Opening and closing the pain gates for chronic pain

So far, we have seen that pain signals can be of different types (slow or fast), can travel along different pathways in the brain, and can be influenced by such things as endorphins in the brain stem. But even with all of that, the human pain system is still more elegant. The brain can send signals down the spinal cord to open and close the nerve gates.

In times of anxiety or stress, descending messages from the brain may actually amplify the pain signal at the nerve gate as it moves up the spinal cord. Alternatively, impulses from the brain can “close” the nerve gate, preventing the pain signal from reaching the brain and being experienced as pain.

Now let's look at some other factors that can open or close the pain gates as messages move up and down the spinal cord. These can be roughly divided into sensory (physical being and activities), cognitive (thoughts), or emotional (feelings) areas, although of course there is substantial overlap between these areas in practice.

The events and conditions that may open the pain gates and cause more suffering include:

• Sensory factors, such as injury, inactivity, long-term narcotic use, poor body mechanics, and poor pacing of activities

• Cognitive factors, such as focusing on the chronic pain, having no outside interests or distractions, worrying about the pain, and other negative thoughts

• Emotional factors, such as depression, anger, anxiety, stress, frustration, hopelessness, and helplessness.

Alternatively, influences that can close the pain gates and reduce suffering include:

• Sensory factors, such as increasing activities, short-term use of pain medication, relaxation training and meditation.

• Cognitive factors, including outside interests, thoughts that help the patient cope with the pain, and distracting oneself from the chronic pain.

• Emotional factors, such as having a positive attitude, overcoming depression, feeling reassured that the pain is not harmful, taking control of one’s chronic pain and life, and stress management.