Ways To Close the Gate on Pain By Margaret Heaton
Written by Margaret Heaton
Living with chronic pain can be a real pain. It impacts many areas of our lives and can become very distressing. A very popular pain management theory, The Gate Control Theory of pain, outlines the interplay between pain and all of our aspects of being (physical, mental, emotional, behavioral, and social). Put in a nutshell, The Gate Control Theory explains how pain signals flow from our nerve endings to our brain and from our brain (i.e. thoughts and emotions) down to our nerve endings. This theory suggests that we can open a “gate” to allow for more pain signals to travel through our body or close the “gate” to reduce the flow of pain signals. We can open and close the “gate” by attending to our aspects of being. Let’s take a closer look at the interplay between our five realms of being and chronic pain:
1) Our Physical Being Things that open the gate: physical degeneration, muscle tension, and drug abuse (Otis, 2007) Things that close the gate: reduced muscular tension, medications, and procedures (Otis, 2007)
Muscle tension is an important aspect to highlight. Many things contribute to muscle tension such as stress, anxiety and physical pain. Often times our automatic response to pain is to tense our body (and maybe even hold our breath) in an attempt to brace against the pain. Muscle tension, no matter what its cause, can open the gate and allow for more pain signals to flow. Thus it is helpful to be aware when your muscles are tense and consciously work to relax and reduce muscle tension. Taking five full, slow, deep breaths (fully inhale and exhale) can help bring calmness and relaxation to your body and brain.
2) Our Mental/Cognitive Being Things that open the gate: attention to pain, thoughts about uncontrollability of pain, beliefs about pain being mysterious, and terrible things (Otis, 2007) Things that close the gate: distraction or external focus of attention, thoughts of control over pain, and beliefs about pain as predictable and manageable (Otis, 2007)
It is very easy to have all of our mental attention focused on how much it hurts when living with chronic pain. Perhaps you may say to yourself, “This pain is so terrible! It is horrible! It’s never going to end!” While pain is uncomfortable to say the least, the more we focus our attention on how much it hurts, the more we increase our pain levels. Distraction, putting your mind elsewhere, either through mental imagery or with an activity, can help reduce pain levels.
3) Our Emotional Being Things that open the gate: depression, fear/anxiety, and anger (Otis, 2007) Things that close the gate: emotional stability, relaxation, and a calm, positive mood (Otis, 2007)
Most of us don’t necessarily acknowledge how closely our emotions and pain levels are related. It is a vicious cycle because persistent pain often fuels feelings of depression, stress/anxiety/worry, and anger. There are a number of ways to address your emotions. A great place to start is to acknowledge and validate the emotion(s) you are experiencing. If you decide you’d like to experience a different emotion, an easy way to accomplish this is to think about the opposite emotion(s). For example, the opposite of sadness is happiness; relaxation is the opposite of anxiety/fear. Thus, engage in activities that make you happy or help relax you. A few suggestions include: calling a good friend, listing 3-5 things you are grateful for, and laughing. Emotions are not our enemy, the more you can acknowledge them, the less power they have and consequently the less they impact pain levels.
4) Our Behavioral Being Things that open the gate: Too much or too little activity, poor diet and other unhealthy behaviors, and an imbalance between work, social, and recreational activities. (Otis, 2007) Things that close the gate: Appropriate pacing of activity, positive health habits, and balance between work, recreation, rest, and social activities. (Otis, 2007)
There is so much in this realm it is hard to know where to start. I will only highlight the behavioral aspect of too much or too little activity, but I hope you strongly consider the other points. I like to refer to activity levels being on a continuum, with too much activity on one end and too little to no activity on the other end. I find that clients teeter-totter between each side, pushing and overdoing and then crashing, being down for hours to days. Both ends of the spectrum increase pain levels. The perpetual teeter-totter is very frustrating for many people. The quality and functioning in living with persistent pain in large part comes in finding the balance in your teeter-totter (activity levels). Pacing and limit setting are key components in balancing activity levels. While pacing may go against every fiber in your being, breaking tasks into manageable chunks, may afford you to keep pain levels more manageable, and increase your functioning and quality of life.
5) Our Social Being Things that open the gate: Little support from family and friends, others focusing on your pain, and others trying to protect you too much (Otis, 2007) Things that close the gate: Support from others, reasonable involvement from family and friends, and encouragement from others to maintain a moderate activity level. (Otis, 2007)
Too little support can breed emotional turmoil and perpetuate cycles of over-activity. Too much support often fosters too little activity and emotional turmoil as well. Thus, communication, especially assertive communication, is the key. Pain and limits involved with living with chronic pain can be a sensitive subject and may not be an easy one to broach. One of the biggest obstacles clients struggle with is maintaining social connections (friendships). Friendships and social connections are truly the key to healthy living. Hopefully this section will inspire you to rekindle an old friendship or develop a new one.
If you feel like you connected with the information in this article and are interested in learning more, consider joining the Coping with Chronic Pain Skills Group or reach out to Margaret for an individual appointment.
The information in this article was based on with works of: Otis, John (2007). Managing Chronic Pain. Oxford University Press. Lewandowski, Michael 2006). The Chronic Pain Care Workbook. New Harbinger Publications, Inc