I. Review of Thinking About Pain
II. Gate Control Theory
III. Factors that Influence the Experience of Pain
IV. What You Can Do
V. Homework – Pain Triggers
VI. Relaxation Techniques - Autogenics for Normalizing the Body

A. Old way of thinking about pain:

There is a one to one relationship between tissue damage and
    pain sensations: By this old philosophy: Pain must equal harm.

B. Old view doesn’t fit with common experience.
1. You can have tissue damage without pain.

Examples:

2. You can have pain without tissue damage.
Phantom limb pain

• First proposed in 1965 by psychologist Ronald Melzack and anatomist Patrick Wall.
• The theory suggested that there is a gating system in the central nervous system that opens and closes to let pain messages through to the brain or block them.
• The theory suggests that our thoughts, beliefs, and emotions affect how much pain we feel from a given physical sensation.
• Psychological as well as physical factors guide the brain’s interpretation of painful sensations and subsequent response.
• Many athletes do not experience pain during the game. However, after the game when they turn their attention towards their injuries they begin to experience pain.

1. Sensory messages travel from stimulated nerves (site of injury) to the spinal cord.
2. There they are reprocessed and sent through open gates to the thalamus, the brain’s department for tactile information. Sharp pains stimulate different nerves than gnawing and dull pains.
3. When the nerve signal reaches the brain, the sensory information is processed in the context of the individual’s current mood, state of attention, and prior experience.
4. The integration of all this information influences the perception and experience of pain, and guides the individual’s response.
5. The brain’s response to this information will determine the extent of pain we get. If the brain sends a message back down to close the gate, the pain signals are blocked and we experience lower pain. If the brain orders the pain gates to open wider, the pain signal intensifies and we can often feel debilitating pain.

PUNCH LINE ONE:
Pain is not a thing, it is a complex perceptual
experience, influenced by many factors.

TWO: Hurt not equal harm.

THREE: All pain is processed and felt at the level of the brain.
For example: Spinal block during birth. Is pain felt? Is there nociception? General anesthetic.

A. Things that Open the Gate and Why.

1. Depression: Less seratonin and endorphins?
Focus more on pain sensations
2. Anxiety: Less seratonin and endorphins?
Focus more on pain sensations
3. Anger: Less seratonin and endorphins?
Focus more on pain sensations
4. Attention on Pain
5. Being tired.
6. Out of shape: Few endorphins. Body weaker.
7. Narcotic medications
8. Rest

B. Things that Close the Gate and Why.

1. Rubbing sends messages down the thick fibers. Spinal Cord Stimulation
2. Exercise: Increases endorphins and strengthens muscles and tendons.
3. Become busy with activities: The brain can only process so much information.
4. Relaxation: Why?

A. Flood the system with information.
a. Exercise, read a book, or watch a movie.
b. Opposite of dwelling on pain.
B. Use exercise also to maintain energy and conditioning.
C. Relaxation.
D. Managing moods and emotional reactions.
E. Experiment with many things until you find what works for you.

A. Sit comfortable in a chair or lie on the floor with your legs about 8 inches apart. Make sure not to cross your hand or arms.
B. Scan your body to make sure that the position you choose is tension free.
C. Close your eyes or pick a point in front of you to softly focus on.
D. Take a few slow, deep, and relaxing breaths.

Repeat the following phrases to yourself as I say them to you. Focus on each phrase as you repeat it to yourself.

I am beginning to feel calm and quiet.
I am beginning to feel quite relaxed.
My right foot feels heavy and relaxed.
My left foot feels heavy and relaxed.
My ankles, knees, and hips feel heavy, relaxed, and comfortable
My stomach, chest, and back feel heavy and relaxed.
My neck, jaw, and forehead feel completely relaxed.
All of my muscles feel comfortable and smooth.
My right arm feels heavy and relaxed.
My left arm feels heavy and relaxed.
My right hand feels heavy and relaxed.
My left hand feels heavy and relaxed.
Both my hands feel heavy and relaxed.
My breathing is slow and regular.
I feel very quiet.
My whole body is relaxed and comfortable.
My heartbeat is calm and regular.
I can feel warmth going down into my right hand.
It is warm and relaxed.
I can feel warmth going down into my left hand.
It is warm and relaxed.
My hands are warm and heavy.
It could be very difficult to raise my hands at this moment.
I feel very heavy.
My breathing is slow and deep.
My breathing is getting deeper and deeper.
I am feeling calm.
My whole body is heavy, warm, and relaxed.
My whole body feels very quiet and comfortable.
My mind is still, calm, and cool.
My body is warm and relaxed.
My breathing is deeper and deeper.
I feel secure and still.
I am completely at ease.
I feel an inner peace.
I am breathing more and more deeply.

Now imagine that you are in a relaxed, comfortable, and quiet place. Remember these good, relaxed feelings as you enjoy slow, easy breathing. Continue to relax until you are ready to wake up. Then slowly stretch your fingers, toes, and arms and legs, and gradually open your eyes.

Jamison, R. N. (1996). Mastering Chronic Pain A Professional’s Guide to
Behavioral Treatment. Sarasota, FL: Professional Resource Press.

Process Questions: