What Is Gate Control Theory?

Table of ContentsView AllTable of ContentsHistoryHow It WorksImpactHow to Use ItPitfalls

Table of ContentsView All

View All

Table of Contents

History

How It Works

Impact

How to Use It

Pitfalls

Close

Gate control theory suggests that the spinal cord contains a neurological ‘gate’ that either blocks pain signals or allows them to continue on to the brain.

In 1965, researchers Ronald Melzack and Patrick Wall published a paper outlining the gate control theory of pain.The purpose was to help explain how mental states impact the perception of pain, either reducing or increasing pain sensations.

Melzack and Wall suggested that this process explains why we tend to rub injuries after they happen.When you bang your shin on a chair or table, for example, you might rub the injured spot. The increase in normal touch sensory information helps inhibit pain fiber activity, therefore reducing pain perception.

Prior to gate control theory, scientists had other theories on pain. These included:

Researchers have long observed that our thoughts,emotions, andexpectationscan influence our perception of pain. If you expect something to hurt, for instance, it will probably hurt worse that it would if had not anticipated it. And if you are upset orfrightened, pain may seem more intense than it would if you were calm.

How Gate Control Theory Works

In some cases, the signals are passed along more readily and pain is experienced more intensely. In other instances, pain messages are minimized or even prevented from reaching the brain at all.

This gating mechanism takes place in the dorsal horns of the spinal cord. These are areas of gray matter in the posterior spinethat have a horn-like appearance. Both small nerve fibers (pain fibers) and large nerve fibers (normal fibers for touch, pressure, and other skin senses) carry information to two areas of the dorsal horn.

One part of the dorsal horn that receives information is the transmission cells. These cells carry information up thespinal cord to the brain. The other is inhibitory interneurons that either halt or impede the transmission of sensory information.

Large Nerve Fibers vs. Small Nerve FibersLarge fiber activity excites the inhibitoryneurons, diminishing the transmission of pain information. When there is more large fiber activity in comparison to small-fiber activity, people tend to experience less pain. This means that the pain gates are closed.Small fibers impede inhibitory interneurons, allowing pain information to travel to the brain. Small fiber activity can inactivate inhibitory neurons and allow pain perception (also known as nociception) to take place. In other words, the pain gates are now open.

Large Nerve Fibers vs. Small Nerve Fibers

Large fiber activity excites the inhibitoryneurons, diminishing the transmission of pain information. When there is more large fiber activity in comparison to small-fiber activity, people tend to experience less pain. This means that the pain gates are closed.Small fibers impede inhibitory interneurons, allowing pain information to travel to the brain. Small fiber activity can inactivate inhibitory neurons and allow pain perception (also known as nociception) to take place. In other words, the pain gates are now open.

Impact of Gate Control Theory

Melzack and Wall’s gate control theory prompted additional research in this area and contributed to the development of newtherapeutic approaches. These impacts were beyond what the pair expected. They noted in 1982: “Fortunately, the theory came at a time when the field was ripe for change.”

Melzack and Wall further noted that the gate metaphor for pain perception served as a way of helping people understand the basic concept, regardless of whether they grasped the complex physiological processes behind the theory. Doctors often utilize the gate metaphor to help patients understand how and why pain can fluctuate so much.

Gate control theory is also used to explain why massage and touch can be helpful pain management strategies during childbirth. Because touch increases large fiber activity, it has an inhibitory effect on pain signals. The theory is even used to explain the benefits of dance and music for relieving labor pain.

How to Use Gate Control to Reduce Pain

The gate control theory suggests that finding ways to close the gate between the spinal cord and brain may help reduce pain. There are several strategies you can use to do this.

Stress, tension, focusing on the pain, and a lack of activity can all make the gate open instead of close.So, avoiding or limiting these factors whenever you can may be helpful in reducing pain.

Potential Pitfalls of Gate Control Theory

Plus, not everyone is convinced that the gate control theory of pain is valid. Some suggest that the theory contains flaws based on human biology. For instance, it contradicts the notion that all excitatory neuron axon terminals are excitatory and all inhibitory neuron axon terminals are inhibitory.

A Word From Verywell

While gate control theory does not explain every aspect of how people experience pain, Melzack and Wall’s theory was the first to consider the psychological factors that influence the perception and experience of pain. Initially, there was resistance to the theory, but over time it has helped transform approaches to pain management.

