Pain Gate Ddsc 018: How This SoundCloud Track Can Help You Manage Your Pain

The Gate Control Theory of Pain is a mechanism, in the spinal cord, in which pain signals can be sent up to the brain to be processed to accentuate the possible perceived pain, or attenuate it at the spinal cord itself. [1]

Pain Gate Ddsc 018

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The pain gate mechanism is located in the dorsal horn of the spinal cord, specifically in the Substantia gelatinosa. The interneurons within the Substantia gelatinosa are what synapse to the primary afferent neurons, and are where the gate mechanism occurs. [1] Thus, the substantia gelatinosa modulates the sensory information that is coming in from the primary afferent neurons. [3]

If the interneurons in the substantia gelatinosa are stimulated by the non-noxious large diameter A-β fibers, an inhibitory response is produced and there are no pain signals sent to the brain, and in this instance the 'pain gate' is closed. [1][3]

When the interneurons are stimulated by the smaller diameter A-δ or C fibers, an excitatory response is produced. In this case, pain signals are sent to the brain, these can be modulated, sent back down through descending modulation, and perceived as varying amounts of pain. [1][3]

Third-order neurons, which are located in the brainstem and diencephalon, transmit the pain signal to the cerebral cortex, where the pain signal, from the A-δ and C fibers, can be further modulated. [4]

The painful sensation that is perceived and experienced isn't only driven by the sensory event, but also the pain signals sent from the brain (through the descending modulation) due to thoughts, attitudes, emotions, and feelings that surround the painful experience.

This relates to the biopsychosocial model, and can help increase or decrease the pain perceived. If someone has worrisome or anxious thoughts, negative emotions or memories, poor past experiences, or receives negative social feedback, pain signals will be sent down from the brain passing through an 'open gate', and the pain perceived will be greater. However, positive thoughts, emotions, and memories about the painful experience, relaxation, or positive social feedback, will cause the gate to close, and the person will essentially experience less pain. [1]

The usage of TENS activates the pain gate mechanism to inhibit pain signals going up to the brain, and thus reduces the sensation of pain. Similar to as described above, the TENS activates non-noxious afferent fibers, which in turn activates the 'pain-inhibiting' interneurons in the spinal cord, and thus minimizes/reduces perceived pain as an output. This is because TENS can activate A-β fibers, which helps facilitate the gate control mechanism. [2] The activation of the A-β fibers will inhibit the input from the noxious A-δ and C fibers. [4]

It was found that both TENS and IFC can greatly reduce exercise induced pain during single limb exercise, while only TENS had a positive effect on endurance of the whole body. A such intervention to reduce pain helps to increase exercise endurance performance. [2]

In regards to low back pain, it was found that the use of TENS, as an intervention on its own, was very effective in reducing pain. Using TENS in addition to other Physiotherapy modalities, such as manual mobilization, massage, stretching, or exercise, further helped to improve painful symptoms and quality of life. [6]

When you have an injury, especially a small injury, such as hitting your thumb with a hammer, burning your hand on your coffee cup, or getting your hand stuck in a door, and experience nociceptive type of pain, the common response is to chase away the pain by rubbing it. This helps sooth and reduce the pain due to the reasons explained above. The non-noxious A-β fibers are activated and inhibit the A-δ and/or C fibers causing the pain.[4] [2]

Massage therapy also makes use of the gate control theory to reduce and inhibit pain, with the same reasoning of activating large diameter A-β nerve fibers. This can be beneficial to many types of patients, and help with improving high blood pressure, sleep, relaxation, depression, stiffness, emotional well-being, recovery time, and many other conditions. Cardiac patients may benefit from massage to various painful body parts, which would help them minimize or eliminate the use of pharmaceuticals, and from experiencing possible side effects. [7]

On February 28, 2003, the United States entered into a settlement agreement with F & K Management, Inc., d/b/a Hard Times Cafes and Santa Fe Cue Clubs, to resolve a complaint brought to the attention of the Division's National Origin Working Group (NOWG) by the Sikh Coalition, a national Sikh advocacy group. The Coalition reported that on September 23, 2001, a young Indian-American Sikh was told by a manager to remove his turban or leave at its Springfield, Virginia club. The Division's investigation revealed that F & K had promulgated and posted a policy in its clubs prohibiting head coverings with the exception of cowboy hats and baseball caps. Pursuant to the agreement, F & K rescinded its head covering policy and replaced it with a dress code approved by the United States, posted nondiscrimination signs at the five (5) establishments it owns and/or operates, agreed to place periodic nondiscrimination ads in the Washington Post and local and national Sikh and Muslim publications over a 3-year period, and arranged for periodic training of its owners and employees by Sikh and Islamic organizations over the three-year term of the agreement. In addition, F & K's owner wrote a formal letter of apology to the complainant and provided free dinner and pool playing privileges for use by him, his family and friends.

