The perception of temperature and thermal pain is a complex sensory function, mediated by thinly myelinated (A-delta) and unmyelinated (C) nerve fibers, whose responses are associated with specialized cutaneous receptors. In the study by Meh and Denílić (1994), conducted with 150 healthy volunteers of both sexes, a systematic evaluation of thermal perception and thermal pain thresholds in different body regions was performed using the Marstock method, with remarkable methodological rigor.
The investigation allowed the determination of normative values for three main parameters: the warm-cold difference threshold, the cold pain threshold, and the heat pain threshold. One of the study’s most robust findings was the influence of age on thermal sensitivity. A significant linear correlation was observed between age and an increase in the hot-cold difference threshold—indicating a progressive decline in sensitivity to thermal variation with aging, especially in distal regions such as the legs and dorsum of the foot. This finding is consistent with the hypothesis of age-related sensory neuropathy, suggesting progressive functional deterioration of small sensory fibers over time (Meh & Denílić, 1994).
Another relevant result concerns gender differences. Women had lower thresholds for heat and cold, as well as greater sensitivity to thermal pain, with the exception of the thoracic region. The explanation for these differences may involve both physiological sensory aspects and psychosocial factors, such as modulation of perception by expectation or emotional context. The hypothesis that emotional factors influence pain tolerance was even discussed by the authors, based on previous studies (Nakahama & Yamamoto, 1979), suggesting a central modulatory component in the experience of thermal pain.
Additionally, no significant differences were found between the right and left sides of the body, corroborating the functional symmetry of the somatosensory system in this regard. Body height also did not demonstrate a significant impact on sensory thresholds, ruling out a possible interference of axial distance in afferent conduction times (Meh & Denílić, 1994).
Methodologically, the study stands out for its careful use of the Marstock thermometer, with precise control of temperature variations and the heating/cooling rate. The intra-individual stability of the data, even with repeated measurements after four days or four weeks, suggests high reproducibility of the technique—reinforcing its clinical applicability and its potential for longitudinal follow-up studies in subclinical peripheral neuropathies.
From a translational perspective, Meh and Denílić’s findings highlight the importance of considering factors such as age, sex, and anatomical location when interpreting thermal sensory tests. The interindividual variability and subjectivity inherent in thermal perception, in turn, reinforce the need to combine these tests with other clinical and laboratory methods, especially in the investigation of small-fiber neuropathies.
In summary, this study provides a robust and detailed normative basis for the assessment of thermal and pain sensitivity, being instrumental in the early diagnosis of sensory dysfunctions. The application of the Marstock method proves effective, sensitive, and clinically viable, especially when combined with a critical analysis of the individual context and integration with broader clinical findings.
Reference:
MEH, Duška; DENIŠLIĆ, Miro. Quantitative assessment of thermal and pain sensitivity. Journal of the Neurological Sciences, Amsterdam, v. 127, p. 164–169, 1994. Available at: https://doi.org/10.1016/0022-510X(94)90069-8. Accessed on: June 20, 2025.
