Three Distinct Categories of Time Course of Pain Produced by Oral Capsaicin

Abstract

Humans vary in oral pain tolerance. Our earlier studies noted that the responses of subjects show 1 of 3 qualitative response patterns to a single oral capsaicin concentration, which we termed a tonic pattern (level detection response), a phasic pattern (change detection response), and an integrator pattern (cumulative irritation) response. These patterns were modeled quantitatively as the sum of 3 underlying processes. Two time-varying capsaicin stimulus profiles were designed from the quantitative model. In the ascending step paradigm, 30 ppm capsaicin was presented to 42 subjects for 15 minutes, followed immediately and without explanation by 300 ppm capsaicin for 25 minutes. In the descending step paradigm, 300 ppm capsaicin was presented to 36 other subjects for 24 minutes, followed by 10 ppm for 22 minutes. Subjective burn was rated at 1 minute and then at 3-minute intervals throughout the presentation. Fuzzy cluster analysis identified 3 distinct response phenotypes in each paradigm, corresponding to level detection, change detection, and cumulative irritation response patterns identified previously. Discriminant functions permitted classification of these phenotypes from the response patterns. Thus, these paradigms provide the first quantitative phenotypic description of distinct oral pain responses to a common irritant, capsaicin. Perspective This study examined the time-dependent behavior of pain produced by oral application of capsaicin. Three distinct temporal response phenotypes were identified objectively: level detection, change detection, and cumulative irritation detection. These time-dependent analyses provide a new dimension to understanding individual differences in pain sensation in clinical settings.