Detailed Explanation of Pain Gate Theory.pptx

Pain gate Theory

1. Submitted by ISHIKA TIWARI Dr. Neha Dubey Mam PAIN GATE THEORY Submitted to

2. 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

3. 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?

4. 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

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

6. 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

7. 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

8. 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

9. 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. The gate is open , the pain signal can pass through and will be sent to the brain to perceive the pain. 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

10. 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

11. 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

12. 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

13. The descending inhibitory pathway depends on the release of opioids at the SG which controls or inhibit signals transmission between the 1 st and 2 nd 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

14. The noxoious stimulus transmit to the cortex via spinothalamic tract that relay as a 3 rd 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

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

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

24. 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. 13 th 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 References