Developed by Wall & Melzack in 1965



                                                                                                                                                                                    Melzack

Ronald Melzack (1929 - )

 

 



                               Wall

Development

The Gate Control Theory (GCT) was developed in 1965 in order to define the relationship between pain and emotion.

The GCT explained that a gating mechanism occurs in the spinal cord.

Pain impulses are transmitted by A delta and C nerve fibers.

The pain impulses travel to the substantia gelatinosa area of the spinal cord.

The substantia gelatinosa allows for inhibiting or prohibiting of pain.

If the substantia gelatinosa inhibits pain, the gate is closed, and no impulses are sent to the brain.

If the gate is open, pain impulses are sent to the brain.

An individual's thoughts and emotions are influenced by the awareness of pain.

(McEwen & Wills, p. 317, 2011)

What is Pain?

• The International Association for the Study of Pain defined pain as the "unpleasant sensory and emotional experience associated with acutual or potential tissue damage or described in terms of such damage".

• "A personal experience that can be utilize through a visual analogue scale".

(Aloraham, 2007) (Bergh, Jakobsson & Sjostrom, 2008)

Acute Pain

• Acute pain is serves as a warning that injury has occurred.
• The pain is limited to an area.
• The pain stimulates the sympathetic nervous system.
• The sympathetic nervous system causes increase heart rates, respiratory rates, apprehension, sweating, restlessness, and dilated pupils.
• Somatic, visceral and referred pain are types of acute pain.
• Somatic is superficial pain that is associated with pain from the skin.
• Visceral pain is associated with pain from internal organs.
• Referred pain is associated with pain that is distal from the stimulus.

(Helms & Barone, 2008)

Chronic Pain

• The pain is prolonged, lasting longer than the expected healing time.
• Central and neuropathic are two types of chronic pain.
• Central pain results from a lesion in the central nervous system such as an infraction, hemorrhage, tumors, traumatic injury, or abscess.
• Neuropathic pain results from an injury to the peripheral nerves.
• There is an increase difficulty in managing chronic pain as compared to acute pain.
• There is a decrease in autonomic nervous system responses such as nausea, vomiting, or swelling.
• The body's has adapted to pain impulses, therefore the fight-or-flight reaction does not occur.

(Helms & Barone, 2008)

Pain

• Pain affects people of all ages.
• Pain has a tremendous affect on daily life activities.
• Pain is often underestimated and uncontrolled.
• Women experience pain more often than men.
• Women have a lower tolerance to pain as compared to men.
• Infants and children experience acute and chronic pain.
• Pain is different for each individual.
• Pain can cause a decline in health.

(Godfrey, 2005) (Helms, 2008)

The Gating Mechanism with Pain Medication

Pain medication administered while the gate is closed results in decreased pain impulses being transmitted and the gate will stay closed longer.

Increase pain causes an increase number of pain impulses to be transmitted.

Increase pain medication is needed if the gate is open completely.

In order to eliminate or decrease pain, the gate must stay closed.



(McEwen & Wills, 2011, p. 318)

Assessment and Treatment

• Assessment is a priority.
• As part of accreditation requirements, The Joint Commission has mandated that all hospitals implement a pain assessment and management program.
• Assessment of pain can be difficult when a patient is unconscious or has an indwelling device that can impeded communication such as an endotracheal tube.  Therefore nurses, must rely on other means such as pain scales or monitoring for increase heart rate and blood pressure, or anxiety.
• Nurses may use pharmacological or nonpharmacological methods to treat pain.
• Pharmacological include utilizing medication as soon as the pain begin.
• Nonpharmacological include utilizing relaxation, heat or cold, massage, or guided imagery.

(Helms, 2008)

Utilizing The Gate Theory in Critical Care

As a critical care nurse, patients are often on the ventilator and unable to express their feelings of pain.  Some patients are on sedation, but a majority of the patients are aware of their surroundings.  The Gate Theory allows me to understand how pain is perceived in the body, and to try to decrease the stimuli in order to cause a reduction or elimination of pain.  Utilizing pain scales, medications, and removing the stimuli that is causing the pain such as a wrinkled pad can help in providing comfort.  Nurses must remember that pain is subjective and is different for each individual.

References

Aloraham, S. (2007). Understanding pain mechanisms: pain can be managed more effectively by studying its pathways. Podiatry Management, 26(4), 215-224

Bergh, I., Jakobsson, E., & Sjostrom, B. (2008). Worst experiences of pain and conceptions of worst pain imaginable among nursing students. Journal Of Advanced Nursing, 61(5), 484-491.

Godfrey, H. (2005). Physiology of pain. Understanding pain, part 1: physiology of pain... first in a two-part series. British Journal Of Nursing (BJN), 14(16), 846-852.

Helms, J., & Barone, C. (2008). Physiology and treatment of pain. Critical Care Nurse, 28(6), 38.

McEwen, M.  &  Wills, E.  (2011).  Theoretical basis for nursing.  (3rd ed.).  China:  Wolters Kluwer/Lippincott Williams & Wilkins