The Perception of Pain

There are a number of distinct theories about the perception of pain.

Specificity Theory

Pain research has been long dominated by Specificity Theory (Baum et al 1983, Horn
& Munafo 1997). The Specificity Theory of Pain describes the traditional
understanding of pain. This theory proposed that a specific system of nerves carry
messages from pain receptors in the skin to a pain centre in the brain and that the
intensity of the pain is correlated to the amount of tissue damage (Banyard 1996,
Melzack & Wall 1996, Curtis 2000, Melzack 2001). However examples of injury
without pain, and pain without injury, show that there is not a direct connection
between stimulation and pain, therefore showing weaknesses in the specificity theory.

Pattern Theory

Pattern Theories, in contrast to Specificity Theories, suggest there are

no separate systems for perceiving pain but instead the nerves are

shared with other senses - such as touch. According to Pattern Theories,

the most important feature of pain is the amount of stimulation. But

again, there are examples of pain without injury (stimulation) and so this

theory is also weak.

Psychologists have been interested in the study of Pain since the

realisation that it has a psychological dimension as well as a physical

dimension (Curtis 2000). But as yet, there seems no way to differentiate

between the pain experienced due to tissue damage and pain without

tissue damage. So, it appears sensible not to tie pain to a particular

stimulus as in the Specificity Theory or Pattern Theory.

Gate Control Theory

The most renowned Pain theory is the Gate Control Theory (GCT), first proposed in
1965 by Ronald Melzack and Patrick Wall in their now famous paper, 'Pain
Mechanisms: a new theory' (Wolfe 1978, Maslar 1986, Brown et al. 1989,
Zimmerman et al 1989, Whipple & Glynn 1992, Horn & Munafo 1997). This theory
combined the medical approach of previous theories with the more recent bio-
psychosocial model of health. Their approach considered biological, psychological
and social factors in pain and not simply the medical factors alone (Horn & Munafo
1997).

The Gate Control Theory model is biologically complex and the description

of the nervous system pathways involved is beyond the scope of this

dissertation. At its simplest, the theory suggests that there is a 'gate'

or 'gating mechanism' in the nervous system that opens and closes in

response to various factors. Opening the 'gate' allows pain messages to

travel to the brain, whereas closing it stops messages travelling to the

brain (Melzack & Wall 1965).

Activity in these pain fibres causes Transmission Cells (T-Cells) to send

pain signals to the brain and open the 'gate'. Activity in sensory nerves

not directly linked to pain causes larger diameter nerves to carry

information (e.g. touching, rubbing or scratching). These activities close

the 'gate' and reduce the likelihood of experiencing pain.

The Gate Control Theory differs from earlier models in a number of

fundamental ways (Ogden 2001): According to the Gate Control Theory,

pain is a perception and an experience rather than a sensation. (This

change in terminology reflects the role of the individual in the degree of

pain perceived.) Also the Gate Control Theory sees pain as an active

process where the individual no longer responds passively to stimuli but

actively interprets and appraises painful stimuli (Ogden 2001).

As stated, the Gate Control Theory Model (see Figure 1) suggests that

pain is a two-way flow of information to and from the brain, and that the

brain not only processes the information but also directly affects the

'gating mechanism' (Melzack & Wall 1965).

Conditions that open the 'Gate' Conditions that close the 'Gate'

Physical Physical

• Extent of the Injury • Medication

• Inappropriate activity level • Counter-stimulation

Emotional Emotional

• Anxiety or worry • Positive Emotions

• Tension • Relaxation
• Depression • Rest

Mental Mental

• Focusing on the Pain • Intense concentration or

distraction
• Boredom
• Involvement and interest in life
activities