Pain Gate & Pathways

Acute pain and chronic pain are different:


Acute or short-term pain normally relates to damage or harm caused to the body, which causes hurt. This pain is a useful protective mechanism, i.e. hurt equals harm.


For example - If we sprain an ankle we feel a very sharp pain at exactly the point of the damaged ligament. The damaged ligament releases chemicals, the ankle swells and gets hot and red and the healing process gets under way. With rest the ankle heals and the pain gradually subsides.


Chronic pain by contrast, is sometimes felt in an area previously hurt but the pain signals have not switched off. Or in some instances, there never was one event that caused hurt. Rather, pain started in an area and has not stopped. In some people the pain will also have spread to other areas of the body as well. The pain (hurt) felt in chronic pain is not useful since there is no harm to which the body should be responding i.e. hurt does NOT equal harm. The continuous presence of pain in an area can cause the nerve endings to become hypersensitive. This is one of the reasons you may find you can do less and less and that even simple movements or light touch over the painful area can cause pain. 


In short, the nervous system can start to produce patterns of pain it expects to be there, even if there is nothing causing this pain. This process is sometimes called ‘wind up’.


How we experience pain

The spinal cord runs from the base of the brain down through the spine (backbone). Nerves come off it through holes between the vertebrae (back bones) and then travel to all parts of the body. It was thought that pain was experienced in the body simply through the sending of pain messages from the painful body part, along fixed nerve pathways to the brain – rather like a telephone system with the central exchange in the brain. We know now that the nervous system is generally more complicated than that. We tend to see it more as a changeable living system.


We know that there is a filter or pain gate in the spinal cord. The amount of pain we experience, and when we experience it, is determined by how many pain messages actually get to the brain from the spinal cord. In other words, how open or closed the pain gate is at any one time. With long-standing or chronic pain the pain gate has been opened often and so is more easily opened. As time goes on fewer messages are needed to open the gate causing us to feel pain.


The good news is that if we can identify what opens the pain gate we can then use strategies to successfully close it more of the time.


Why is the gate sometimes more open so we experience more pain?

  • Stress and Tension – too much to manage at work and/or at home 
  • Thinking about the pain – focusing on how bad the pain is
  • Lack of exercise – increased stiffness and reduced fitness
  • Poor posture – doing activities carelessly e.g. lifting with straight knees; using poor sitting posture e.g. shoulders slumped and neck poking and poor standing posture e.g. tummy sticking out; walking with uneven gait

How to close the gate, and reduce the pain


  •  Relaxation – learn when you are beginning to feel stressed and use relaxation techniques to reduce stress


  • Distraction – activities or time with friends that takes your mind off the pain. Be careful not to be so distracted that you forget about maintaining good posture and changing positions regularly! 
  • Exercise and improved fitness – establish a regular exercise programme to support some of the activities you find difficult or have not done for a while
  • Improve your posture - feel what is not right with your posture and find ways to improve it. Then establish those new ways as habits. 
  • Medication
  • TENS 


Gate open – more pain messages to the brain, so more pain experienced.

Gate closed - fewer pain messages to the brain, so less pain experienced 

Helpful Hint: Practice the pain gate closing strategies so that you can control the pain gate to stay closed more of the time. 


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