The patient is receiving transcutaneous electrical nerve stimulation (TENS) for back pain. Describe how this m?
The patient is receiving transcutaneous electrical nerve stimulation (TENS) for back pain. Describe how this may work, based on the gate control theory.
The gating theory of pain regulation was created by Melzak and Wall. It states that the stimulation of large diameter nerve fibers (e.g., neurons carrying proprioceptive information) interferes with the sensation of information from small fibers (e.g., pain). This is the basis of TENS units, massage, and acupuncture. The larger diameter fibers are more sensitive to electrical and mechanical stimulation than are the smaller diameter fibers.
Howard Fields of UC San Francisco did an interesting experiment with respect to this gating mechanism. He found a group of Chinese patients in San Francisco who were to get dental work using acupuncture as anesthesia. In a controlled study, some of the patients received an injection of Naloxone (a drug used to treat patients who have taken an overdose of opiates), while other just got a control injection of saline. The test subjects did not get any pain relief from the acupuncture while the control subjects did get pain relief. This showed that the pain control mechanism of acupuncture (and presumably TEMS and massage) require the opiate receptors in the brain. That is, the traditional mechanism that acupuncturists believe (energy flows along meridians) is completely wrong.
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