Name: a protocol of manual tests to measure sensation and pain in humans
Uploaded: 2016-12-19T15:00:00
Description: Watch this Scientific Journal Video about A Protocol of Manual Tests to Measure Sensation and Pain in Humans at JoVE.com

作者承认以下资金来源：杜肯大学教师发展基金的拨款颁发给金佰利Szucs博士和Alex Kranjec博士和本笃Kolber博士和马修Kostek，博士学位。我们也承认雷切尔Sweetnich从授予Sweetnich（导师：Szucs和Kostek）杜肯大学本科疼痛体验的研究实验计划援助和资金。

以人类为对象所有测试应该由机构审查委员会在个别机构的批准。对于目前的研究中描述的所有测试人体试验是经杜肯大学机构审查委员会。培训和各措施说明如下： 1.皮肤机械敏感性测定13 注：已登记的参与者被要求在椅子上坐下，与为下肢支持进行测试。该法包括确定无害皮肤刺激灵敏度阈值。刺激设置有标准的感官评估的von Frey长丝（见设?...

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我们已经证明具有成本效益的，并且可以用来评估在人受试者机械感，热感和疼痛，以及压疼简单的定性和定量感官测试。这些测定的值是其易于实施和必要的培训时间的低量。每个实验者所接受的训练（一项试验观察和一个试行）少量。因此，多个技术人员可以在一天的培训。结果表明强间实验者和受试者内的可靠性。取决于每个实验使用测试的数量，对于多个IC卡的测试统计校正是可取的。 <...

