EVALUATING PAIN THEORIES: PATTERN, GATE CONTROL & BIOPSYCHOSOCIAL

CRITICAL EVALUATION OF HOW WE EXPERIENCE PAIN

Mohamedh Mazin

The Maldives National University (MNU)

Bachelor of Psychology

Human Biology (BIO119)

Aminath Shazly

November 8, 2023

CRITICAL EVALUATION OF HOW WE EXPERIENCE PAIN

Pain, an intricate aspect of the human experience, has been extensively studied by

researchers for many years. According to the International Association for the Study of Pain

(IASP, 2020), pain is defined as "An unpleasant sensory and emotional experience associated

with, or resembling that associated with, actual or potential tissue damage." While pain is

predominantly explored as a physical experience, it is crucial to acknowledge that it can also

have psychological implications that may persist over time (Tossani, 2013). Pain is a

complex sensory and emotional experience that can vary greatly between individuals and

even within an individual depending on the context, meaning of the pain, and their

psychological state.

Understanding how we perceive pain is important not only for improving medical

treatments but also for providing psychological support. In this essay, we delve into the

intricate nature of pain perception by critically evaluating three central theories that have

shaped our understanding of this phenomenon: the Pattern Theory, Gate Control Theory, and

Biopsychosocial Theory (Moayedi & Davis, 2013). These theories not only help us

understand the physical aspects of pain but also its biological, psychological, and emotional

dimensions which hold significant importance in healthcare and psychological assistance.

To establish a foundation for our examination of pain theories, it is essential to grasp

the nature of pain perception. The American Psychological Association (APA) defines pain

perception (APA, 2023) as involving conscious recognition usually initiated by stimuli that

cause tissue damage or pose a potential threat thereof. Pain perception can be measured based

on its intensity and classified in various ways such as sharp or dull sensations, localized or

widespread areas affected, and long-lasting or temporary duration.

The process is called nociception, which refers to how our nervous system processes

harmful stimuli like tissue damage or extreme temperatures. This involves activating
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nociceptors and related pathways in both the central and peripheral systems (Kendroud &

Hanna, 2019). When these stimuli trigger nociceptors, the insula and anterior cingulate cortex

in our brain consistently become active. This activation corresponds with the individual's

subjective experience of pain. These interconnected structures within the thalamocortical and

corticolimbic systems, collectively known as the 'pain neuromatrix,' play a crucial role in

processing somatosensory input and transmitting neural signals that impact both nociception

and pain perception (Garland, 2012).

As a psychologist, understanding pain perception is essential for predicting treatment

outcomes. Negative thoughts about a patient's pain can contribute to increased stress,

depression, anxiety, and reliance on medication (Jamison, 2003). Therefore, knowing how to

respond appropriately is vital for delivering optimal treatment to each client.

To begin, let's explore the Pattern Theory of pain. This theoretical framework was

introduced by the American Psychologist John Paul Nafe (1888-1970) in direct contrast to

the Specificity Theory developed by Max Von Frey in 1895. Specificity theory suggested that

there are separate brain areas and systems dedicated to perceiving pain, similar to specialized

systems for vision or hearing (Moayedi & Davis, 2013). However, Nafe argued that there

were no distinct receptors for each sensory modality. Instead, he proposed that every

sensation transmits a unique pattern or sequence of signals to the brain. The brain then

interprets this pattern resulting in a specific sensation that aligns with the deciphered pattern.

However, this theory ignored findings of specialized nerve endings and many of the

observations supporting the specificity theory of pain. The idea was that every physical

sensation was linked to a specific pattern of nerve activity. This pattern, determined by how

and when nerves fired in our body, conveyed information about the type and strength of the

stimulus. Lele et al. (1954) supported this theory and also noted that, excluding the nerves
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connected to hair cells, all the sensory nerves on our skin were identical. When it was first

introduced, the pattern theory got a lot of attention from researchers. However, as more

studies happened and we found specific receptors for each type of feeling, we can confidently

say that this theory isn't a correct explanation for how we experience pain.

In 1965, Patrick David Wall and Ronald Melzack proposed an alternative theory

called the Gate Control theory. This theory takes into account both the physical and

psychological aspects of pain. According to this theory, signals traveling to the brain must

pass through certain areas in the spinal cord referred to as "gates." These gates include cells

in the dorsal horn's substantia gelatinosa, fibers in the dorsal column, and transmission cells

in the dorsal horn. When these gates are closed, signals are blocked from reaching the brain

and we do not feel pain. However, if a signal is strong enough to open these gates, it reaches

the brain and we experience pain (Ropero Peláez & Taniguchi, 2016).

