Applying the “Gate Control Theory”
Have you ever wondered how pain really works beyond the bodies response to a physical injury? Well, that’s not easy to sum up in a blog post, but what I do want to cover in this post, is the Gate Control Theory of Pain, and give you some alternative ways to look at the pieces of pain and the amplification process.
Frankly, pain science can come across incredibly offensive if delivered wrong to a chronic pain patient. It can come from a place of ignorance or assumption at worst, and lack of empathy or poor tone not helping at best, creating inadvertent harm that affects a patient long into the future.
But understanding what results in worsening pain and how it really works beyond a physical site of injury is absolutely critical, because it affects what we believe we can do about it and how we inherently feel about our situation. How clinicians communicate this matters.
Pain management has a depressing connotation (i.e. ‘where pain patients go to die). Great, huh...But it doesn’t have to be like that.
If you don’t think it you can change anything, it is depressing. But if you are open minded to understanding how you can affect pain, it immediately creates optimism. In fact I’d argue that to be able to more effectively manage pain, you have to understand how it works and believe you can impact it.
That’s what I’ve made my mission in a lot of ways. To help patients be inspired around the fact that there are a lot of other variables at play, and there are different theories and analogies to make sense of it.
According to the gate control theory, pain signals that originate in an area of injury or disease do not travel directly or automatically to the brain. Rather, there exists within the spinal cord a ‘gate mechanism’ that determines the degree to which pain signals actually end up being transmitted. And how much this gate is opened or closed, is influenced by a lot of factors in our daily lives and habits. What controls this? In a lot of ways, YOU!
When the gate is ‘wide open’, more pain signals get through than when the gate is closed more narrowly. Instead of being completely open or shut, the gate is open to varying degrees.
Some things that OPEN the gate wider?
Physical: Extent of injury, readiness of nervous system to send pain signals, innapropriate activity level
Emotional: Depression, worry, tension, anxiety, anger
Mental: Focusing on the pain, boredom, lack of routine, non-adaptive attitudes, diminished purpose/meaning
Behavioral: Withdrawal from positive activities, isolation and lack of connection, poor sleep and energy management
Some things that CLOSE the gate more?
Physical: heat or icing, massage/releases, down-regulating skills (lower readiness of nervous system to transmit pain), appropriate activity to desensitize and maintain neuromuscular connection
Emotional: having more positive emotions, creating joy, managing stress
Mental: Distraction away from pain, increased connection and social activities, feeling agency, positive attitudes
Behavioral: Increase positive life activities, appropriately progressed exercise, healthy nutrition, recovery
This is why people experience pain so differently and to varying degrees at times. The output is the result of many unique inputs and context variables. What I help patients do, is optimize all the pieces besides the inherent mechanisms or physiological processes of the disease, so your nervous system amplifies that underlying pain less and you can do more.
This is why my MARS Method has changed so many patients lives. Not because I invented something totally new. It’s the combination of how I put it together and help folks actually implement and gain consistency with these vital skills that over time decrease their output of pain.
Some other helpful ways to look at pain and the amplification of it, are to use the metaphors of “the pain pie” and “pain is a sound system” which we discuss on the podcast.
It’s not about one theory or analogy being right or wrong, but what makes sense for your brain. I hope this helped you understand persistent pain better and feel empowered to change more things in your life that impact it. If you need help decreasing your pain, reach out about individual sessions.