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Pain Theories History

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    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 .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 and individuals interpret pain differently even though the extent of


    Adams, B. & Bromley, B.1998, Psychology for Health Care: Key terms and

    Barber,J.& Adrian,C.1982,Psychological Approaches to the management of
    pain,Brunner/Mazel INC,USA.

    Brannon, L.& Feist, J.2000, Health Psychology: An Introduction to Behaviour and
    Health ,4th edn ,Brooks/Cole,USA.

    Bond,M.1984,Pain:Its Nature,Analysis and Treatment ,2nd end, Churchhill
    Livingstone ,UK.

    Goleman ,D. & Gurin,J.1993,Mind,Body,Medicine: How to use your mind for better
    health, Consumer Report Books,USA.

    McCaffery,M. and Beebe, A.1994, Pain:Clinical Manual for Nursing

    McCance,K.&Huether,S.1990,Pathophysiology:The Biological Basis for Diseases in
    Adults and Children,Mosby Books,USA.

    Plotnik,R.1999, Introduction to Psychology ,5th edn,Wadsworth Publishing

    Sheppard, J.1981, Advances in behavioural medicine,Vol 1,Cumberland Collage of
    Health Science,Australia.


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