慢性疼痛是一个世界性的临床问题。全球有超过1.5十亿人患有慢性疼痛，以及全球人口的约5％的神经性疼痛症，与发病率与1年龄的增长。在美国，据估计，疼痛影响比糖尿病，心脏疾病和癌症更多的人，组合2。虽然这个问题的认识正在增加，治疗并不总是成功的，可以是昂贵的，并可能有严重的副作用，包括瘾。研究治疗正在进行中，但作为疼痛的个体之间变化很大，用于研究或诊断疼痛测量可能是有问题。特别是，关于定性方法，如视觉模拟评分（VAS）的依赖，用于确定治疗功效，因为疼痛3的主观和个人性质是有问题的。随着越来越多的研究实验室和世界各地的答案疑问句小诊所关于和治疗疼痛系统蒸发散，是准确的，一致的，可移植的，定量的，和负担得起的措施是很大的需求。 在测量疼痛的关键区别是急性与慢性疼痛。急性疼痛是损伤，感染或其他有害刺激的正常反应。急性疼痛通常与治疗时间解决，疼痛的位置通常是位点特异性的。慢性疼痛，然而，可以进行相关的急性疼痛的初始回合，或者它可以是自发性的。慢性疼痛可能与损伤部位，但它往往是整个身体4普遍。慢性疼痛可以持续数周，数月，甚至数年，对患者及家属，雇主和社会造成重大的生理，心理和金钱的负担。识别和量化疼痛的能力是正确的诊断，持续治疗的评估和新的止痛治疗发展的关键。定量和定性感觉试验是日我们进行诊断和治疗的关键。 几种方法可用于检查外围感觉和疼痛：神经传导速度（NCV），体感诱发电位（SEP），皮肤活检，并定量感官测试（QST）。临床医生也经常使用床边的神经感官检验，但这个测试没有校准，并且不使用一个标准化的指令集5。 NCV和SEP的考试可以是信息，但相比QST，它们需要高度专业化的设备，通常只检查大神经纤维，只测量功能丧失，不测试整个躯体感觉系统6,7。皮肤活检来评估神经纤维密度，但相比QST，它们是侵入性的，并要求组织处理和显微镜的时间，这可能需要几天的时间才能完成8。此外，所述活检仅检查体感系统的一个小的，特定区域和不测试神经功能。 QST测量克服了大多数其他测试方法的局限性。最近，已经进行了QSTs标准化规范的数据可用，这进一步增加了它们的效用，以评估疼痛和神经感觉9-11。因此，我们专注于QST措施慢性疼痛当前协议。 新技术使已建立的内部协议12装备精良的实验室内的疼痛和身体的感觉（如压力和热）精确和可靠的评估。许多这些技术，然而，不容易携带并且是成本过高为新的或小的研究实验室和医疗诊所。此外，对于技术使用的协议不跨越实验室13，其可能会影响可靠性标准化。因此，该手稿的目的是演示有效和可靠的疼痛以及可与设备中可用来进行感官措施大多数诊所或研究实验室。对当前协议的发展的理由是，虽然许多人患有慢性疼痛病症和疼痛的准确评估，需要用于诊断和治疗患有，有与测定的视觉演示没有公布的协议。 用于测试急性疼痛几乎完全自动化的装置的一个例子是神经感官分析仪，它可以可靠地评估热痛觉，由焦虑等人所证明。以下在人类受试者14的皮肤烧伤。单位是模块化的，并且可以添加额外的感官检验设备。在他们的研究中，焦虑等。也说明与使用间断压力传感器，这是定制的压力感官检验。虽然这些探头应该提供更一致的结果，少数的实验室或诊所有他们。 目前的协议表明慢性疼痛QST措施：冯FREý长丝用于皮肤感觉试验，辐射（“哈格里夫斯”的方法），并接触热技术，和压力algometry为深部组织的疼痛。这些QST测量不是唯一的。相反，它们是用于医疗诊所，医院和研究实验室13,15,16人的感官测试中最常见和普遍接受的测量。机械和热的刺激是用来检查皮肤和深感觉。这些措施，此外，包括正常的感觉和疼痛小型和大型纤维灵敏度的评价。为了评估深部组织疼痛（肌肉），压力algometry被使用，这是疼痛的软组织的量化，如肌肉17,18最常应用的技术。这两个A-三角洲和C纤维调解压力刺激19引起的疼痛。两种纤维的刺激是一种优点也是缺点，因为它探讨多种途径，使其成为一个良好的整体措施，但它是一个LSO那么具体。为了检查触摸敏感性，皮肤用的von Frey长丝的机械刺激的使用，因为它们是在疼痛和医疗神经诊所中最常用的感测装置中的一个。冯Frey细丝刺激的Aβ纤维，20但不具体，既低阈值机械感受器，并可以激活21。使用这些细丝一直被人诟病，主要是因为申请程序的潜在变化和关注，机械灯丝特性可能随时间变化22,23（细丝缩进或手部的意外移动度）的。此协议通过提供具有丝的脚本和校准的详细说明解决这些问题。 对于热痛，使用使用“哈格里夫斯”的方法（可见光和斜坡温度）和加热块检查接触热辐射热。联系和辐射热激活热受体不同，甚至可以混淆彼此。它已经显示，动态接触可以抑制热伤害感受24。这类似于热转诊的概念，其中，触摸有助于正常温度感知25-27。因此，热感觉的一种措施，热痛的两项措施都包括在内。首先，辐射热被用来确定（从室温开始）对温度变化的检测的阈值。其次，辐射热源用于确定热痛阈值。暖热变化（非伤害性）的检测部分由对C纤维瞬时受体电位（TRP）通道介导的，而热疼痛是由TRPV1 / V2和上C和A-δ纤维28等较高阈通道介导的-30。在阈值判断，快速加热皮肤先激活A-δ纤维，相当于“第一痛”，其次是一个C纤维介导的“第二痛”descri床为“悸动，燃烧或肿胀”31。暖气给出了C纤维的优惠激活和是第二疼痛32最好的评价。在接触热测定法，恒定伤害性温度被施加到确定定性强度和疼痛的情感方面。 在开发QST协议考虑的另一个变量是解剖学位置。对于急性或特定位置的疼痛，疼痛的解剖部位通常用于测试。由于协议在设计时考虑到慢性疼痛的条件下，我们采取一个更具全球性的做法。协议评估上，而不是手的前臂和腿感觉，因为它已经显示，热疼痛阈值是在手比在前臂33和热伤害感受可以在手被感知显著更高，虽然较不频繁和少强烈比前臂24。而该协议被设计为m个的慢性疼痛病症ajority，我们提醒一些慢性疼痛病症影响特定解剖区域的用户，这应该修改为特定的患者群体的协议时加以考虑。 虽然这些QST措施是最常用的和被接受为一些最可靠的，它们价格便宜，很常见，大多数诊所和研究实验室可能已经访问它们，能买得起他们，并能运送他们。这QST协议是在需要与慢性疼痛人类措施的实验室或诊所有用。迄今为止，目前没有公布可视化报表显示对这些措施的使用性和可靠性的协议。基于此协议的示范和提高可靠性的提示，实验室或诊所可以很容易地审视自己的重测信度。因为许多诊所将需要利用几个技术员来衡量所有的患者，除鼠呃可靠性数据会在选择协议是有用的。我们有一个小的组数据表明，该协议具有良好的可靠性，但每个临床和实验室强烈建议使用此作为一个例子，因为每个诊所和慢性疼痛每个病人的人口是独一无二的。 对感觉和疼痛测试损伤的危险注意事项： 有关皮肤力学性能试验有受伤的危险是极为罕见的，不可能。机械测试是安全的和广泛使用的。风险对个人是最小的，因为1）这是不是一个痛苦或伤害性刺激; 2）科目被指示，他们可以随时停止任何程序，无不良后果; 3）感觉的受试者所经历的水平远低于其耐受程度和阈值的疼痛。 与热痛测试伤害的风险是最小的。热测试是安全的和广泛使用的。虽然热测试确实PRODUCE疼痛，个别风险很小，因为：1）疼痛是一过性的，一般在手术后立即消退; 2）科目被指示，他们可以随时停止任何程序，无不良后果;和3）由受试者经历疼痛的水平低于其耐受水平。与哈格里夫斯热刺激，有接收一燃烧的非常轻微的风险，但是这是由以下最小化：1）阳性的刺激参数高于50℃的锁定; 2）内置的关闭系统时，防止长时间或高强度的刺激（20秒）的递送的刺激;和图3），该前和每次使用过程中测量在玻璃表面的温度的电子式温度计（见下文中的仪器部分）。痛阈试验将进行只有当在20秒截止检测到的温度≤50℃。 有关压力测试的疼痛伤害的风险是最小的。普雷斯确保测试是安全并广泛使用。虽然压力测试不产生疼痛，个别风险很小，因为：1）疼痛是一过性的，一般在手术后立即消退; 2）科目被指示，他们可以随时停止任何程序，无不良后果; 3）疼痛由受试者经历的水平低于其公差水平; 4）施加的疼痛是从未比检者的痛苦阈值时，这远远低于可能导致损害的任何压力以上。压力测试的一个罕见的副作用的刺激部位擦伤。在这种情况下，受试者不应该在压伤现场重新测试。易怒的机会可以通过很容易碰伤或正在服用血液稀释剂的个人研究排斥最小化。 在登记期间，参与者给出的将要使用的所有的感觉和疼痛的措施的完整说明。与最初的同意，所有参与者都异体结婚满入学前体验所有的感官和疼痛的措施。所有感觉和疼痛测定法基于在健康人类受试者和慢性疼痛的患者34使用既定测定。所有检测涉及要么无害（无疼痛刺激）或急性伤害性刺激（疼痛刺激）不损伤组织。不同的测试之间的时间&gt; 5分钟，以允许受试者休息并减少感觉疲劳或致敏的可能。测试的顺序是每次测试期间相同。测试的具体位点仅限于左和右前臂和L3 / S2皮上的左，右小腿T1的皮。所有站点进行测试都标有一个标记，各个网站的传播出去，以避免重叠感受野激活（ 图1）。请参阅材料和设备表的完整材料清单。对于重测信度研究，个别科目我们再由两个实验者在一天的测试。

