Page 62 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Models of Pain 35

Pain at
dressing
change

Stress related
More to
dressing anticipatory
pain

Avoidance
Pain
behaviour

Delayed
wound
healing

Figure 2.2 Cycle of pain, stress, wound healing and pain

activation of small fibres (nociceptive) open the gate and
facilitate T cell activity (See Fig. 2.2 ). This activity is said to be
responsible for the experience of pain (Weisenberg 1977 ).
Simply put, the GTC suggests that the pain messages on
route to the brain are subject to a gate. If the gate is closed
then less pain messages get through and, hence, less pain is
experienced. In contrast, if the gate is open then potentially
more pain is experienced. Both physiological (e.g. rubbing
the wounded area) or psychological (e.g. stress or anxiety)
can influence whether the gate is open or closed.
Within this theory, the experience of pain is seen as an
on- going sequence of activities which is both reflexive and
modifiable. The process described above results in overt
communication and expressions of pain by the patients and
the strategies they may adopt in order to control the painful