Pain – The Gate Control Theory

I am a pain and fibromyalgia patient, not a doctor; this post is about my own experience with chronic pain and what I have learned in my journey.  I was first introduced to the Pain Gate Theory by a pain specialist and then in a support group run by a psychologist who specialised in patients with pain.  The Pain Survival Guide, How to Reclaim Your Life by Turk and Winter has been extremely helpful in explaining pain but also explains a new way to live with chronic pain.  I have used this book as a sort of “bible” for life and it is interesting to note that my time in recovery has really helped me keep an open mind about the suggestions.  It has also turned out that most of the recovery information, living by spiritual principles, is part of the answer to living with chronic pain.

Now back to the Pain Gate Theory. 
The central nervous system is a complex entity; a living system and therefore doesn’t work in a straightforward way like a transit system or railway.  They cannot repair, cut out, or reroute an area and expect the pain to be solved.  The nerves are so complex and often intervention can make things worse than the original problem.  My understanding of gate theory, as a patient, is that the spinal cord has most of the nerve gates where the signal travels through to and from the brain to the body.  By manipulating the physical and emotional factors as well as our thought life we can open and close the pain gate.  When the gates are open there is more pain and the more they close the less pain we feel.

Physical factors that can close the pain gate include medications, rest, low stress, heat, massage, and pacing.  The opposite is true in opening the pain gate; it will open when there is injury or an inappropriate level of activity.  Pacing in something I found difficult at first.  I have the ability to do things like walk, move, etc however if I do not learn my limits then I end up being laid up for weeks at a time.  Learning my physical limitations took time, I documented what I did and how I felt because I didn’t trust my own memories.  Because my limits are changing slightly over time I find I can over do it and have to re-evaluate.  If I have a special occasion or anything important I may rest up ahead of time and then try my best to pace the amount of physical activity during the event.

One of my dirty little secrets is that I use caffeine to beat the fatigue almost daily.  I was told by a chiropractor, who specializes in synergistic living, that caffeine depletes the adrenals.  Apparently, this depletion will increase the fatigue and then continue the fatigue/caffeine cycle; this is hard on the body.  There are a lot of factors that can play into the physical side of the gates.  Trial and error have worked for me as well as keeping notes.  My memory is not what it used to be because of the meds.  Once I got over my denial I realized daily notes were the only way to really know for sure what was happening.  I started doing a daily checklist breakfast, lunch, dinner, bedtime and overnight check in of pain, list activity, what I ate, and how I felt emotionally.  Once I was set up it took no time at all I just kept it with my meds so as I take them four times a day I can do a quick checklist. 

The main emotional factor that can regulate the pain gate is emotional stability.  The more stable one is emotionally the less pain we feel.   The difficult part of that equation is when we are in acute pain it is difficult to do all the things that contribute to our wellbeing.  I find it hard to keep a thought straight let alone keep up friendships, get out of the house, do something for someone else, etc.  What can help us to keep up emotional health is relaxation and meditation.  We need to experience positive emotions, remain optimistic about life.  It is difficult and I have struggled at times with this but mindfulness meditation is an excellent resource.  There are a lot of different things we can do to get out of our own heads.  Helping other people, chatting on the phone, watching a funny movie, surfing the internet, visit a friend.  When we close into our selves and allow ourselves to succumb to the negativity the pain gates open further and our pain increases.  When we are experiencing tension, worry, fear and any other strong negative emotion it can lead to more pain.  By taking action in a move to self-care we can work through our difficulties, living in the solution, with the goal of inner peace. 

Our emotional health can be helped by our thoughts.  Thoughts are the final factor that help regulate the pain gates.  When we are focused on pain and/or uninvolved with life we can fall into a cycle of negative thinking.  Pain is one of those things I find to be crazy-making; the pain will be acute but I try to think of something else or do something and my brain keeps reminding me “you’re in pain, you’re in pain, you’re in pain”.  It interrupts me all the time: If I’m awake my body is telling my brain we are not happy down here, do something! 

So how do we get through that? Is there another way to live?  The short answer is yes. My thought life is directly related to what I do and what I decide to tell myself.  If I believe I am suffering, then I suffer.  If I believe I live in abundance, I live in abundance.  Suffering truly is optional.  We just need to consciously retrain our brain.  We do this by refocusing.  In my case I just decided that I was in pain and that sucked but the world goes on, my life continues, my family and friends are still there, and it’s just not all about me.  I decided on my goal: inner peace, a lofty order.  I think aim high and if you get close you are a still better off than when you started.  I began to get involved in life again, not just at home but out in the community helping others.  I started to slowly pick up some of my former hobbies on a much smaller level.  These things helped and then finding likeminded people who are going through the same thing is always a boost.  At some point I have to adapt and make the best of the life I have left.  I never want to get to the end and regret wasting my time on me; being busy feeling sorry for myself.  Some days are better than others but an attitude of gratitude is always helpful. 

So our thought life is within our control.  I like using little postings on my mirror, in the kitchen cupboards, posted on the wall or by the phone.  The postings can be affirmations or the positive thoughts you wished you could believe such as: “I can be calm”, “worry only pretends to be necessary”, “I am capable despite the pain”, “I love my life”.  This may seem hokey but what have you got to lose other than a bad attitude.  Positive affirmations are just one way to change the way you think.  When you change the way you think you can reduce the pain.

This gate theory is not the only option but I use it in combination with a few other things and have had positive results.  I am definitely easier to be around and feel better in my own skin.  The best part of these factors: physical, emotional, and thoughts, is that we can have complete control over them.  We are not at the mercy of a surgeon, researcher, physiotherapist, etc. It is in our hands and that feels pretty empowering.  Bonnie J