"gate control theory of pain"

Pain is both one of the oldest complaints known to medicine and a field for some of medicine's latest breakthroughs and innovations. Pharmacologic treatment of pain is one of the oldest remedies, and opioids have been used since ancient times as an effective pain reliever but with certain specific risks for abuse. Greater knowledge of opioids led to a more thorough understanding of the complexities of pain, which may have any number of mechanisms. A greater understanding of nerve fibers and pain signaling led to the development of more drugs and the more targeted delivery of analgesics using the hollow needle...

UNLABELLED: As virtual reality (VR) technology becomes smaller and more affordable, it is gaining in popularity as a tool to address the patient experience of pain and anxiety during invasive procedures. In this study, we explore the effect of VR on the patient experience in two clinical environments of different anxiety levels to propose a possible mechanism of VR on pain and anxiety reduction. METHOD: Twenty-five wound care patients were randomly assigned to either a VR group or non-virtual reality (NVR) group, singly blinded...

OBJECTIVES: Cluster headache is considered a trigeminal autonomic cephalalgia and may present with characteristic symptoms of sympathetic/parasympathetic activation on the affected side of the face, such as nasal discharge, tearing, and conjunctival injection. Invasive therapies targeting the sphenopalatine ganglion have been performed in these headache syndromes and can have a medication-sparing effect, especially in refractory, difficult-to-manage cases. The gate control theory of pain suggests that electric pulses delivered to nerve tissues can modulate neuronal activity, thus aiding in management of nociceptive or neuropathic pain, and studies have demonstrated the efficacy and safety of sphenopalatine ganglion neurostimulation...

INTRODUCTION: The gate control theory of pain was the starting point of the development of spinal cord stimulation (SCS). We describe the indications for the treatment in pain management and other uses not related to pain. DEVELOPMENT: There are currently several paradigms for SCS: tonic, burst, and high frequency. The main difference lies in the presence of paraesthesias. SCS is most beneficial for treating neuropathic pain. Patients with failed back surgery syndrome show the best response rates, although a considerable reduction in pain is also observed in patients with complex regional pain syndrome, diabetic neuropathy, radiculopathy, and low back pain without previous surgery...

This review highlights recent findings of different amplitude ranges, roles, and modulations of A-type K+ currents (IA ) in excitatory (GAD67-GFP- ) and inhibitory (GAD67-GFP+ ) interneurons in mouse spinal cord pain pathways. Endogenous neuropeptides, such as TAFA4, oxytocin, and dynorphin in particular, have been reported to modulate IA in these pain pathways, but only TAFA4 has been shown to fully reverse the opposing modulations that occur selectively in LIIo GAD67-GFP- and LIIi GAD67-GFP+ interneurons following both neuropathic and inflammatory pain...

Delayed onset muscle soreness (DOMS) is hypothesized to be caused by glutamate excitotoxicity-induced acute compression axonopathy of the sensory afferents in the muscle spindle. Degeneration of the same sensory afferents is implicated in the disease onset and progression of amyotrophic lateral sclerosis (ALS). A series of "silent" acute compression proprioceptive axonopathies with underlying genetic/environmental factors, damaging eccentric contractions and the non-resolving neuroinflammatory process of aging could lead to ALS disease progression...

Presents an obituary of Ronald Melzack (1929-2019). Melzack died on Sunday, December 22, 2019, at 10:00 p.m. News of his death spread like wildfire through the network of long-time friends and colleagues who had heard of his imminent passing. At that moment, the world lost a compassionate and caring soul, an advocate for chronic pain sufferers around the globe, and a giant in the international pain community. He is survived by his wife of 59 years, Lucy (née Birch), their son, Joel, and daughter, Lauren. Ron is known for four major accomplishments: establishing Canada's first multidisciplinary pain center at the Montreal General Hospital with neurosurgeon colleague and friend the late Joseph Stratford; the 1965 publication, in Science , of the gate control theory of pain with the late Patrick Wall; development of the McGill Pain Questionnaire and its derivatives; and later in his career, at 60 years of age, publication of the neuromatrix theory of pain, moving the field beyond the spinal gating mechanism into the brain...

Almost a half century of research has elaborated the discoveries of the central mechanisms governing the analgesic responses of opiates, including their receptors, endogenous peptides, genes and their putative spinal and supraspinal sites of action. One of the central tenets of "gate-control theories of pain" was the activation of descending supraspinal sites by opiate drugs and opioid peptides thereby controlling further noxious input. This review in the Special Issue dedicated to the research of Dr...

Background: Transcutaneous electrical nerve stimulation (TENS) is a safe, noninvasive treatment for chronic pain that can be self-administered. Conventional TENS involves stimulation of peripheral sensory nerves at a strong, non-painful level. Following the original gate-control theory of pain, stimulation is typically near the target pain. As another option, remote stimulation may also be effective and offers potential advantages. Objective: This narrative review examines mechanisms underlying the remote analgesic effects of conventional TENS and appraises the clinical evidence...