<table border="0" cellpadding="0" cellspacing="0" width="906">
	<tbody>
		<tr height="86">
			<td height="86" style="height:87px;width:224px;">Pressure Algometer / Force Dial</td>
			<td style="width:144px;">Wagner Instruments</td>
			<td style="width:111px;">FDK 20</td>
			<td style="width:427px;">The pressure algometer quantifies pressure pain threshold.&#160; It has a rubber tip attachment that is applied to the marked skin site by the investigator.&#160; The dial records the pressure and is reset after each measurement.</td>
		</tr>
		<tr height="100">
			<td height="100" style="height:100px;width:224px;">von Frey cutaneous stimulators</td>
			<td style="width:144px;">Touch Test</td>
			<td style="width:111px;">NC1275-01 through -08</td>
			<td style="width:427px;">These von Frey filaments are commonly used to examine sensitivity in research and clincial settings.&#160; Our set of 8 filaments covers a range of sensitivites.&#160; The individual filaments are 1.65 mN, 2.36 mN, 2.44 mN, 2.83 mN, 3.22 mN, 3.61 mN, 3.84 mN, 4.08 mN.</td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:224px;">&#34;Hargreaves&#34; apparatus, testing platform</td>
			<td style="width:144px;">Custom</td>
			<td style="width:111px;">n/a</td>
			<td style="width:427px;">One complete base and four supporting columns are used to form a platform for a sheet of safety glass through which the heat source directs heat to the subjects arm or leg that is resting on the glass.&#160; The heat lamp is placed beneath the glass.</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:224px;">0.64cm Pyrex safety glass</td>
			<td style="width:144px;">DuPont</td>
			<td style="width:111px;">n/a</td>
			<td style="width:427px;">Safety glass is important to avoid injury in the unlikely event of a fracture in the glass surface.</td>
		</tr>
		<tr height="66">
			<td height="66" style="height:67px;width:224px;">Electronic thermometer / thermocouple 53 IIB</td>
			<td style="width:144px;">Fluke</td>
			<td style="width:111px;">3821062</td>
			<td style="width:427px;">The thermocouple is used for thermal testing.&#160; The thermocouple is placed on the glass underneath the subject&#39;s arm or leg and measures the temperature at the glass level.</td>
		</tr>
		<tr height="105">
			<td height="105" style="height:105px;">IITC Plantar Analgesia Meter&#160;</td>
			<td style="width:144px;">Life Science Inc. Woodland Hills, CA</td>
			<td style="width:111px;">390</td>
			<td style="width:427px;">This is the heat source and timer for Hargreaves testing.&#160; The unit&#39;s heat source has an &#8220;idle state&#8221; that allows exact placement of the heat source.&#160; The heat source is radiant light and the light beam is focused to the top of the glass to creates a 4X6mm intense spot on the arm or leg.</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:224px;">Examiner script</td>
			<td style="width:144px;">Custom</td>
			<td style="width:111px;">n/a</td>
			<td style="width:427px;">A written script for the examiner is used for every testing session.&#160; Because pain and sensitivity can be affected by envrionmental stresses, we attempt to maintain as much consistency as possible between subjects.&#160; The examiner reads directly from the script every time a measure is made to ensure&#160; verbal consistency.</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Markers for testing site</td>
			<td>Sharpie</td>
			<td>n/a</td>
			<td style="width:427px;">Washable markers may be preferable for situations where multiple days of testing is not necessary</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:224px;">Constant heat stimulus block</td>
			<td>Benchmark Scientific</td>
			<td>BR10-00</td>
			<td>This block is digitally controlled. The surface of the block is 2x3cm.</td>
		</tr>
	</tbody>
</table>

