sensory testing: a study of 101 control subjects. Journal of Clinical Neuroscience, 22(3), 588-591. [2] Blankenburg, M., Boekens, H., Hechler, T., Maier, C., Krumova, E., Scherens, A., … & Zernikow, B. (2010). Reference values for quantitative sensory testing in children and adolescents: developmental and gender differences of somatosensory perception. PAIN®, 149(1), 76-88. [3]Yarnitsky, D., & Sprecher, E. (1994). Thermal testing: normative data and repeatability for various test algorithms. Journal of the neurological sciences, 125(1), 39-45. [4] Sampaio, F. A., Sampaio, C. R., Cunha, C. O., Costa, Y. M., Alencar, P. N., Bonjardim, L. R., … & Conti, P. C. (2019). The effect of orthodontic separator and short‐term fixed orthodontic appliance on inflammatory mediators and somatosensory function. Journal of oral rehabilitation, 46(3), 257-267. [5] Yang, Q., Dorado, R., Chaya, C., & Hort, J. (2018). The impact of PROP and thermal taster status on the emotional response to beer. Food Quality and Preference, 68, 420-430. [6] Hainsworth, K. R., Simpson, P. M., Ali, O., Varadarajan, J., Rusy, L., & Weisman, S. J. (2020). Quantitative Sensory Testing in Adolescents with Co-occurring Chronic Pain and Obesity: A Pilot Study. Children, 7(6), 55. [7] Rosner, J., Hostettler, P., Scheuren, P. S., Sirucek, L., Rinert, J., Curt, A., … & Hubli, M. (2018). Normative data of contact heat evoked potentials from the lower extremities. Scientific reports, 8(1), 1-9. [8] Jutzeler, C. R., Rosner, J., Rinert, J., Kramer, J. L., & Curt, A. (2016). Normative data for the segmental acquisition of contact heat evoked potentials in cervical dermatomes. Scientific reports, 6, 34660. [9] Granovsky, Y., Anand, P., Nakae, A., Nascimento, O., Smith, B., Sprecher, E., & Valls-Solé, J. (2016). Normative data for Aδ contact heat evoked potentials in adult population: a multicenter study. Pain, 157(5), 1156-1163. [10]Hüllemann, P., Nerdal, A., Binder, A., Helfert, S., Reimer, M., & Baron, R. (2016). Cold‐evoked potentials–Ready for clinical use?. European Journal of Pain, 20(10), 1730-1740. [11]Staud, R., Weyl, E. E., Riley III, J. L., & Fillingim, R. B. (2014). Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients. PloS one, 9(2), e89086. [12]Bar-Shalita, T., Vatine, J. J., Yarnitsky, D., Parush, S., & Weissman-Fogel, I. (2014). Atypical central pain processing in sensory modulation disorder: absence of temporal summation and higher after-sensation. Experimental brain research, 232(2), 587-595. [13] Elman, I., Upadhyay, J., Langleben, D. D., Albanese, M., Becerra, L., & Borsook, D. (2018). Reward and aversion processing in patients with post-traumatic stress disorder: functional neuroimaging with visual and thermal stimuli. Translational psychiatry, 8(1), 1-15. [14] Harrison, R., Zeidan, F., Kitsaras, G., Ozcelik, D., & Salomons, T. V. (2019). Trait mindfulness is associated with lower pain reactivity and connectivity of the default mode network. The Journal of Pain, 20(6), 645-654. [15]Russo, A., Tessitore, A., Esposito, F., Di Nardo, F., Silvestro, M., Trojsi, F., … & Tedeschi, G. (2017). Functional changes of the perigenual part of the anterior cingulate cortex after external trigeminal neurostimulation in migraine patients. Frontiers in neurology, 8, 282. [16] Grahl, A., Onat, S., & Büchel, C. (2018). The periaqueductal gray and Bayesian integration in placebo analgesia. Elife, 7, e32930 [17] Baad-Hansen, L., Lu, S., Kemppainen, P., List, T., Zhang, Z., & Svensson, P. (2015). Differential changes in gingival somatosensory sensitivity after painful electrical tooth stimulation. Experimental Brain Research, 233(4), 1109-1118 [18] Rahal, V., Gallinari, M. D. O., Barbosa, J. S., Martins-Junior, R. L., Santos, P. H. D., Cintra, L. T. A., & Briso, A. L. F. (2018). Influence of skin cold sensation threshold in the occurrence of dental sensitivity during dental bleaching: a placebo controlled clinical trial. Journal of Applied Oral Science, 26. [19] Mo, X., Zhang, J., Fan, Y., Svensson, P., & Wang, K. (2015). Thermal and mechanical quantitative sensory testing in chinese patients with burning mouth syndrome–a probable neuropathic pain condition?. The journal of headache and pain, 16(1), 84. [20] Gruenwald, I., Mustafa, S., Gartman, I., & Lowenstein, L. (2015). Genital sensation in women with pelvic organ prolapse. International urogynecology journal, 26(7), 981-984. [21]Reed, B. D., Sen, A., Harlow, S. D., Haefner, H. K., & Gracely, R. H. (2017). Multimodal vulvar and peripheral sensitivity among women with vulvodynia: a case-control study. Journal of lower genital tract disease, 21(1), 78. [22] Lesma, A., Bocciardi, A., Corti, S., Chiumello, G., Rigatti, P., & Montorsi, F. (2014). Sexual function in adult life following Passerini-Glazel feminizing genitoplasty in patients with congenital adrenal hyperplasia. The Journal of urology, 191(1), 206-211. [23] Chen, X., Wang, F. X., Hu, C., Yang, N. Q., & Dai, J. C. (2018). Penile sensory thresholds in subtypes of premature ejaculation: implications of comorbid erectile dysfunction. Asian journal of andrology, 20(4), 330.