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Gate Control Theory
The Gate Control Theory postulates that the body cannot produce a stress response and a relaxation response at the same time. Presented in 1965 by Melzack and Wall, it shows a correlation between the emotional and cognitive state of the patient and the degree of response to pain stimuli. Though controversial with respect to its physiological basis, the pain research community widely supports its findings.
As a pain impulse is generated in the receptor cell it goes through the spinal cord to the brain where it is interpreted as painful or not painful. The spinal cord is referred to as the "gate." The signal is sent to the brain from the gate. Simultaneously a signal is sent from the brain to the gate to either open or close the gate. This action modifies the intensity of the pain response. If the patient experienced fear during a dental appointment in the past, and if they are expecting pain, their brain signals the gate to be wide open. Thus, the patient will react to the smallest pain impulse.
The theory states that if a patient can learn effective relaxation methods, have confidence in the dentist and staff, and use positive self-talk, then he or she can make their brain signal the gate to be closed. If the patient is relaxed during a procedure, the anesthetics can be more effective. If the anesthetics are more effective, the patient will not respond to minor impulses from the area being treated.
The Gate Control Theory has had a tremendous impact on the way pain is defined. The anatomical and physiological responses to stimuli are influenced by the mental and emotional state of the individual. Current expectations, experiences, and distractions all play a role in the pain experience.
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