a protocol of manual tests to measure sensation and pain in humans

众多的定性和定量技术可用于测试在研究和临床环境感觉神经和疼痛。目前的研究表明用技术来衡量使用便携式和容易地访问设备的压力和热量触觉和痛觉阈值定量感官测试协议。这些技术和设备非常适合新的实验室和诊所的成本是一个问题或一个限制因素。我们演示了以下测量技术：在胳膊和腿（冯弗雷细丝），辐射和接触热灵敏度（与两个阈值和使用视觉模拟评分（VAS）定性评估）和机械压力的敏感性皮肤的机械灵敏度（痛觉计，与两个阈值和增值业务）。该技术和设备描述和演示在这里可以很容易地购买，储存，并通过世界各地的大多数诊所和研究实验室运输。一个limitati这种方法的缺乏自动化或电脑控制。因此，这些方法可在人员训练和数据记录不是更复杂的设备方面更多的劳动密集的。我们提供了一组用于展示技术的可靠性数据。从我们的描述，一个新的实验室应该能够建立和运行这些测试和开发自己的内部可靠性数据。

这里，我们描述了具有成本效益的定性和定量的分析的执行来测量使用VAS（ 图2）人类受试者无害的感觉和疼痛。视觉表示是非常重要的，因为这些检查的准确和精确的结果取决于由技术人员正确和一致的协议执行。此外，这是有价值的知道，如果所描述的可以收集再生的数据的多个技术人员执行的技术。虽然这不是本研究的意图完成一个全面的可靠性分析（...

