Detailed Explanation of Pain Gate Theory.pptx

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ISHIKA TIWARI Dr. Neha Dubey Mam
PAIN GATE THEORY
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Pain
Understanding Pain
Classification of Pain
Characteristics of Pain
Pain pathway
Pain Gate Theory
Gate Control Theory of Pain
Pain Modulations
Biopsychological Model of Pain
Physical Therapy Interventions for Pain Modulations
Modalities
Theories
Topics To Be Learned

 Pain is an unpleasant sensory
experience.
 It can be elicited by the application of
noxious stimulus.
 It is a symptoms for many diseases
 It is warning signal of tissue damage.
 It causes the individual to react to the
pain to withdraw from noxious
stimulus.
What is the Pain?

 FAST PAIN - It is also called Acute pain,First
pain, Sharp pain etc.
For example – skin cut with knife.
 SLOW PAIN - It is also called Chronic Pain
Second Pain ,Throbbing Pain, Burning Pain .
It is associated with tissue destruction.
Understanding Pain

Pain
Somatic Viscera
from viscera
Example- chest pain in heart
Superficial deep
from skin muscles & joints
ex- cut , burns ex- fracture
Classification of Pain

 Thresold and intensity
Stimulus does not produce pain, increasing strength of stimulus
causes increased intensity of pain.
 Adaptation
Pain receptors do not adopt .This is beneficial . This makes us to
put effort for removal of injuries agent.
 Localisation
Superficial pain is better localised than deep pain .
 Emotions
Pain is associated with comfortable emotion.
 Extent of Pain
Higher the tissue damage,the most severe is the pain.
Characteristics of Pain

 The pain is carried by two types of
fibres.
 A delta fibres and C fibres.
 A delta fibres carry fast pain and
fibres carry slow pain.
 These fibres from receptors carry
to the dorsal or position horn of
spinal cord and form there they
are carried to the thalamus and
then to the cerebrum.
Pain Pathway

Detailed Explanation of Pain Gate Theory.pptx

 This theory was first proposed by Melzack and Wall.
 When touch sensation receptors are also stimulated
along with pain sensation ,then pain sensation is
less felt .
 The position horn o the spinal cord is viewed as a
gate through which touch ,pain, temperature and
other sensory impulses are entering.
 When pain alone is entering it can enter very well
and the person feels pain.
 But when there is touch sensation also
accompanying ,the pain sensation ,the touch
sensation may block the entry of pain sensation,
resulting in reduction of pain.
 Thus,when a high diameter fibres carrying
sensations are passed through the posterior horn, it
will block the pain sensation.
Pain Gate Theory

The Gate Control Theory Of Pain is a
mechanism in the spinal cord in which pain
signals can be sent up to the brain.
 The GATE is the mechanism pain signals
can be let through or restricted.
 One of two things can be happen ,the gate
can be OPEN or the gate can be CLOSED.
1. The gate is open, the pain signal can pass
through and will be sent to the brain to
perceive the pain.
2. The gate is closed, pain signals will be
restricted from travelling up to the
brain, and the sensation of pain will not
be perceived.
Gate Control Theory Of Pain

Pain modulation is the process of alterations in the
pain signals along the transmission pathway of pain
.
Level -1
Level -2
Level -3
Level -4
Pain Modulation

 Levels 1 – Periphery
Pain modulation refers to events acting in the
periphery of the body.
Nociceptors are peripheral cell nerve endings that
initiate pain sensation,respond to a noxious
stimulus.
It divided into A-delta and C fibres .
 A-Delta fibres are large myelinated ,fast
conduction fibres, concerned with
localised ,sharp and fast sensation of pain.
 C- fibres are small, unmyelinated ,slow conducting
nerve fibres,concerned with dull and slow pain
sensation.
 A-beta are myelinated ,large diameter ,and
havee the fastest conduction velocity.
LEVEL OF MODULATONS

Pain modulation refer to events in the dorsal horn of
the spinal cord.
The modulations at the level of the spinal cord takes
at substantial Gelatenosa of Ronaldo S G under the
effect of Gate Control Theory which was the first
theory to propose that pain experience is not only the
outcome of a linear process.
Neural impulses from the peripheral nervous system
that could represent pain are modulated in the spinal
cord by a gate like process in the dorsal horn before
being transferred to the central nervous system.
 Level 2- Dorsal Horn

 The descending inhibitory pathway depends on the
release of opioids at the SG which controls or inhibit
signals transmission between the 1st
and 2nd
order
neurons.
 The descending pathways slant from peiaqueductal
grey matter (PAG) in the midbrain then to raphe
nucleus in the medulla to the dorsal horn of the
spinal cord.
 These pathways release serotonin and
noradrenergic neuron to inhibit the release of
substance P from the presynaptic cleft of the fir
order neuron.
 Also stimulate the inhibitory interneuron to release
opioids which in turn inhibit the presynaptic from
releasing substance P and inhibit the post synapse of
the second order neuron from transmitting signals.
 Level 3- Fast neuronal descending
pathways