The gate control theory recognizes that psychological factors also play a role in our

experience of pain. Melzack and Wall suggested that there is another control mechanism in

cortical regions of the brain. Recent research has shown that cognitive and emotional factors

can influence these brain controls. For example, a negative state of mind can make the gates

more open, allowing more signals through and increasing our sensitivity to pain even from a

normal stimulus (Garland, 2012). Unhealthy lifestyle choices can also keep these gates open

for longer periods of time, leading to disproportionate levels of pain.

The gate control theory has been instrumental in our understanding of pain by

highlighting its complex nature influenced by both physical and psychological factors. It

emphasizes that pain is not solely about physical injury but involves a complex experience

encompassing various aspects of our well-being.

In 1977, George Engel introduced the biopsychosocial theory of pain, a revolutionary

framework that delves into the origins of pain in a complex and intricate manner. This model

not only marks a significant turning point, but also presents a compelling argument,

bolstering the integration of medicine into the broader realm of science (Smith, 2002).

According to this innovative theory, pain does not solely arise from physical factors; rather, it

emerges from intricate interactions among biological, psychological, and sociological

elements. Unlike theories that narrowly focus on the physical aspects of pain, the

biopsychosocial model acknowledges the profound impact of cognitive, emotional, and

societal factors on an individual's experience of pain (Sen et al., as cited in Trachsel &

Cascella, 2020). It challenges simplistic notions that solely attribute pain to physical injuries

and emphasizes the need to consider a web of interconnected influences in order to gain a

nuanced understanding and effectively manage pain.

The biopsychosocial model provides a comprehensive perspective on why individuals

experience pain. It suggests that pain arises from a combination of biological, psychological,

and sociological factors. Any theory that fails to account for all three aspects falls short in

explaining why someone is in pain. Although the term "biopsychosocial" was not coined until

1954, forward-thinking doctors like John Joseph Bonica had already contemplated adopting

this approach as early as the 1940s (Meints & Edwards as cited in Trachsel & Cascella,

2020).

However, it was not until 1977 that the biopsychosocial model was officially

proposed as an explanation for certain medical conditions (Shorter, 2015). This model asserts

that gaining a comprehensive understanding of how individuals perceive pain necessitates

considering multiple factors and viewing patients holistically instead of focusing solely on

one issue. It recognizes that treatment cannot neatly compartmentalize the body into separate

categories. According to this model, illness and disease result from a combination of
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biological, psychological, and sociological factors that impact an individual's physical and

mental well-being.

Taking all these factors into account paints a more complete picture of why someone

experiences pain. Neglecting any of these elements when determining the cause or planning

treatment may result in an incomplete assessment or inadequate care. Loeser's approach

underscores the comprehensive nature of the biopsychosocial model, providing a necessary

framework for initiating appropriate therapy to manage chronic pain in patients (Loeser &

Melzack, 1999).

Conclusion

In conclusion, the exploration of pain theories uncovers the ever-changing nature of

our understanding of pain perception. The Pattern Theory, initially captivating, fell short as

subsequent research revealed specific receptors for different sensations. While the Gate

Control Theory recognized the intricate interplay of physical and psychological dimensions

in the pain experience, it was George Engel's introduction of the Biopsychosocial Theory in

1977 that marked the zenith of this intellectual journey.

At that crucial moment in medical history, the Biopsychosocial Theory fundamentally

transformed our perspective on pain. It recognized that pain is not solely a result of physical

injury but is intricately intertwined with biological, psychological, and sociological elements.

This theory challenges reductionist views and emphasizes the need to consider individuals'

holistic experiences to truly grasp the nuances of pain.

The Biopsychosocial Model stands as a comprehensive framework that surpasses its

predecessors in inclusivity and superiority. As we trace the evolution of pain theories, it

becomes unmistakably clear that the Biopsychosocial Model offers the most thorough

explanation for the intricate origins of pain. By recognizing and appreciating the interplay
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between various influences on pain perception, it not only deepens our understanding but also

illuminates pathways to more effective and compassionate approaches in managing pain, both

within healthcare and psychological support settings. In the realm of psychology, this model

becomes not just a theoretical construct but a guiding philosophy, urging practitioners to

embrace the richness of human experience in comprehending and addressing the complex

tapestry of pain.

(1552 Words)

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