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Gate Control Theory

The Gate Control Method of Pain Relief

There is a physiological basis for pressing on & rubbing a mom’s lower back during labor. It’s not just something nice we do to help her feel better. Read on!


[nociceptive- adj.: causing or reacting to pain]

The Gate Control Theory devised by Patrick Wall and Ronald Melzack in 1965: pain is a function of the balance between the information traveling into the spinal cord through large nerve fibers and information traveling into the spinal cord through small nerve fibers. Large nerve fibers carry non-nociceptive information and small nerve fibers carry nociceptive information. If the relative amount of activity is greater in large nerve fibers, there should be little or no pain. However, if there is more activity in small nerve fibers, then there will be pain. Here is what the gate control theory looks like:

Without any stimulation, both large and small nerve fibers are quiet and the inhibitory interneuron blocks the signal in the projection neuron that connects to the brain. The "gate is closed" and therefore NO PAIN.

With non-painful stimulation, large nerve fibers are activated primarily. This activates the projection neuron, BUT ALSO activates the inhibitory interneuron which then BLOCKS the signal in the projection neuron that connects to the brain. The "gate is closed" and therefore NO PAIN.

With pain stimulation, small nerve fibers become active. They activate the projection neurons and BLOCK the inhibitory interneuron. Because activity of the inhibitory interneuron is blocked, it CANNOT block the output of the projection neuron that connects with the brain. The "gate is open", therefore, pain.

---From the spinal cord, the messages go directly to several places in the brain including the thalamus, midbrain and reticular formation.
----Some areas of the brain connect back to the spinal cord - these connections can change or modify information that is coming into the brain. In fact, this is one way that the brain can REDUCE pain.

1st stage labor pain goes to the posterior spinal cord at T10, T11, T12 & L1.

GATE CONTROL THEORY for pain relief:

Block the gate at those levels by inhibiting the transmission to the brain BEFORE it is perceived as pain.
STIMULATE LARGE NERVE FIBERS to block impulses from smaller nerve fibers.
Massage & pressure to her back (she says where) to block the transmission of the nerve reaction from the uterus. The area to massage will change throughout labor, as the uterus changes. Whats good at 10 pm may be unbearable at 11 pm.

As 2nd stage approaches and continues, focus on her lower spine. Do MORE overwhelming massage to the large muscles, with hands, heat, cold, pressure.

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