Closing the gate on pain

In 1965, Psychologist Ronald Melzack and Neurobiologist Patrick Wall proposed a new theory on how pain is perceived. I first learnt about this theory while attending an NHS-run pain management programme and again later during my Hypnotherapy training at The Clifton Practice. This theory was the catalyst that led to my recovery from chronic pain and as such I feel it is the most important piece of information that I can relay to my clients. It also actively demonstrates that changing the way one mentally perceives pain can actually change (decrease) the experience of pain on a physiological level.(1)

Melzack and Wall’s Gate Control Theory of Pain suggested that when there is damage to the body, be it a cut or burn, fracture or sprain, messages carrying information about the injury travel up to the brain along two separate sets of nerve fibers; small nerve fibers (pain receptors) and large nerve fibers (“normal” receptors).(2)

The large fibers transmit messages about sensations such as joint movement, heat, cold, touch, etc. while the smaller fibers carry pain signals. The large fibers are faster transmitters of messages compared to the small fibers therefore messages being transmitted by the large fibers arrive at the spinal cord before those being transmitted by the small fibers.

According to Melzack, “Pain messages flowing along peripheral nerves to the spinal cord on their way to the brain encounter ‘nerve gates’ that can inhibit (close) or facilitate (open) the incoming nerve impulses.” (3) It’s the balance between the messages flowing along the small fibers (pain) and the messages flowing along the large fibers (pressure) that determines whether this gate opens and pain is perceived or the gate closes blocking the pain signals from reaching the brain.(4) The nerve or pain gate opens when there are more messages being transmitted along the smaller fibers and the pain gate closes when there are more messages being transmitted along the larger fibers.

In addition to these ascending nerve pathways which transmit messages up to the brain, there are also descending pathways which transmit messages down from the brain. These messages are what causes your hand to pull away from something that is causing you pain and they also depress the reactions from the autonomic nervous system such as increased heart rate and blood pressure which would have been triggered as a result of the pain.

More importantly the descending messages cause a release of natural pain-relieving opiate-like neurotransmitters such as endorphins, dynorphins and enkephalins which closes the gate and also blocks the release of neurotransmitters which are responsible for increasing pain such as Substance P.(4)

Melzacks model suggested that “psychological factors such as past experience, attention, and emotion influence pain response and perception by acting on the gate control system”.(3) People who suffer with chronic pain often note that their pain is worse when they are feeling stressed or having a bad day!

When people suffer from chronic pain they often withdraw from activities, such as socialising, going out, exercising, housework, going to work etc., based on the idea that it will minimise the pain. But what actually happens is the opposite! It’s quite ironic really how we stop doing all the things that actually could help keep that pain gate closed.

Things that cause the "gate" to open and therefore making the pain worse include stress, tension, anxiety, worry, depression and negative thoughts; focusing on your pain; boredom; and lack of activity and exercise.

Things that help close the "gate" on pain include relaxation; feeling happy and thinking positively; socialising, taking an interest in life and doing things you enjoy; being active and exercising regularly even if it is only light exercise or walking; and counter-stimulation such as massage, acupuncture, heat/cold, and TENS.

Knowing about the Gate Control Theory of Pain made me realise that I had a choice; I could either continue living my life as I had been where the pain was in control or I could take positive steps to help close the gate on pain for good. That is when I decided to try hypnotherapy to help reduce my stress and anxiety levels, stop the negative thoughts about my pain, and help me realise what I wanted from life rather than just “not being in pain”!

More information on how Hypnotherapy can help you manage chronic pain

References:

(1) Dalton, Ph.D., Erik. The Pain Game Part Two, Massage & Bodywork Magazine (2006)

(2) Freudenrich, Ph.D., Craig. How Pain Works, HowStuffWorks.com (2007)

(3) Melzack, T., Wall, P. D., Pain Mechanisms: A New Theory, Science 150 (1965): 971.

(4) Koman, K. The Science of Hurt, Harvard Magazine, (2005)

Bibliography:

Dalton, Ph.D., Erik. The Pain Game Part One, Massage & Bodywork Magazine (2006)

Jackson, M. Pain and Its Mysteries, Adapted from Pain the Fifth Vital Sign (2002)