INTRODUCTION: The gate control theory of pain was the starting point of the development of spinal cord stimulation (SCS). We describe the indications for the treatment in pain management and other uses not related to pain. DEVELOPMENT: There are currently several paradigms for SCS: tonic, burst, and high frequency. The main difference lies in the presence of paraesthesias. SCS is most beneficial for treating neuropathic pain. Patients with failed back surgery syndrome show the best response rates, although a considerable reduction in pain is also observed in patients with complex regional pain syndrome, diabetic neuropathy, radiculopathy, and low back pain without previous surgery...

OBJECTIVE: Mindfulness interventions may be beneficial for patients with chronic pain; however, the effects for acute pain are not understood. The purpose of this study was to pilot test a brief mindfulness intervention for acute pain and stress for patients in an inpatient medical setting. DESIGN: Pilot randomized clinical trial. SETTING: An inpatient Acute Care Surgery service at an urban hospital. SUBJECTS: Sixty patients with acute pain were randomly selected and agreed to participate...

The treatment of chronic pain depends mainly on our understanding of the mechanisms such as central sensitization which is involved in it. Wind-up of spinal cord is one of the most important phenomena in the study of central sensitization which has received considerable attention in recent years. Wind-up is a form of short-term synaptic plasticity (STP) that can lead to central sensitivity. Although several models have been proposed for wind-up, none of them are based on the experimental evidence. In this study, a new network model is introduced according to the gate control theory of pain...

The Gate Control Theory of pain, published more than half a century ago to explain nociceptive modulation of peripheral sensory input, assumes inhibition of incoming nociceptive (pain) information produced by mechanical stimulation. To verify the presence of such a gate control mechanism at the level of the human trigeminal system, we evaluated the effects on pain sensation of a proprioceptive trigeminal stimulation induced by mandibular extension. We found that such a stimulation, applied for 7 min, was effective in increasing both the threshold and tolerance of tooth pain induced by electrical activation of dental nociceptors...

BACKGROUND: Lidocaine is used to alleviate procedural pain but paradoxically increases pain during injection. Pain perception can be modulated by non-noxious stimuli such as temperature or touch according to the gate control theory of pain. We postulated that lidocaine dripped onto the skin prior to injection would cool or add the sensation of touch at the skin surface to reduce pain perception from the procedure. METHODS: A randomized clinical trial of patients referred to the procedure service from February 2011 through March 2015 was conducted...

The Central Governor Model (CGM) ignited a paradigm shift from concepts of catastrophic failure towards central regulation of exercise performance. However, the CGM has focused on the central integration of afferent feedback in homeostatic control. Accordingly, it neglected the important role of volitional self-regulatory control and the integration of affective components inherently attached to all physiological cues. Another limitation is the large reliance on the Gestalt phenomenon of perceived exertion...

In 1905, Henry Head first suggested that transmission of pain-related protopathic information can be negatively modulated by inputs from afferents sensing innocuous touch and temperature. In 1965, Melzak and Wall proposed a more concrete gate control theory of pain that highlights the interaction between unmyelinated C fibers and myelinated A fibers in pain transmission. Here we review the current understanding of the spinal microcircuits transmitting and gating mechanical pain or itch. We also discuss how disruption of the gate control could cause pain or itch evoked by innocuous mechanical stimuli, a hallmark symptom for many chronic pain or itch patients...

Patients with multiple sclerosis (MS) often complain of neuropathic pain. According to the Gate Control Theory of Pain, spinal networks of GABAergic inhibitory interneurons are important in modulating nociceptive inputs from the periphery. Na+-K+-2Cl- co-transporter 1 (NKCC1) and K+-Cl- co-transporter 2 (KCC2) generally dictate the tone of GABA/glycine inhibition by regulating intracellular chloride concentrations. In this study, we investigated the role of NKCC1 and KCC2 in neuropathic pain observed in the animal model, experimental autoimmune encephalomyelitis (EAE), a commonly used model to study the pathophysiology of MS...

BACKGROUND: Fractional CO2 laser is an effective treatment for scars, but most patients complain about sharp burning pain, even after the application of lidocaine ointment. This study analyzed the impact of a vibrating device to nonpharmacologically reduce the acute pain of laser treatment, in accordance with the gate control theory of pain management. METHODS: This is a prospective study performed from May 2013 through March 2014. Fifty-three patients (mean age, 26...

The gate control theory of pain proposed by Melzack and Wall in 1965 is revisited through two mechanisms of neuronal regulation: NMDA synaptic plasticity and intrinsic plasticity. The Melzack and Wall circuit was slightly modified by using strictly excitatory nociceptive afferents (in the original arrangement, nociceptive afferents were considered excitatory when they project to central transmission neurons and inhibitory when projecting to substantia gelatinosa). The results of our neurocomputational model are consistent with biological ones in that nociceptive signals are blocked on their way to the brain every time a tactile stimulus is given at the same locus where the pain was produced...

OBJECTIVE: In general, needling and injection are painful procedures, especially when the face is the target. Although local anesthetics (cream or tape) can be used to reduce the pain, they are not sufficiently effective. It has been suggested that vibration can reduce pain. The aim of this case study was to determine whether application of a vibration device to an area adjacent to the facial target area to be injected/needled would relieve pain. METHODS: Consecutive women scheduled to undergo facial injection with hyaluronic acid or botulinum toxin were recruited...