Applying the Gate Control Theory to
Former or Current Substance Abusers with Pain
Pain is an immensely complex physiologic and psychologic phenomenon. It is now understood to involve multiple structures (i.e. peripheral nerves, spinal cord, brain), physiologic behaviors, neurotransmitters (i.e. dopamine, endorphins) as well as cultural factors, psychological factors, personal histories of pain, and expectations of pain (Grossman & Porth, 2014). The Gate Control Theory of pain addresses few of these factors, which is why many believe it is an oversimplified model of pain (Grossman & Porth, 2014).
Even still, the pain modalities which were developed based on the theory (i.e. TENS units), can continue to be used in both the general population as well as those who have or continue to abuse substances. Relief of pain in such novel ways can be helpful in those with a past history of substance abuse because these individuals may be cautious of using pharmaceutical analgesia for fear of addiction. Also, untreated pain is a significant risk factor for addiction relapse so using such modalities to provide relief should be attempted (Prater, Zylstra, & Miller, 2002).
In those who continue to abuse substances, pain must still be treated appropriately. Refer to the stepladder approach below developed by the World Health Organization and adapted by Prater, Zylstra, & Miller (2002). The lowest effective doses of medications should be prescribed, while noting that significant tolerance may already be present in those with substance abuse histories, requiring large and more frequent dosing (Prater, Zylstra, & Miller, 2002). Although tolerance was not specifically addressed by Melzack and Wall in 1965, it is reasonable to surmise that tolerance may affect the function of the gate control mechanism in the substantia gelatinosa. In addition to these pharmaceutical agents outlined in the table below, other proven modalities, which can be explained by The Gate Control Theory (i.e. warm compresses), should be used as adjuncts.
Pharmacologic Pain Management Strategies (Prater, Zylstra, & Miller, 2002)
Even still, the pain modalities which were developed based on the theory (i.e. TENS units), can continue to be used in both the general population as well as those who have or continue to abuse substances. Relief of pain in such novel ways can be helpful in those with a past history of substance abuse because these individuals may be cautious of using pharmaceutical analgesia for fear of addiction. Also, untreated pain is a significant risk factor for addiction relapse so using such modalities to provide relief should be attempted (Prater, Zylstra, & Miller, 2002).
In those who continue to abuse substances, pain must still be treated appropriately. Refer to the stepladder approach below developed by the World Health Organization and adapted by Prater, Zylstra, & Miller (2002). The lowest effective doses of medications should be prescribed, while noting that significant tolerance may already be present in those with substance abuse histories, requiring large and more frequent dosing (Prater, Zylstra, & Miller, 2002). Although tolerance was not specifically addressed by Melzack and Wall in 1965, it is reasonable to surmise that tolerance may affect the function of the gate control mechanism in the substantia gelatinosa. In addition to these pharmaceutical agents outlined in the table below, other proven modalities, which can be explained by The Gate Control Theory (i.e. warm compresses), should be used as adjuncts.
Pharmacologic Pain Management Strategies (Prater, Zylstra, & Miller, 2002)