On June 28, 2000, the United States signed a settlement agreement with a real estate company settling our allegations that one of its former agents violated the Fair Housing Act on the basis of race by engaging in a pattern or practice of discrimination in the sale of a dwelling. The settlement agreement obligates the real estate company, First Boston Real Estate, to implement a non-discriminatory policy, which will be displayed in its offices and distributed to any persons who inquire about the availability of any properties, as well as to all agents. There are reporting requirements and the Metropolitan Fair Housing Council of Oklahoma City, Oklahoma will receive $3,000.00 in compensatory damages.

On October 21, 2003, the court entered a consent decree resolving United States v. Pacific Northwest Electric (D. Idaho). The complaint, which was filed on January 11, 2001, alleged the defendants: Boise, Idaho developers, Walter T. Sigmont and Wirt Edmonds, Pacific Northwest Electric, Inc., Edmonds Construction Co., Inc., and architects Teal Whitworth Architects, P.A. and Capstone, Inc. discriminated on the basis of disability by failing to design and construct five Boise complexes in accordance with the Fair Housing Act's accessibility requirements for new multifamily housing. The five Boise complexes that were the subject of the suit are Grayling Place, Jade Village, Imperial Court, Eagleson Park and Harborview Station (formerly known as Lawton Apartments). The consent decree requires the defendants: to retrofit the complexes by, among other things: removing steps; reconfiguring kitchens and bathrooms to provide added maneuvering space; widening doorways; leveling sidewalks; and adding accessible parking and curb ramps at an estimated cost of approximately $300,000. In addition, the defendants are required to: pay damages in the amount of $29,000 to persons harmed by the lack of accessible features at the complexes; pay $5,000 in damages to the Intermountain Fair Housing Council ("IFHC"); and ensure that new construction complies with the Fair Housing Act with respect to new construction comply with the provisions of the Fair Housing Act. The consent decree will remain in effect for two years. The case was referred to the Division by the Department of Housing and Urban Development (HUD) after HUD investigated complaints it had received from the Intermountain Fair Housing Council ("IFHC").

Albright J, Allman R, Bonfiglio RP, et al. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther. 2001;81(10):1641-74. doi:10.1093/ptj/81.10.1641

Abstract:The aim of this review is to draw attention to neurosurgical approaches for treating chronic and opioid-resistant pain. In a first chapter, an up-to-date overview of the main pathophysiological mechanisms of pain has been carried out, with special emphasis on the details in which the surgical treatment is based. In a second part, the principal indications and results of different surgical approaches are reviewed. Cordotomy, Myelotomy, DREZ lesions, Trigeminal Nucleotomy, Mesencephalotomy, and Cingulotomy are revisited. Ablative procedures have a limited role in the management of chronic non-cancer pain, but they continues to help patients with refractory cancer-related pain. Another ablation lesion has been named and excluded, due to lack of current relevance. Peripheral Nerve, Spine Cord, and the principal possibilities of Deep Brain and Motor Cortex Stimulation are also revisited. Regarding electrical neuromodulation, patient selection remains a challenge.Keywords: deep brain stimulation (DBS); dorsal root entry zone (DREZ); motor cortex stimulation (MCS); peripheral nerve stimulation (PNS); spinal cord stimulation (SCS); pain management; cordotomy; myelotomy; trigeminal nucleotomy; mesencephalotomy; cingulotomy; chronic pain

In June 2017, the EEOC investigated a restaurant operating over 100 facilities in the Eastern U.S. involving issues of hiring discrimination against African Americans. The restaurant agreed to pay $9.6 million to class members as part of a conciliation agreement. Additionally, the restaurant will overhaul its hiring procedures and has agreed to institute practices aimed at meeting hiring targets consistent with the labor market in each of the locations in which it has facilities. The new hiring procedures include implementation of an extensive applicant tracking system that will better enable the EEOC and the company to assess whether the company is meeting the targeted hiring levels. The restaurant will also provide an annual report to EEOC detailing the company's efforts in complying with the agreement and its objectives over the term of the five-year agreement, including detailed hiring assessments for each facility covered by the agreement. 2ff7e9595c