The Power of a Hug On Our Health

12 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mendell L.Constructing and deconstructing the gate theory of pain.Pain. 2014;155(2):210-216. doi:10.1016/j.pain.2013.12.010Ropero Peláez FJ, Taniguchi S.The gate theory of pain revisited: Modeling different pain conditions with a parsimonious neurocomputational model.Neural Plast. 2016;2016:4131395. doi:10.1155/2016/4131395Moayedi M, David KD.Theories of pain: from specificity to gate control.J Neurophysiol. 2013;109(1):5-12. doi:10.1152/jn.00457.2012White L, Cant N.Internal anatomy of the spinal cord. Duke University School of Medicine, Duke Institute for Brain Sciences.Katz J, Rosenbloom B.The golden anniversary of Melzack and Wall’s gate control theory of pain: Celebrating 50 years of pain research and management.Pain Res Manag. 2015;20(6):285-286. doi:10.1155/2015/865487Gönenç İM, Dikmen H.Effects of dance and music on pain and fear during childbirth.J Obstet Gynecol Neonatal Nurs. 2020;49(2):144-153. doi:10.1016/j.jogn.2019.12.005Department of Veteran Affairs Center for Integrated Healthcare.The gate control theory of pain.U.S. Department of Health and Human Services.Physical Activity Guidelines for Americans, 2nd edition.Dikmen HA, Terzioglu F.Effects of reflexology and progressive muscle relaxation on pain, fatigue, and quality of life during chemotherapy in gynecologic cancer patients.Pain Manage Nurs. 2019;20(1):47-53. doi:10.1016/j.pmn.2018.03.001dos Santos Felix MM, Guimarães Ferreira MB, da Cruz LF, Barbosa MH.Relaxation therapy with guided imagery for postoperative pain management: An integrative review.Pain Manage Nurs. 2019;20(1):3-9. doi:10.1016/j.pmn.2017.10.014Lefebvre J, Jensen M.The relationships between worry, happiness and pain catastrophizing in the experience of acute pain.Eur J Pain. 2019;23(7):1358-1367. doi:10.1002/ejp.1405Melzack R.Gate control theory: On the evolution of pain concepts.Pain Forum. 1996;5(2):128-138. doi:10.1016/S1082-3174(96)80050-XAdditional ReadingMelzack R, Wall PD.Pain mechanisms: a new theory.Sci. 1965;150(3699):971-9. doi:10.1126/science.150.3699.971

12 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mendell L.Constructing and deconstructing the gate theory of pain.Pain. 2014;155(2):210-216. doi:10.1016/j.pain.2013.12.010Ropero Peláez FJ, Taniguchi S.The gate theory of pain revisited: Modeling different pain conditions with a parsimonious neurocomputational model.Neural Plast. 2016;2016:4131395. doi:10.1155/2016/4131395Moayedi M, David KD.Theories of pain: from specificity to gate control.J Neurophysiol. 2013;109(1):5-12. doi:10.1152/jn.00457.2012White L, Cant N.Internal anatomy of the spinal cord. Duke University School of Medicine, Duke Institute for Brain Sciences.Katz J, Rosenbloom B.The golden anniversary of Melzack and Wall’s gate control theory of pain: Celebrating 50 years of pain research and management.Pain Res Manag. 2015;20(6):285-286. doi:10.1155/2015/865487Gönenç İM, Dikmen H.Effects of dance and music on pain and fear during childbirth.J Obstet Gynecol Neonatal Nurs. 2020;49(2):144-153. doi:10.1016/j.jogn.2019.12.005Department of Veteran Affairs Center for Integrated Healthcare.The gate control theory of pain.U.S. Department of Health and Human Services.Physical Activity Guidelines for Americans, 2nd edition.Dikmen HA, Terzioglu F.Effects of reflexology and progressive muscle relaxation on pain, fatigue, and quality of life during chemotherapy in gynecologic cancer patients.Pain Manage Nurs. 2019;20(1):47-53. doi:10.1016/j.pmn.2018.03.001dos Santos Felix MM, Guimarães Ferreira MB, da Cruz LF, Barbosa MH.Relaxation therapy with guided imagery for postoperative pain management: An integrative review.Pain Manage Nurs. 2019;20(1):3-9. doi:10.1016/j.pmn.2017.10.014Lefebvre J, Jensen M.The relationships between worry, happiness and pain catastrophizing in the experience of acute pain.Eur J Pain. 2019;23(7):1358-1367. doi:10.1002/ejp.1405Melzack R.Gate control theory: On the evolution of pain concepts.Pain Forum. 1996;5(2):128-138. doi:10.1016/S1082-3174(96)80050-XAdditional ReadingMelzack R, Wall PD.Pain mechanisms: a new theory.Sci. 1965;150(3699):971-9. doi:10.1126/science.150.3699.971

