Monday, August 05, 2019

Gate Control Theory - An Alternative Approach to Pain Management

This week, we focused on a way to manage pain by looking at Gate Control Theory and related practices.

In 1965, Ronald Melzack and Patrick Wall outlined a scientific theory about psychological influence on pain perception called the ‘gate control theory’.The gate control theory of pain asserts that non-painful input closes the nerve "gates" to painful input, which prevents pain sensation from travelling to the central nervous system. Therefore, the theory goes, stimulation by a non-noxious input is able to suppress pain.

According to the gate control theory, pain signals are not free to reach the brain as soon as they are generated at the injured tissues or sites. They need to encounter certain ‘neurological gates’ at the spinal cord level and these gates determine whether the pain signals should reach the brain or not. In other words, pain is perceived when the gate gives way to the pain signals and it is less intense or not at all perceived when the gate closes for the signals to pass through. 
by Viatcheslav Wlassoff, PhD, 2014

But what closes the gate?

There are many ways to close the gate and control pain should this approach work. Beneficial strategies need to be active rather than passive strategies and include heat/cold treatments, meditation, mindfulness, acupuncture, socialising, taking part in a creative activity such as singing, painting, drawing, playing a musical instrument, crafting and so on. More passive activities such as reading and listening to music can be helpful but don't tend to be as successful in 'closing the gate'.

On reflection, and after trying this over the time since this session, I have certain ways I can close the gate but this tends to work before the pain becomes too severe. I do try to hold off medication top ups now though which generally is improving my pacing and lessening a yoyo effect for activity and crashes. I practise tai chi, I read, write and sing - all of which need lots of effort on my part initially - and these not only distract me but help me forget about my pain. Heat treatments also work well when all else fails. Listening to music and singing along works well as does watching films, box sets and documentaries - even though these are passive they do help a little.

Opening the gate tends to occur when you are overdoing it - for me that is walking too far, standing for too long and sitting for too long - and pushing yourself beyond what your body is telling you is okay.

Medications work to a point and are prescribed for main management - they are rated from quite low level to high level opiods such as morphine.

We were rather amazed to discover the wide range of meds that we were on, sometimes for similar conditions, but medications are often matched due to existing conditions, sensitivities and allergies.
However, the side effects can often outweigh the benefits experienced.

Personally, I've been on many different meds: morphine, oramorph, amitriptiline, dihydracodeine - which didn't suit me - and then tramadol which i found really effective for pain but wiped out my quality of life - then gapapentin and codeine which cause weight gain and brain fog but on balance have been the most effective. Fluoxetine for mood and muscle tension is also something I've tried and been glad of from time to time.

However,  I find that when I take codeine, I have increased energy and increased movement for the time I take it but then I crash terribly for 3-5 days afterwards as I lose sense of my limitations. In the group, we all shared that we had meds that we take more of in order to get through events and busy times but then there is payback after doing so.

We are encouraged to be pro-active where medication is concerned as everyone has different experiences and reactions. Members of the group had stories of staying on meds long term even though they either felt no benefits or had shocking side effects but persisted with them.

Over time, we all build up tolerances to meds and sometimes that is why we need to take more of the same medication or change to a slightly stronger type.

Medications generally cause side effects and we have to decide on a case by case basis whether or not the pros outweigh the cons. Here were ours:

Pain relief
Increases activity
Improves sleep
Less tension
Improved balance
Improved posture

Brain fog
Memory loss
Poor concentration
Weight gain
Unable to work
Loss of identity
Short duration of effectiveness

Therefore, medication is only part of the way we should manage our conditions. Movement and exercise, mindfulness and meditation, creativity and socialising are equally as important. We were asked to continue tai chi and movement each day at least twice a day. I've found tai chi works for me in the morning and I have certain repetitive tai chi movements that ease pain in my back, hips, neck and shoulders which i do throughout the day.

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