Watch this Scientific Journal Video about A Protocol of Manual Tests to Measure Sensation and Pain in Humans at JoVE.com

A Protocol of Manual Tests to Measure Sensation and Pain in Humans

The goal of this procedure is to demonstrate a battery of quantitative techniques for sensory and pain measurement in humans. The equipment and techniques described are commonly found in pain clinics or are easy to obtain.

手动测试的协议来衡量感觉和疼痛人类

Numerous qualitative and quantitative techniques can be used to test sensory nerves and pain in both research and clinical settings. The current study ...

The overall goal of this data collection procedure is to measure pressure and heat pain thresholds as well as tactile sensation in humans. These sensory measures include both quantitative measures of sensation as well as qualitative measures that help asses individuals sensory and emotional experience during testing. This method can help answer key questions in the Study of Chronic Pain Conditions by providing concrete data points to evaluate the efficacy of various therapies in the context of pain.The main advantages of these techniques are that they're easy to implement and offer reliability between experimentaters. The equipment is easily purchased, stored, and transported by most clinics and research laboratories around the world. Individuals will struggle with these methods because small changes in the time of stimulus application, placement of stimulus application, and/or application pressure can introduce significant variability in the data set.Application procedures of these tests are seemingly subjective, which can lead to inconsistent results. Visual demonstration is therefore critical to ensure accuracy and precision across multiple tests, multiple technicians, and multiple patients. Escort the subject into the testing room and have them sit on an exam table that provides arm support.Give the filament to the subject and let them gently bend it against the skin of their hand. During each trial, ask the subject to look away from their forearm. Start by applying the smallest filament at 0.078 millinewtons to the subject's forearm until it boes and ask if they feel the filament.Complete four positive trials where the filament is applied to the forearm, and one randomized negative trial where the filament is not applied, but the subject is still asked if they feel the filament. Finally, score the trials on the data form, such that if a subject detects greater than three of the positive trials, and zero of the negative trials for a filament, record that filament as the subject's mechanical sensory threshold. For a single filament, if the subject detects less than two of the positive trials, and or greater than zero of the negative trials, then start another round of five trials with the next biggest filament until the sensory threshold is reached.Begin by showing the radiant heat device to the subject and allowing them to feel the stimulus with their hand. Next, ask the subject to rest their forearm on the room temperature glass plate, which is covered with a rubber insulating sheet except for the small opening for stimulus presentation. Use a mirror to position the light source under a marked area on the subjects forearm.Then, for each trial, ask the subject to depress the stop button when they feel the temperature change. To achieve the withdraw threshold, set the device to ramp up the temperature so that the stimulus temperature reaches 47 degrees Celsius at 10 seconds. Begin by showing the constant heat block to the subject and allowing them to feel the stimulus with their hand.Next, apply the stimulus for three seconds to the marked location on the left forearm. Finally, immediately following the stimulus, ask the subject to evaluate the quality and unpleasantness of the pain using a standard zero to 10 visual analog scale. Before starting the experimental trial, allow the subject to handle the algometer, and apply the stimulus to themselves under careful supervision.Complete a pain threshold trial by placing the probe on the subject's forearm and gradually applying pressure until the stimulus transitions from innocuous pressure to painful pressure. Ask the subject to say stop when they want the stimulus removed from their forearm. Complete two trials to the forearm in two distinct sights on the right and left arm to avoid damage to a single area.Then, remove the algometer from the subject. Record the greatest applied pressure as the pressure pain threshold for the trial. Finally, to complete a constant pressure trial, apply a painful stimulus for three seconds and ask the subject to evaluate the quality and unpleasantness of the pain on two standard, zero to 10 visual analogue scales.Inform the subject that on the quality scale, zero is represented as no pain, and 10 is represented as the worst pain imaginable. On the unpleasantness scale, zero is represented as not unpleasant, and 10 is represented as the most unpleasant sensation imaginable. This intra-class correlation coefficient analysis examines the reliability between two examiners, male and female.Inter-experiment reliability was strong for mechanical, thermal, and pressure testing. Such that average inter-experiment reliability measures were all statistically significant except for the mechanical sensitivity test. In addition, all visual analogue scale results for constant heat and constant pressure, showed significant correlations between the male and female experimenters.Once mastered, these techniques can be completed in 30 minutes if performed properly. While attempting these procedures, it's important to remember to remain as consistent as possible when applying stimuli to the subject's testing areas. This is especially important for application of the Von Frey filament for cutaneous mechanical sensitivity, and the algometer for pressure sensitivity.Following these procedures, other methods that evaluate cold hypersensitivity and mechanical pain, can be performed in order to answer additional questions related to other sensory modalities that are altered in the context of pain. Quantitative sensory testing is regularly applied in pre-clinical, and clinical testing. When combined with traditional qualitative measures, the entire procedure provides a valuable snapshot of an individuals sensory and emotional experience to noxious stimuli.After watching this video, you should have a good understanding of how to measure quantitative and qualitative sensation and pain in humans. This includes tactile sensation and pain threshold for pressure and heat, as well as VAS qualitative assessments. Don't forget that working with noxious stimuli in human subjects can be hazardous, and precautions should always be taken when performing this procedure.

