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Gate Control Pain Theory

(ĐTĐ) – The gate control theory of pain was developed by Melzack and Wall to account for mechanisms by which other cutaneous stimuli and emotional states alter the level of pain.

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They suggested that within the substantia gelatinosa of the dorsal horn, there are interneurons that presynaptically inhibit transmission of nociceptive information to the ascending tracts. These interneurons are activated by large-diameter afferents and inhibited by small-diameter afferents. In addition, they suggested that the brain exerts descending control on this system, relying on the fact that cognitive factors are known to influence pain behavior.

Several studies have failed to provide support for the gate control theory. It remains significant, although incorrect in detail, in hypothesizing that nociceptive pain undergoes dynamic integration and modulation. The gate control theory of pain has altered the concept of pain as solely an afferent sensory experience, broadening the concept to include the affective and motivational factors involved in the human pain experience. The gate control theory has been modified extensively during the past 40 years. It still represents the first attempt to describe a pain-modulating system that responds to input by noxious stimuli, innocuous afferent impulses, and descending control.

Gate Control Pain Theory

Gate Control Pain Theory explains why thoughts and emotions influence pain perception, Ronald Melzack and Patrick Wall proposed that a gating mechanism exists within the dorsal horn of the spinal cord. Small nerve fibers (pain receptors) and large nerve fibers (“normal” receptors) synapse on projection cells (P), which go up the spinothalamic tract to the brain, and inhibitory interneurons (I) within the dorsal horn.

The interplay among these connections determines when painful stimuli go to the brain:

  1. When no input comes in, the inhibitory neuron prevents the projection neuron from sending signals to the brain (gate is closed).
  2. Normal somatosensory input happens when there is more large-fiber stimulation (or only large-fiber stimulation). Both the inhibitory neuron and the projection neuron are stimulated, but the inhibitory neuron prevents the projection neuron from sending signals to the brain (gate is closed).
  3. Nociception (pain reception) happens when there is more small-fiber stimulation or only small-fiber stimulation. This inactivates the inhibitory neuron, and the projection neuron sends signals to the brain informing it of pain (gate is open).

Descending pathways from the brain close the gate by inhibiting the projector neurons and diminishing pain perception.

This theory doesn’t tell us everything about pain perception, but it does explain some things. If you rub or shake your hand after you bang your finger, you stimulate normal somatosensory input to the projector neurons. This closes the gate and reduces the perception of pain.

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