Pain Theories History

Pain has been experienced by everyone regardless of age, gender or economic status. Pain is usually described as unfavorable experience that has a lasting emotional and disabling influence on the individual. Theories that explain and assist in understanding what pain is, how it originates and why we feel it are the Specificity theory, Pattern Theory and Gate theory.

In this paper I will attempt to demonstrate my understanding of the theories and also will be critically analyzing the theories about the experience of pain by incorporating relevant concepts from literature and relating Pain has been described with a wide range of different words. McCaffery (cited in Adams and Bromley, p192, 1998 ) simply states that the experience of pain as being “what the experiencing person says it is, existing when he says it does”. This definition by McCaffery strongly indicates that pain is conceived and experienced differently in an individualized manner .

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McCafferys’s definition of pain suggests experiences of pain depends only on the person experiencing the pain and that no other person is fully capable to understand how he/she may be feeling as the result of pain. McCaffery does not actually state in his definition what pain is and what causes the discomfort, how and why pain arises(Adams and Bromley,1998). Bond (1984) describes pain as being a personal and unique experience which arises in the brain due to injury to the body tissue, disease or due to biochemical changes in our bodies. There are two main types of pain, acute and chronic. Acute pain is experienced for a short time and usually has a specific cause and purpose such as injury to body tissue (Adams and Bromley, 1998).

Acute pain can be treated using drugs such as aspirin or other method of pain relieve. Chronic pain has no time limit therefore, can last for months and years, and serves no obvious biological purpose. Chronic pain can have a significant impact on the quality of person’s life as chronic pain can trigger psychological as well as physical and emotional problems that leads to feelings of helplessness and hopelessness as most chronic pain can not be cured (Goleman and Pain theories that I will discussing in this paper are specificity , pattern and gate control theory as these are the major theories that assist in explaining the concepts of pain .

The modern perspective sees the concept of pain from a view that includes psychological factors but the earlier theories such as Specificity theory and Pattern theory were more focused on tissue damage as the cause of pain. The Specificity theory was originated in Greece .This theory was highlighted by Descartes in 1664 who expressed that the pain system as being like a “bell – ringing mechanism in a church”(Melzack and Wall , p196,1984) .

Descartes (cited in Melzack and Wall ,1984) explained that when someone pulls the rope to ring the bell, the bell rings in the tower. Hence, specificity theory suggests that pain is caused by injury or damage to body tissue. The damaged nerve fibres in our bodies sends direct messages through the specific pain receptors and fibres to the pain center, the brain which causes the individual to feel pain (Adams and Bromley ,1998).

This theory suggest that there is a strong link between pain and injury and that the severity of injury determines the amount of pain experienced by the person (Brannon and Feist , The Pattern theory was incorporated into the specificity theory which added more concepts to explain and extended its hypothesis of pain .The pattern theory states that nerve fibres that carry pain signals can also transmit messages of cold, warmth and pressure can also transfer pain if an injury or damage to body tissue occurs (Adams and Bromley,1998).

The Pattern theory claims that pain is felt as a consequence to the amount of tissue damaged (McCance and Huether, 1990). Both Pattern theory and Specificity Theory are part of Linear model of pain which simply demonstrates that noxious stimulus such as tissue damage or injury results in the nerve tissues being stimulated which causes painful sensation which causes a response or painful behavior (Adams and Bromley, 1998).

The Specificity theory and Pattern theory are not sufficient in explaining the experience of pain as the theorists fail to include any psychological aspects of pain. Adams and Bromley ,(1998) felt that the specificity theory does not see the individual difference in how pain is perceived by people. Brannon and Feist (2000) also emphasize that this particular theory declines to incorporate how pain is felt throughout the society. Melzack and Wall, (1984 )claims that soldiers who were severely injured during the wars reported experiencing little or no pain for days after the injury while people with chronic pain show unbearable amount of pain even though they have no detectable injury to body tissue.

Adams and Bromley (1998) illustrates that if severity of injury was seen as amount of pain experienced then pain relief would be given according to the amount of injury , not according to the person who had sustained the injury , regardless of how the person conveys their pain . Hence clients with chronic pain would be seen as ‘crocks’ as they have no visible injury or damaged tissue and will not treated with analgesics and would be rejected Melzack and Wall proposed the idea of Gate Control theory in 1965. This new theory was against the idea of Liner model as the theorist believed that pain perception is influenced by a number of factors which begins in the spinal cord.

Melzack and Wall highlighted that pain messages are carried by the specific nerve fibres that can be blocked before reaching the brain by the actions of other nerves and psychological factors (Brannon and Feist, 2000, Polnik 1999, Goleman and Gurin, Melzack and Wall suggested that when pain signals first reach the nervous system, the pain messages are sent the thalamus and the ‘gate’ opens to allow the pain messages to be sent to superior centers in the brain(Brannon and Feist, 2000).

However, the gate may remain closed if neurons come in contact with pain signals , the neurons has the ability to overpower the pain signals which results in the gate remaining closed(Brannon and Feist, 2000). Pain signals can also be stopped if the hypothetical gate remains closed as our natural painkiller, endophins, blocks the pain signals from getting to the brain(Goleman and Gurin , 1993).

Melzack and Wall (cited in Bromley and Adams ,1998) highlights that previous memory of how the prior painful situation was handled , supportive support members, positive thinking of pain , distraction, prior conditioning , cultural values, boredom, stress, negative thinking, poor pain coping skill may allow the gate to open or to remain closed by affecting the central control system.This concept can be explained by Beecher (cited in Brannon and Feist, 2000) who noticed that the soldiers during World War II reported slight pain even though they had sever damage to tissue due to the battle.

These soldiers had positive thinking and were distracted because injury meant that the soldiers would be allowed to go home or sustain no further injury ( Beecher cited The gate control theory states that non painful stimulus such as distraction competes with the painful impulse to reach the brain. This rivalary limits the number of impulses that can be transmitted in the brain by creating the hypothetical gate (Plotnik ,1999).

The Gate control theory is the first and the only theory to take into account psychological factors of pain experiences. Experiences of pain are influenced by many physical and psychological factors such as beliefs , prior experience, motivation , emotional aspects, anxiety and depression can increase pain by affecting the central control system in the brain. The specificity theory and the pattern theory suggests that pain occurs only due to damage to body tissue while the gate control theory claims that pain may be experienced without any physical injury.


  1. Adams, B. & Bromley, B.1998, Psychology for Health Care: Key terms and Concepts,MACMILLAN PRESS LTD,USA.
  2. Barber,J.& Adrian,C.1982,Psychological Approaches to the management of pain,Brunner/Mazel INC,USA.
  3. Brannon, L.& Feist, J.2000, Health Psychology: An Introduction to Behaviour and Health ,4th edn ,Brooks/Cole,USA.
  4. Bond,M.1984,Pain:Its Nature,Analysis and Treatment ,2nd end, Churchhill Livingstone ,UK.
  5. Goleman ,D. & Gurin,J.1993,Mind,Body,Medicine: How to use your mind for better health, Consumer Report Books,USA.
  6. McCaffery,M. and Beebe, A.1994, Pain:Clinical Manual for Nursing Practice,Mosby,UK.
  7. McCance,K.&Huether,S.1990,Pathophysiology:The Biological Basis for Diseases in Adults and Children,Mosby Books,USA.
  8. Plotnik,R.1999, Introduction to Psychology ,5th edn,Wadsworth Publishing Company,USA.
  9. Sheppard, J.1981, Advances in behavioural medicine,Vol 1,Cumberland Collage of Health Science,Australia.


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