Gate control theory of pain

The gate control theory of pain of Ron Melzack and Patrick Wall arises from evolutionary psychology. It holds that evolution of intelligence in any natural environment, historically, begins with the recognition of the entity's own body - called the kinesthetic sense.

Pain, in this view, is then a part of this very sense, a way in which parts of the body learn where they should be, and where not to be.

Experiments on dogs which grew up confined in cages, who when released were excited, constantly ran around, and when pain (such as contact with a burning match or being pinched) is encountered, required several attempts to learn to avoid it, seemed to demonstrate that pain is understood and avoided only by experience - aversion to it is simply not inbuilt or automatic, and the organism has no way to know what will cause repeated pain without a repeated experience.

Nervous systems are composed of two kinds of fibers - one fast fiber that carries messages quickly with intense pain, and a large fiber that carries the longer term throbbing and chronic pain. The two pathways interfere with each other, constructively, so that the brain can control the degree of pain felt, based on which pains are to be ignored to pursue potential gains. This it does based on the inherited ideas from the past about what is worth doing. Thus, the brain controls the flow of pain quite directly, and can be trained to turn off forms of pain that are not "useful".

Pain is in the brain, according to Melzack, and only there.

In his paper The Tragedy of Needless Pain, he further asserts that pain is a fundamental human experience, and requires an integrative understanding of that whole experience, and every choice we have made, that has formed our own "gates". He frames the choice to deal with pain or ignore it as moral: if the brain can control pain, we who know that must make use of that capacity, and in turn take control of pain on a species level - only by doing so can we achieve control of the larger causes of all of the pain that humans cause each other by carelessness, hatred, and failures of empathy - which might extend beyond humans.

The brain in prior theories of neurochemistry had simply not been taken into account - pain was thought to be simply a direct response to a stimulus - the so-called pain/pleasure theory, a one-way "alarm system" like system as proposed by René Descartes. This did not for instance explain why a carpenter can hit his thumb and not feel much pain, whereas a novice is doubled over in agony, nor did it explain phantom limb pain, when the signal is in fact impossible to receive, since the wiring for it is gone.

The impact of this theory on medical treatment for pain has been profound, and has made it a multi-disciplinary field. A major advantage of the theory is that those being taught pain control techniques can actually be told why they work. This seems to play a major role in achieving results - which is explained most readily by psychoneuroimmunology, which sees the nerves as the link between the sensory/cognitive and immune system.

It usually takes about ten classes, covering diet (tryptophan-heavy foods such as turkey help control pain), to drugs and psychiatry, social network choices, and so on, at the McGill University pain control centre founded by Melzack, for a typical chronic benign pain sufferer to feel in control of their own life again. Very often, the pain has restricted their existence - choices of friends, activities, lifestyle and profession. In the gate control theory, this is only to be expected, as the failure to control pain can be seen as a mental illness - a brain being unable to deal with challenges that a body faces.

Pain being an entirely personal experience, it is difficult to measure, but Melzack's McGill Pain Questionnare asks a number of directed questions to assess and categorize that experience. By collecting words used to describe pain by the patients themselves, Melzack ended up with about 200 words. A "burning pain" for instance, can be described as "hot" or even "searing". "Throbbing" becomes "palpitating". Some describe sensory aspects of pain, and others, such as "excruciating", describe emotional experiences. More intense pain generally requires more words to describe. A patient, in the questionnare, picks one of 20 set of words to describe their pain, and assign it a point on a scale. The test is used all over the world, but culture and language seem not to matter - the same words appear in almost every assessment in different languages. For instance, group 1 lays out the scale "flickering, quivering, pulsing, throbbing," all of which imply some kind of movement or change. Another group has the words "hot, burning, scalding, searing". These words seem to describe actual experiences, something common to the hominid nervous system.

In The Body in Pain, Elaine Scarry writes that this process was the first to actually qualify and define types of pain - something impossible prior to the gate control theory. An advantage of this was to make it easier to determine the difference between organic pain and non-organic pain - the latter being entirely treatable by psychological means.

Healing is directly affected by the physiological way the body behaves when the brain is or is not experiencing pain - post-traumatic stress disorder for instance can set in a long time after the physical insult, causing inordinate levels of caution, emotional withdrawal, and dealing an injury not just to the body but to the whole person. Rates of healing are drastically affected - more serious injuries can be recovered from up to three times more quickly when pain is under control, than when it is not.

The phantom limb pain commonly experienced even by quadriplegics who have lost large portions of the spinal cord and cannot possibly be receiving any messages from it, is explained most readily by Melzack's notion of the body-self neuro-matrix, a sort of committee that can create a composite map of the body, and "represents the sense of self of the body". The sensation of a foot that is burning, for instance, has become separated from the foot that is still attached to a useless leg dangling into space - the disconnection actually frees the neurological part of the matrix to "invent" a body. Different parts of the brain then perceive the whole body in different ways, and these are more free to clash if real signals from a real body are not disciplining them all with a common external experience.

See also: touch