Gate Control Theory and Non-pharmacological Pain Management (Nursing)

00:01 Now, as we get into managing or what we can do to promote comfort, we're going to talk about pharmacologic, meaning using medications and non-pharmacologic measures.

00:12 Now, one of the things that we really need to understand is one of the theories behind pain that happens in labor or really pain that happens anywhere.

00:21 This is a theory by Melzack and Wall that came out in the 1960's called the Gate Control Theory and the theory here is that whenever there's an injury or a source of pain, that neurologic message travels from that site to the spinal cord.

00:36 And then, at the level of the spinal cord, there are gates.

00:39 And the gates control whether that particular message goes to the brain and says, "Ouch, this hurts." Or whether it doesn't.

00:47 So, the idea here that Melzack and Wall figured out is that if we're able to close the gates, then, we keep that pain message from moving up to the brain and we can do this in two ways.

00:58 So, if we think about the message that goes from the spinal cord to the brain, it may be either a large stimulus of pain like, "Oh, I've really got a big gash on my leg or I'm having a contraction." Or it could be light touch. And if we use light touch, we can close the gate so that the message of the contraction doesn't get to the brain.

01:20 So, it actually decreases the sensation of pain.

01:23 So, using things like massage or touch to distract and close the gate actually decreases pain.

01:32 So, that is the gate control theory.

01:34 Keep that in mind as we continue to talk about non-pharmacologic methods.

01:39 To make this easier, we're going to divide our non-pharmacologic measures into three categories, cognitive, meaning it has to do with how our brain is working, sensory, more of a feeling, or cutaneous, so, direct skin stimulation or thinking about that gate control theory, ways we can distract.

01:59 So, when we think about cognitive, non-pharmacologic measures, we think about things like support.

02:04 So, providers, the partner, the family, friends.

02:09 Remember, one of the biggest things we can do to promote positive birth outcomes is make sure that someone is with the birthing person at all times.

02:18 Another method we may use is music or guided imagery. It's interesting.

02:24 Guided imagery is very effective in fooling the brain.

02:28 Have you ever had someone tell you, "Go to your happy place." Well, we've actually done studies and if you go to your happy place in your mind.

02:37 It actually stimulates the same part of your brain that would be stimulated if you were actually in your happy place. So, guided imagery does work.

02:47 It does require practice however, so, it's a good idea if you're going to introduce that as a method that you start doing that earlier in labor.

02:55 When we think about sensory sorts of non-pharmacologic methods, we might use things like hydrotherapy. So, having the client sit in water.

03:05 Maybe a tub is not an option. Perhaps a shower is.

03:08 That is something that you absolutely can use to help promote comfort.

03:12 Having the client get up and walk.

03:15 There's nothing worse that when you're in pain, staying in a bed and not moving.

03:20 So, getting up and walking actually will help in terms of sensory and maybe a little bit of cognitive distraction, too.

03:27 Using breathing methods and techniques which they may learn in a childbirth class but let's say, they didn't go to a childbirth class, still helping the client to take deep breaths to slow down that amygdala, that fight or flight or freeze sensation.

03:43 If we can have them take slower breaths. Don't say, "Take a breath." Or, "Relax." Say, "Can you breathe in? We're going to breathe in slowly. We're going to do it together." That actually can help. When we think about cutaneous things that we can do.

03:58 Things that are related to sensory, specifically in the skin, we can think about doing acupressure or counter pressure where we actually press up against the back or the lower spine or the hips.

04:09 We can do things like using a TENS unit.

04:12 So, a TENS unit has pads that deliver electrical stimulation to the skin.

04:17 It also helps to distract.

04:19 So, it works again sort of in the same principals as the gate control theory.

04:24 We can use saline injections and I said it exactly right.

04:27 Saline injections, so, just plain old salt water right around the lower back area can actually also be very effective in reducing pain.

04:36 And then, using Effleurage. Now, you know I love those French words.

04:41 So, this is another one. So, Effleurage is just light touch where we rub sort of in this sort of circular direction on the abdomen and again, this operates under the same principles as the gate control theory as a way to distract and close the gate to those large, painful contractions and go with the sensation of the nice Effleurage rub, see, say that, Effleurage, everybody together.

05:07 Alright, I want to show you this fantastic road map of labor that was created by a doula by the name of Penny Simpkins.

05:14 So, this road map walks you through the process of all the things that you can do to help promote comfort for a client who's experiencing labor.

05:22 And you start up here at the top left and you have a couple who has a bun in the oven, get it? But they're starting through the latent phase of labor and you can see at the beginning, the client's lying on a pad, dreaming about going someplace wonderful, to the happy place.

05:37 And then, they call the provider and then, you see around three to six centimeters, the client's in the shower.

05:43 So, what I want you to notice as we go through this map are all the different position changes this client uses throughout this process.

05:51 So, we see the first detour for someone who's experiencing back labor and they're on hands and knees as a way to alleviate some of that pressure for a baby that's persistent occiput posterior.

06:03 They might lean over the birthing ball.

06:05 They may lean over the side of the bed. They may be on their side.

06:09 These are position changes that are going to help facilitate rotation of the fetus and also, provide a sense of distraction.

06:16 You can see as we move further down this detour that the client is in the tub and they're in the tub on all fours.

06:23 Again, another position change as a way to help facilitate that rotation.

06:28 You see the support person giving counter pressure on the lower part of the back as a way to help alleviate some of that pressure as the baby descends into the pelvis.

06:37 You can also see on this roadmap around five centimeters that we have a client that's decided to have an epidural.

06:44 This is a perfectly wonderful way to manage pain in labor and so, you can see all the things that the nurse is doing.

06:50 We're going to talk about that in a little more detail in just a second but I want you to note that it's on this map for the roadmap of labor.

06:57 You can also see a client sitting in a rocking chair.

07:00 Another position change as a way to help facilitate that rotation and descent of the fetus.

07:06 There's a client here as we get to transition in side lying position with a pillow.

07:11 You can use this element called a peanut ball and it looks like a peanut.

07:15 And so, that's why it's called a peanut ball and the great part is that the part that constricts is right where you put your legs.

07:22 So, it allows the pelvis to stay open, again, to help facilitate that rotation of the fetus.

07:27 So, noticing all the things that are done here to promote non-pharmacological benefits that are on this map, position changes, hydrotherapy, ambulation, walking around, counter pressure and touch from someone else, thinking about that gate control theory, this is what it looks like in full display.