Page 60 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Models of Pain 33

This earlier view of pain as a simple linear concept was
very popular up until the twentieth century when evidence to
suggest that pain was not as simple as a mere linear relation-
ship between injury and perceived pain started to mount up
(Melzack and Wall 1996 ). Not only did evidence emerge that
the level of pain was influenced by factors other than extent
of injury- for example, personality, culture, anxiety and so on-
but there was evidence that individuals with no nerve trans-
mission could still experience pain. People who have lost
limbs through amputation often have severe pain in the miss-
ing limbs. Thus, in those with phantom limb pain where there
are no nerve transmissions but there is pain (e.g. Bosmans
;
et al. 2010 Fieldsen and Wood 2011 ). Phantom limb pain has
no physical basis but the pain can feel excruciating and feel
as if it is spreading. Not only is the pain not related to actual
tissue damage but not all people who have had a limb ampu-
tated experience this pain, or the level of pain may vary from
individual to individual (Bosmans et al. 2010 ).
These pieces of evidence – the variation in medication’s
success at reducing pain, the variation in individual’s percep-
tion of pain relating to the same tissue damage and pain
without injury – indicate the pain process to be more complex
than the linear-biomedical model, and that pain does not
simply equate to injury. In response to this, the Gate Control
Theory (GTC) was developed.
The Gate Control Theory (GTC) is probably the most
influential theory of pain to date. This theory is said to have
had a particularly important contribution to the understand-
ing of pain due to the emphasis it places on the central neural
mechanisms (Melzack 1999 ) and the appreciation that pain
can be influenced by both a range of factors and not just
those physiological ones related to the wound. Indeed, the
gate-control theory was developed in order to account for the
importance of both the mind and brain in the perception of
pain (Melzack and Wall 1965 ). This particular theory, although
accounting for primarily mental phenomena, considers the
physiological basis in order to explain the complex phenom-
enon of pain. Thus, it established the brain as an active system
that filters, selects and modulates inputs (Melzack 1999 ).