Pain Theories

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 it to psychology. 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 .McCafferyss 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 persons 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 Gurin ,1993). 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 , 2000). 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 by doctors (Bond, 1984). 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,
1993). 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 Brannon and Feist , 2000). 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 injury is the same.

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REFERENCE LIST Adams, B. & Bromley, B.1998, Psychology for Health Care: Key
terms and Concepts,MACMILLAN PRESS LTD,USA. 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 Practice,Mosby,UK. 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
Company,USA. Sheppard, J.1981, Advances in behavioural medicine,Vol 1,Cumberland
Collage of Health Science,Australia.


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