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Mendell L.Constructing and deconstructing the gate theory of pain.Pain. 2014;155(2):210-216. doi:10.1016/j.pain.2013.12.010Ropero Peláez FJ, Taniguchi S.The gate theory of pain revisited: Modeling different pain conditions with a parsimonious neurocomputational model.Neural Plast. 2016;2016:4131395. doi:10.1155/2016/4131395Moayedi M, David KD.Theories of pain: from specificity to gate control.J Neurophysiol. 2013;109(1):5-12. doi:10.1152/jn.00457.2012White L, Cant N.Internal anatomy of the spinal cord. Duke University School of Medicine, Duke Institute for Brain Sciences.Katz J, Rosenbloom B.The golden anniversary of Melzack and Wall’s gate control theory of pain: Celebrating 50 years of pain research and management.Pain Res Manag. 2015;20(6):285-286. doi:10.1155/2015/865487Gönenç İM, Dikmen H.Effects of dance and music on pain and fear during childbirth.J Obstet Gynecol Neonatal Nurs. 2020;49(2):144-153. doi:10.1016/j.jogn.2019.12.005Department of Veteran Affairs Center for Integrated Healthcare.The gate control theory of pain.U.S. Department of Health and Human Services.Physical Activity Guidelines for Americans, 2nd edition.Dikmen HA, Terzioglu F.Effects of reflexology and progressive muscle relaxation on pain, fatigue, and quality of life during chemotherapy in gynecologic cancer patients.Pain Manage Nurs. 2019;20(1):47-53. doi:10.1016/j.pmn.2018.03.001dos Santos Felix MM, Guimarães Ferreira MB, da Cruz LF, Barbosa MH.Relaxation therapy with guided imagery for postoperative pain management: An integrative review.Pain Manage Nurs. 2019;20(1):3-9. doi:10.1016/j.pmn.2017.10.014Lefebvre J, Jensen M.The relationships between worry, happiness and pain catastrophizing in the experience of acute pain.Eur J Pain. 2019;23(7):1358-1367. doi:10.1002/ejp.1405Melzack R.Gate control theory: On the evolution of pain concepts.Pain Forum. 1996;5(2):128-138. doi:10.1016/S1082-3174(96)80050-X

Mendell L.Constructing and deconstructing the gate theory of pain.Pain. 2014;155(2):210-216. doi:10.1016/j.pain.2013.12.010

Ropero Peláez FJ, Taniguchi S.The gate theory of pain revisited: Modeling different pain conditions with a parsimonious neurocomputational model.Neural Plast. 2016;2016:4131395. doi:10.1155/2016/4131395

Moayedi M, David KD.Theories of pain: from specificity to gate control.J Neurophysiol. 2013;109(1):5-12. doi:10.1152/jn.00457.2012

White L, Cant N.Internal anatomy of the spinal cord. Duke University School of Medicine, Duke Institute for Brain Sciences.

Katz J, Rosenbloom B.The golden anniversary of Melzack and Wall’s gate control theory of pain: Celebrating 50 years of pain research and management.Pain Res Manag. 2015;20(6):285-286. doi:10.1155/2015/865487

Gönenç İM, Dikmen H.Effects of dance and music on pain and fear during childbirth.J Obstet Gynecol Neonatal Nurs. 2020;49(2):144-153. doi:10.1016/j.jogn.2019.12.005

Department of Veteran Affairs Center for Integrated Healthcare.The gate control theory of pain.

U.S. Department of Health and Human Services.Physical Activity Guidelines for Americans, 2nd edition.

Dikmen HA, Terzioglu F.Effects of reflexology and progressive muscle relaxation on pain, fatigue, and quality of life during chemotherapy in gynecologic cancer patients.Pain Manage Nurs. 2019;20(1):47-53. doi:10.1016/j.pmn.2018.03.001

dos Santos Felix MM, Guimarães Ferreira MB, da Cruz LF, Barbosa MH.Relaxation therapy with guided imagery for postoperative pain management: An integrative review.Pain Manage Nurs. 2019;20(1):3-9. doi:10.1016/j.pmn.2017.10.014

Lefebvre J, Jensen M.The relationships between worry, happiness and pain catastrophizing in the experience of acute pain.Eur J Pain. 2019;23(7):1358-1367. doi:10.1002/ejp.1405

Melzack R.Gate control theory: On the evolution of pain concepts.Pain Forum. 1996;5(2):128-138. doi:10.1016/S1082-3174(96)80050-X

Melzack R, Wall PD.Pain mechanisms: a new theory.Sci. 1965;150(3699):971-9. doi:10.1126/science.150.3699.971

Hannah Owens, LMSW

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