Control of Pain: The Gate Theory

Taken in part from Wikipedia, the free encyclopaedia

This theory asserts that activation of nerves that do not transmit pain signals can interfere with signals from pain fibres and inhibit an individual's perception of pain.

Consequences:

The impact of this theory on medical treatment for pain has been profound, and has made it a multi-disciplinary field. Those being taught pain control techniques can actually be told why they work. This seems to play a major role in achieving results.

What does this mean to you and me?

A trained medical therapist can interrupt the sensation of pain, not stop the pain, but stop the body recording what is happening and sending out signals - so we don't feel it in a physical way.

This has great impact on medical operations and the treatment of pain in post operative conditions. Hypnosis can now prevent pain being felt by inducing conditions that over-ride the normal responce, in other words the theory now confirms the facts long known, that it is possible to induce a feeling of no pain just as conversly one can feel pain where there is none, for example in the 'phantom limb' condidtion.

Operations are carried out using hypnotherapy (and often in conjunction with acupuncture) without anaesthetic safely and thus without all the accompanying complications so often inhibiting recovery, so making a swifter and less emotional experience for the patient.

Technical Theory:

The gate control theory of pain, put forward by Ronald Melzak (a Canadian psychologist) and Patrick David Wall (a British physician) in 1962, and again in 1965, is the idea that the perception of physical pain is not a direct result of activation of nociceptors, but instead is modulated by interaction between different neurons, both pain-transmitting and non-pain-transmitting. 

Firing of the 'AB' fibres activates the inhibitory interneuron, reducing the chances that the projection neuron will fire, even in the presence of a firing nociceptive fibre.

Gate control theory asserts that activation of nerves, which do not transmit pain signals, called nonnociceptive fibres, can interfere with signals from pain fibers, thereby inhibiting pain. Afferent that carries messages quickly with intense pain, and a small, un-myelinated, slow C2 fiber that carries the longer-term throbbing and chrinic pain.  Large-diameter Aβ fibers are nonnociceptive (do not transmit pain stimuli) and inhibit the effects of firing by Aδ and C fibers. pain-receptive nerves, those that bring signals to the brain.

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CHILDREN & PAIN

The purpose of therapy is always to increase the child's control of desired feeling or behaviour, and any suggestion that emphasizes loss of control can only inhibit therapeutic progress. The techniques and the specific therapeutic suggestions used emphasize children's involvement and control, and encourage their active participation in the process of experiencing and utilizing hypnosis.

Hypnosis has established a successful record in the paediatric setting mainly in the management of procedure-related pain with hospitalisation being short or long term, they might undergo numerous painful procedures and a number of controlled studies have shown that hypnosis is effective in treating procedure-related pain.

Children have long been regarded as good respondents to hypnosis and hypnotic interventions with hypnotic-like states common to their experience. Antecedent conditions are found in childhood play, fantasy, and imaginary playmates.

Hypnosis therapy has been found to be of significant help in reducing pain and anxiety in all of the studies conducted so far. Results indicate that both hypnosis and other coping skills are effective in preparing patients for medical procedures, with hypnosis being superior in minimizing anxiety and behavioural distress. There is consistency of the findings among the studies contacted so far.

Compared with adults, children are more likely to wriggle and move about, open their eyes or refuse to close them and make spontaneous comments during hypnotic inductions and treatment. Although these behaviours may indicate resistance, this is not necessarily the case. Most often the child is simply adapting hypnosis to their behavioural style.

Additionally, there is possibility for hypnosis to be utilized for the management of other symptoms such as chronic pain, phantom limb pain, needle phobia, generalized anxiety, dysphagia for pills, insomnia etc.

Preparation usually includes discussion of the reasons for utilizing hypnosis, clarification of misconceptions, and full reply to questions. Details of the child's likes and dislikes, significant experiences, fears, hopes, and comfort areas are discussed. Children respond to a large number of hypnotic inductions each with countless variations. The choice of an appropriate induction for any given child depends on the needs and preferences of the child.

The therapist can also teach the patient self-hypnosis as a way for them to participate actively (in a motivated and purposeful way) in the treatment process, and to reinforce self-mastery. Moreover, hypnosis is an opportunity for the clinician to be inventive, spontaneous and playful, and to build a stronger therapeutic relationship with a child while providing symptom relief.

HYPNOSIS ADVANTAGES: Hypnosis has several attractive features. It is safe and does not produce adverse effects or drug interactions. Children enjoy the hypnotic experience. They obtain relief without destructive or unpleasant effects. There is no reduction of normal function or mental capacity and no development of tolerance to the hypnotic effect.

It is a skill, which children can easily learn, that provides a personal sense of mastery and control over their problems and counters feelings of helplessness and powerlessness. A beneficial change in attitude towards treatment and hypnosis also fosters a sense of control.

An additional benefit is that hypnosis can be generalized to many distressing circumstances. The child who learns hypnosis for management for one treatment may apply their skills to lessen the distress of others, insomnia, anxiety etc.

CONCLUSION: It is clear that children would benefit tremendously from the wider application of hypnosis in paediatric centres. In terms of clinical practice, the optimal control of children's symptoms requires an integrated approach because many factors are responsible - however seemingly clear-cut the cause.

Children might well receive hypnotic intervention in conjunction with pharmacological treatments. Hypnosis is a reasonably cost-efficient technique that may well enhance patient compliance, reduce time allocations of expensive medical personnel and equipment, and minimize the distress of children who must undergo medical procedures.

Only properly trained and certificated health care professionals who have been trained in the clinical use of hypnosis and are working within the areas of their professional expertise should be employed. It is therefore imperative that paediatric practitioners are well trained, properly supervised and that the provision of services is carefully planned, resourced and managed.