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Pain and the Gate Control Theory
Pain, an unpleasant sensation that occurs in response to tissue injury, is a normal protective mechanism that signifies that something is wrong.
Our nervous system is made up of the central nervous system (brain and spinal cord) and the peripheral nervous system (nerve fibers, nerve endings, receptors), which work together, transmitting signals to and from the brain, spinal cord and other body parts, enabling us to feel good and bad sensations, such as a foot rub and unfortunately pain.
Nerve trunks that run along the spinal column consist of three categories of large and small nerve fibers; A, being of large diameter, B being of mediocre, and C being the smallest. The transmission of sharp well localized pain and sensory information such as joint position, pressure and vibration is performed by A fibers, while C fibers transmit information regarding temperature, aching, burning, and generalized pain.
PAIN TRANSMISSION:
Nerve endings, called “receptors”, are located throughout our body. When injury, disease or inflammation occurs, pain receptors in our skin, muscles, ligaments and joints are able to detect tissue damage. In turn, neurotransmitters, located in each nerve cell as well as in the brain, transmit electrical impulses from the pain receptor to the peripheral nerve and up the spinal cord. Finally, these impulses are relayed to the brain whose role is to process and interpret pain signals.
GATE CONTROL:
In 1965, Drs Ronald Melzack and Patrick Wall introduced the Gate Control Theory of Pain in an attempt to explain how sensory-overload to the brain could diminish or eliminate pain signals. The theory was that if the “gate” were flooded with several other types of sensations, it would reach its capacity and be unable to accommodate additional sensory input. As a result, further pain input would be blocked.
Acupuncture, trigger point injections, TENS units, spinal cord stimulation, therapeutic muscle massage and soft tissue manipulation can be used to block pain signals because they stimulate A fibers via needling, electric stimulation, pressure, vibration or heat and cold application. Because our brain receives, processes and interprets pain signals, individual feeling, previous memories and attitude can alter gate control. Signals that are sent back down the spinal cord to the gate can either increase or decrease incoming pain signals.
By Dr. Yong H. Tsai
Published in The Daytona Beach News-Journal
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