Understanding Pain

Pain is the most common reason that people seek medical care. For this reason, it is important to understand a little about the pain process, how acupuncture is perceived to work and why patient participation is critical. Like most things, pain is complex. It serves as a warning to prevent further injury but can become quite a burden if felt for extended periods of time. It has been long observed that thoughts, emotions, and expectations influence our perception of pain. For instance, if we are in a state of fear or have a history of pain, it tends to hurt worse.

There are different types of pain including nociceptive (sensory nerves), neuropathic, psychogenic and idiopathic. Nociceptive pain is triggered by inflammation, other chemicals or physical trauma. When we experience pain from an injury, the nociceptive pain process is not simply linear. It is actually a complex series of processes that occur between the spinal cord and the brain. The spinal cord contains a “gate like” mechanism that either blocks pain signals or allows them to be sent to the brain. This is called the Gate Control Theory (GCT). These “gates” are subject to a number of modulations within the spinal cord and from the brain itself.

“The brain can send electrical messages down nerve pathways to close the gate and shut out or reduce the flow of nerve impulses to the brain, or send messages that do just the opposite”.

IMG_2010Nociceptive pain is profoundly influenced by emotions. Worry, anxiety, past trauma or negative expectations may actually open the gate to pain. Alternatively, positive emotions, meditation, and movement close the “gates”, ultimately reducing the sensation of pain. This theory, discovered by Ronald Melzack and Patrick Wall in 1965 has withstood the test of time and revolutionized modern treatment approaches to pain. Understanding this mechanism is critical to the healing process and provides hope that pain relief is possible.

The Gate Control Theory also recognizes large, medium and small fibers within our nervous system which all transmit information. The small fibers conduct very slowly while the large fibers conduct very quickly. Interestingly, the large fibers are stimulated by touch, pressure or vibration and actually produce pain-inhibiting chemicals which decrease the sensation of pain. When there is more large fiber activity in comparison to small fiber activity, people tend to experience less pain.

This process explains why we tend to rub our elbow after we have bumped it and also why “touch” therapies such as massage, acupuncture, and electrical stimulation (E-stim) are effective modalities for pain management. Acupuncture, especially electrical stimulation acupuncture, encourages the body to regulate homeostasis, respond to stress and reduce pain by releasing endogenous (internal) pain-relieving chemicals known as endorphins.

When we develop a clearer picture of the pain cycle, we can address it in a more effective way. From this view, a multi-faceted approach is critical for pain reduction. Movement, maintaining mental health, diet, acupuncture, and treatment from other health care practitioners are important pieces in the whole paradigm of healing and pain reduction.

Katz J, Rosenbloom B. The golden anniversary of Melzack’s and Wall’s gate control theory of pain: Celebrating 50 years of pain research and management. Pain Res Manag. 2015; 20(6): 285-286.