Gate Control Theory of Pain

Ronald Melzack

The specificity theory of pain that we inherited in the 20th century derives from a concept of the nervous system proposed by René Descartes three centuries earlier. Specificity theory maintains that injury activates specific pain receptors and fibers, which, in turn, project pain signals through a spinal pain pathway to a pain center in the brain. The psychological experience of pain, therefore, is virtually equated with peripheral injury. In the 1950s, there was no room for psychological contributions to pain, such as attention, past experience, and the meaning of the situation. Instead, pain experience was held to be proportional to peripheral injury or pathology. Patients who suffered chronic pain syndromes without presenting signs of organic disease were labeled “crocks” and sent to psychiatrists. The picture, in short, was simple. However, to thoughtful clinical observers, it was clearly wrong (Livingston, 1943; Noordenbos, 1959). In 1965, Melzack and Wall proposed the gate ...

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