Wednesday, June 12, 2013

Melzack & Katz, Pain. Part 7: Gate control theory has stood the test of time: Patrick David Wall

The paper, Pain

Part 1 First two sentences Part 2 Pain is personal Also Pain is Personal addendum., Neurotags! Pain is Personal, Always.

Part 3a Pain is more than sensation: Backdrop Part 3b Pain is not receptor stimulation Part 3c: Pain depends on everything ever experienced by an individual

Part 4: Pain is a multidimensional experience across time

Part 5: Pain and purpose

Part 6a: Descartes and his era; Part 6b: History of pain - what’s in “Ref 4”?; Part 6c: History of pain, Ref 4, cont.. : There is no pain matrix, only a neuromatrix; Part 6d: History of Pain: Final takedown Part 6e: Pattern theories in the history of pain Part 6f: Evaluation of pain theories Part 6g: History of Pain, the cautionary tale. Part 6h: Gate Control Theory.




GATE CONTROL THEORY

So, last post, we made it to the short section, Gate Control Theory, as a final goodbye to the history of pain.


GATE CONTROL THEORY OF PAIN STANDS THE TEST OF TIME (2002)



A delicious paper listed as reference 12 turns out to be open access!
I want to comb through it, for yummy bits.
Editorial I: Gate Control Theory of pain stands the test of time. Br. J. Anaesth. (2002) 88 (6):755-757, by A. H. Dickenson.

I think this is likely A. H. Dickenson. It looks as though he is a prolific nociception researcher, with 245 papers listed in pubmed. Forty-one of them are open access.

Anyway, here is a bit of what he has to say about gate control theory (2002).

"In 1965, Pat Wall (who died August 8, 2001) and Ron Melzack published their paper in Science, entitled a ‘New Theory of Pain’.1Despite the mention that it was a theory, endless arguments and debates ensued. Poring over the details, arguing over the substrates, all futile and pointless since the theory has stood the test of time and has changed the way we think about pain—the new theory has endured."
 "Why? The theory simply stated, in an elegant and succinct way, that the transmission of pain from the peripheral nerve through the spinal cord was subject to modulation by both intrinsic neurones and controls emanating from the brain (Fig. 1)."  

THE ORIGINAL 1965 PAPER BY MELZACK AND WALL ON GATE CONTROL THEORY!

Reference #1 goes to Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971–9, which [wonderfully!] is open access. 
It's the original!! 
The original paper on Gate Control Theory!! The one that opened a new round in the big battle, helped to force thinking about pain to consider the central nervous system as having some sort of modulatory control over pain perception, helped expand the topic a bit further away from Descartes' ... premise

[I foresee that a lot more meandering might have to happen here.]

Source

BACK TO THE 2002 DICKENSON PAPER:
Figure 1 goes to an image depicting gate control theory

Source
"Fig 1 The Gate Theory proposed that small (C) fibres activated excitatory systems (black neurone) that excited output cells—these latter cells had their activity controlled by the balance of large‐fibre (A‐beta) mediated inhibitions and were under the control of descending systems."
Ah... yes. 
I can see that we're definitely in for a long meander, for readers of this blog (both of you), and myself. Please pardon me while I reminisce for a little while about Patrick Wall. 
I suppose this is the first (and kind of sad) meander.
Here is a list of his publications. Twenty-one of them are free

Patrick David Wall
25 April 1925 – 8 August 2001
Source

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FURTHER READING ABOUT PATRICK WALL

Patrick David Wall, Wikipedia entry
Obit in Nature, by Clifford Woolf
Obit NewYorkTimes
Obit in The Guardian
"He once remarked that in order to succeed in science, one has to choose an important subject that no one else is working on, write a book about it and start a journal for it. So he started research on the mechanisms of pain, a subject largely ignored by research at the time, founded Pain, the premier journal of the field, and co-edited the first, and authoritative, Textbook of Pain (1983, fourth edition 1999)."
Patrick Wall's Foreword to Pain: A Textbook for Therapists, Neuroscience and Pain Science for Manual Physical Therapists page on Facebook










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