 The noxoious stimulus transmit to the cortex
via spinothalamic tract that relay as a 3rd
interneuron in the somatosensory area.
 Cortex activates the PAG in the midbrain so it
activates the descending pathway which
interrupts and inhibit pain signals at dorsal
horn so by extension the spinothalamic tract is
inhibited.
 The interaction between diifferent areas –
Cerebral Cortex , limb forebrain structures,
Basal Ganglia .
 Thhe importance of the interaction is to
perceive the noxoious stimulus but as a painful.
 Level 4- Cortical

 The biopsychosocial models states that pain is not simply
a neurophysiological phenomenon.
 It also involves social and pyschological factors.
 It says that factors factors like culture , family ,nociceptive
stimuli and environment influence pan perception and
thus ultimately affect a person’s emotions, behaviours
and cognition.
Biopsychosocial Model Of Pain

As systematic review delivered by Arribes Romano A et al
2020, demonstrated the physiotherapy modalites can alert
pain perception with Chronic Musculoskeletal Pain ( CMP)
through –
• Decrease in temporal summation.
• Increase conditional pain modulation.
• Slight improvement in central sensitization.
• Manual Therapy.
• Strengthening Exercises
• Massage
• Joint Mobilization
• Spinal Manipulative Therapy.
Physical Therapy Interventions For
Pain Modulations

 Direct Current Stimulation
 An important modality to reduce perception in chronic pain conditions.
 The pre central cortical area of the motor cortex is the most target area
for pain modulation .
 Transcutaneous Electrical Nerve Stimulation
(TENS)
 Gate Control Therory
 Release of Endrophins
Modalities

 Acupunture
 Used as a complementory modality for pain management.
 Releasing of endogeneous opioids ,serotonin and
norepineprine.
 Low level Laser Therapy
 Interferential Therapy (IFT)
 Dry Needling
Modalities

Hardy, wolff and goodell,1940
theory of pain
It states that pain was composed of two components:
The perception of pain and the reaction one has towards it.
The reaction was described as a complex biopsychosocial
process involving cognition, past experience, culture and
various psychological factors which influence pain
perception.
Theories

Sensory interaction theory
(noordenbos,1959)
It describes two systems involving transmission of pain :
FAST and SLOW system.
The later presumed to conduct somatic and visceral
afferents whereas the former was considered to inhibit
transmission of the small fibres .
Theories

Gate control theory ( melzack and wall,1965)
 Melzack has proposed a theory of pain that stimulated considerable interest and debate
and has certainly been a vast improvement on the early theories of pain.
 According to his theory , pain stimulation is carried by small, slow fibres that enter the
dorsal horn of the spinal cord; then others cells transmit the impulses from the spinal cord
up to the brain.These fibres are called T- cells.
 The T- cells can be located in a specific area of the spinal cord, known as the substantial
gelatinosa.
 These fibers can have an impact on the smaller fibers that carry the pain stimulation.
 In some cases they can inhibit the communication of stimulation,while in other case they
can allow stimulation to be communicated into the central nervous system.
 Large fibers can prohibit the impulses from the small fibers from ever communicating with
the brain . In this way, the large fibers create a hypothetical “GATE” that can open or close
the system to pain stimulation.
 According to the theory, the gate can sometimes be overwhelmed by a large number of
small activated fibers. In other words, the greater the level of pain stimulation, the less
adequate the gate in blocking the commmunication of this information.
Theories

 An unpleasant sensory experience , which can be elicted by the
application of noxious stimulus is called
A. Pain
B. Inflammation
C. Spasm
D. None
Ans(A)
 Acute pain is also called
A. Fast Pain
B. Slow Pain
C. Visceral Pain
D. All of the above
Ans (A)
MCQ

 Pain Gate Theory is proposed by
A. Newton
B. Melzack and Wall
C. Edison
D. Dena Gardener
Ans (B)
 Which nerve fibres carries acute pain ?
A. A delta
B. A beta
C. Cfibres
D. All of the above
Ans (A)
 Which type of pains are usually referred ?
A. Fast Pain
B. Slow Pain
C. Visceral pain
D. All of the above
Ans (C)
MCQ

Books
 (Potturi G,Agarwal A , Rastogi N, Chaudary KBRS ).Pain Gate Theory .CBS publishers and
Distributors .First edition.2020: 49-52
 (Khokkhar V kr ). Pain gate theory .top publishing company. 13th
edition .2020 115-118
Internet
 http://www.phsiopedia.com/PainGateTheory
 http://www.slideshare.com/Paingatetheory
 http://www.youtube.com/Paingatetheory
 http;//www.goggle.com/Paingatetheory
Journal
 (Campbell TS,JOHNSON JA, ZERNICKE KA. Gate Control Theory of Pain.In:
Encyclopedia of Behavioural Medicine.Cham:Springer International Publishing;2020.p.914-
916.
 Barron,C.J.,Klaber Moffett,J.A.,&Pooter,M.(2007).Patient expectations of
Physiotherapy:Definitions , concepts, and theories.Physiotherapy Theory and
Practice,23(1),37-46
 Moayedi M,Davis KD. Theories of Pain: from specially to gate control. J Neurophysiol
2013;109:5-12
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