Thanks @Stuntdill for providing context to the discussion.
So the short answer to your question - no, pain gating isn’t something I give much credence to our discussion. The term has morphed over the years to phrases such as DNIC (Diffuse noxious inhibitory control) - which I also don’t tend to speak to with patients or teach. We know pain may improve for many reasons (natural history, regression to the mean, expectations, conditioning - to name a few). Often when I hear pain gating or DNIC - I’m waiting for the inefficacious intervention (read as silly bs) to be peddled so my skepticism spikes fairly high.
There have been many proposed theories over the years about pain. There were 4 primary pain theories that emerged in the 1800s and 1900s, the ones which stand out: 1. Specificity Theory (1895)
2. Intensity Theory (1874)
3. Pattern Theory (1929)
4. Gate Control Theory (1965) You can read more about these HERE.
A major premise for the Gate Control Theory (GCT) by Melzack and Wall -
“The central tenet of the GCT was that the transmission of nerve impulses from afferent fibers to spinal cord transmission (T) cells were modulated by a spinal gating mechanism operating through the substantia gelatinosa.”
However, later GCT was built onto creating the neuromatrix of pain. According to Melzack regarding GCT’s greatest contribution to our understanding of the human pain experience:
"I believe it was the emphasis on CNS mechanisms. Never again, after 1965, could anyone try to explain pain exclusively in terms of peripheral factors.
The theory forced the medical and biological sciences to accept the brain as an active system that filters, selects and modulates inputs. The dorsal horns, too, were not merely passive transmission stations but sites at which dynamic activities - inhibition, excitation and modulation - occurred.
This then was the revolution: we highlighted the central nervous system as an essential component in pain processes.” See Melzack 1999
The nueromatrix idea expanded on GCT with these 4 conclusions: 1. Brain processes can be activated and modulated by inputs from the body and can act in the absence of any inputs (e.g., phantom limb pain)
2. Origins of patterns underlying our experience can be found in the neural networks of the brain: stimuli may trigger the patterns but do not produce them.
3. Body as unity and identified as “self” - distinct from other people and environment.
Body as “self” is produced by central neural processes and cannot derive from the peripheral nervous system or spinal cord.
4. The underlying brain processes creating self are “built-in” by genetic specification BUT can be modified by experience.
Sullivan (linked above) proposed the BioPsychoMotor model of pain. Lorimer Moseley is likely one of the more well known for being considered the individual who took Engel’s BioPsychoSocial Model and adapted to the human pain experience. However, much of this has become hinged heavily to a neurocentric (brain and nervous system) cornerstone to why someone experiences pain (output of the brain). I do not agree with this premise and tend to lean more towards pain as an emergent phenomenon where we clinicians try and examine known variables that we may influence (one of which sometimes is biology/physiology) and others are related to behaviors such as responses to the experience of pain or modifiable factors such as sleep, physical activity, and stress coping. I don’t have a model to label this approach but I think Stilwell and Hartman are leading us in a good direction for understanding pain by layering in philosophy and cognitive sciences with a 5E enactive approach.
Are these testable ideas, from one perspective yes we may create inquiries through these models of pain and as such the information we garner builds upon the evidence we have about pain (pain theories). On the other hand, we must stop and reflect on our premise about the human experience pain and our purpose for inquiry - if it is to solve pain then I’m afraid we are doomed to fail but if it is for addressing human suffering related to pain, then perhaps we can learn some information through the scientific method as researchers and clinicians to help individuals with their pain experience and coping. These are tricky waters to navigate that I certainly don’t postulate to have the answer to but try to critically think through as many others do as well.