Research

JoVE Journal

Behavior

Use of the Operant Orofacial Pain Assessment Device (OPAD) to Measure Changes in Nociceptive Behavior

Use of the Operant Orofacial Pain Assessment Device OPAD to Measure Changes in Nociceptive Behavior

使用操作性口面疼痛评估设备（OPAD）测量伤害行为的变化

We present an operant  system for the detection of pain in awake, conscious rodents. The Orofacial  Pain Assessment Device (OPAD) assesses pain behaviors ...

科研

行为学

The Crossmodal Congruency Task as a Means to Obtain an Objective Behavioral Measure in the Rubber Hand Illusion Paradigm

一致性的任务作为一种手段来获取目标行为的措施中的橡胶手错觉范式Crossmodal

The rubber hand illusion (RHI) is a popular experimental paradigm. Participants view touch on an artificial rubber hand while the participants' own hidden ...

Studying Food Reward and Motivation in Humans

研究食品奖赏和动机在人类

A key challenge in studying reward processing in humans is to go beyond subjective self-report measures and quantify different aspects of reward such as ...

Disrupting Reconsolidation of Fear Memory in Humans by a Noradrenergic &#946;-Blocker

由去甲肾上腺素能β受体阻滞剂破坏恐惧记忆在人类再固结

The basic design used in our human fear-conditioning studies on disrupting reconsolidation includes testing over different phases across three consecutive ...

Force and Position Control in Humans - The Role of Augmented Feedback

力和位置控制人类 - 增强反馈的作用

During motor behaviour, humans interact with the environment by for example manipulating objects and this is only possible because sensory feedback is ...

Psychophysical Tracking Method to Measure Taste Preferences in Children and Adults

心理跟踪方法来衡量儿童和成人的口味偏好

The Monell two-series, forced-choice, paired-comparison tracking method provides a reliable measure of sweet taste preferences from childhood to ...

Frame-by-Frame Video Analysis of Idiosyncratic Reach-to-Grasp Movements in Humans

人体特异 Reach-to-Grasp 运动的帧-帧视频分析

Prehension, the act of reaching to grasp an object, is central to the human experience. We use it to feed ourselves, groom ourselves, and manipulate ...

An Electrophysiology Protocol to Measure Reward Anticipation and Processing in Children

儿童奖励预期与处理的电生理学协议

We present a protocol designed to measure the neural correlates of reward in children. The protocol allows researchers to measure both reward anticipation ...

Simultaneous Recordings of Cortical Local Field Potentials and Electrocorticograms in Response to Nociceptive Laser Stimuli from Freely Moving Rats

在自由运动大鼠的反应中, 皮质局部电位和电皮质图谱的同时记录

Electrocortical responses, elicited by laser heat pulses that selectively activate nociceptive free nerve endings, are widely used in many animal and ...

Using Facial Electromyography to Assess Facial Muscle Reactions to Experienced and Observed Affective Touch in Humans

面部肌电图对人体有经验和观察到的情感触觉的影响评估

"Affective" touch is believed to be processed in a manner distinct from discriminatory touch and to involve activation of C-tactile (CT) afferent fibers. ...