Concept analysis is an exercise that is structured to enable a researcher as familiar as possible with a concept or theory. In nursing, the theoretical framework is built in a process that is quite dynamic, and it arises from practice and reproduced by research. The research is mainly by analysis and theory development. General science demands a movement from common sense to a critical evaluation. Clarity of concepts contributes to the construction of a well-defined body of knowledge in a given theory or concept and poor clarity in concepts results in poorly defined theories and low consistency in science, a factor that is not desired in science (Treede, 2016) . Finding understanding and concern for a concept to facilitate reflection and action towards practice are critical motivators behind concept development in nursing. The phenomena in nursing practice encountered by nurses should be investigated with the aim of identifying and defining their attributes. The most logical and operational way to enable a nurse to examine a phenomenon deeply is by beginning to illustrate the concept of interest (Treede, 2016) . This allows the development of theories directly related to the nurses' clinical practice. Concept analysis development is, therefore, key to the enhancement of nursing knowledge. To wrap up the elucidation on concepts and concept analysis, the main reason for this is to develop theories, analyze for their application in nursing practice and enhance the nursing practice itself.
Definition of Pain Concept
In this paper, the concept it reviews is one to do with pain. Pain by definition is an unpleasant sensory and emotional experience arising from actual or potential tissue damage. Various factors affect the perception of pain in different individuals. In the body, there are four major processes of pain transmission namely transduction, transmission, modulation and perception (Pereira & Lerner, 2017) . Transduction is the process by which nerve endings are activated by painful stimuli. Transmission is all about relay functions by which the message from nerve endings is carried to the brain. Modulation works to reduce activity in the transmission system, and perception is the awareness of the pain produced by the sensory signals. It involves the combination of many sensory messages into one. The pain experience for patients is affected by culture, age, attention to the pain, sex, anxiety, and the ability to control the pain (Richardson, Percy, & Hughes, 2015) . Several theories have been proposed to explain the physiological etiology of pain from as far back as the eighteenth century. This paper seeks to discuss the gate control theory proposed by Ronald Melzack and Patrick Wall in 1965 (Pereira & Lerner, 2017) .
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The gate control theory is a very interesting one and is thought to have been an improvement of previous theories of pain. It suggests that stimulation of pain is carried by small, slow fibers that enter the dorsal horn of the spinal cord. The fibers are known as the T-cells located at the Substantia Gelatinosa of the spinal cord (Fuentes, Armijo Olivo, Magee, & Gross, 2016) . Pain signals encounter ‘gates' at the level of the spinal cord and have to be cleared via these gates to reach the brain. At the neurological gates, various factors determine how the signals are treated. The factors include the intensity of the pain signals, the intensity of other signals such as touch, temperature, and pressure generated at the same site of injury and the message of the brain itself. The Substantia Gelatinosa consists of interneurons that act as the neurological gates (Fuentes, Armijo Olivo, Magee, & Gross, 2016) .
Pain signals are carried by small fibers called A-delta and C fibers. These fibers are less intense than the fibers that transmit touch, pressure, and temperature and therefore act as inhibitory neurons for pain transmission through the T cells (Ropero Peláez & Taniguchi, 2016) . In their presence, they override the pain signals resulting in pain not being perceived by the brain. When pain signals are more intense than the other signals of touch, pressure, and temperature, the inhibitory neurons are rendered inactive, and the neurological gates are opened. T cells transmit pain signals to the spinothalamic tract that works in the transmission of pain to the brain. By this, the relative amount of activity in the large and small nerve fibers influences the opening of the neurological gates (Ropero Peláez & Taniguchi, 2016) .
The gate control theory of pain also explains that emotions and thoughts can also influence pain transmission. Pain does not affect individuals who concentrate on other activities that interest them apart from the pain they experience (Mendell, 2014) . In contrast, people who are anxious, depressed, or disturbed experience more intense pain and find it very difficult to cope with and control it. The theory explains that this is because the brain sends messages through descending fibers that either reduce, stop or amplify the transmission of pain signals through the gate depending on the emotions or thoughts of a person (Mendell, 2014) .
Literature Review
A research article on modeling different pain conditions with a Parsimonious Neurocomputational model revisited the Gate Control theory of pain through two mechanisms of neuronal regulation, which include the NMDA synaptic plasticity and intrinsic plasticity. The article's objectives were to highlight the dependence of pain responses on gate circuit parameters and the contribution of the nociceptors and mechanoreceptors (Ropero Peláez & Taniguchi, 2016) . In the paper, a parsimonious computational model of the gate circuit is presented enabling it to account for some different pain conditions. It shows that the weakening of mechanoreceptor input produces abnormal pain like in demyelinating syndromes and no inputs produce pain such as in phantom limbs (Ropero Peláez & Taniguchi, 2016) .
A study of the gate control theory of pain using experimental pain stimulus of potassium iontophoresis done at the Massey University, Palmerston North, New Zealand investigated a prediction derived from the theory. The speculation is that there would be a pulse of pain as a pain stimulus was being ramped off due to the rapidly transmitting, inhibitory large fiber activity falling away sooner at the spinal level than the excitatory activity of the slow transmitting, small pain fibers (Mendell, 2014) . The results of the inquiry were consistent with the predictions of gate control theory, and there was no data that contradicted the projections.
A psychotherapy article on gate control theory and the brain explains that researchers have observed factors such as thoughts, emotions and expectations and their influence on the perception of pain. If one expects something to hurt, it most probably will. In periods of anger, anxiety or being upset, the pain would be more intense than when one is calm. The ‘Gate Control theory springs a leak' article sheds light on the mechanism underlying the events described by different subjects in psychophysical studies. The authors of the report suggest that subjects feel itch as weak, painful sensations because the stimuli are not sufficient enough to fire the required threshold to produce pain (Pereira & Lerner, 2017) . This is by the Grp neurons. Encephalin -expressing neurons are not activated as a result, and therefore weak pain is not blocked resulting in itch.
The gate control theory of pain attributes to pain being a function of the balance between the information traveling to the spinal cord through small and large fibers (Pereira & Lerner, 2017). The large fibers do not carry the nociceptive information and transmit stimuli faster than the smaller nociceptive information transmitters (Treede, 2016) . The larger fibers activate the inhibitory interneurons which block signals in the projection neurons to the brain, closing the gates resulting in no pain perception. The theory does not explain the concept of pain perception. It alludes to painful perception being present when small nerve fibers are activated by painful stimuli that exceed the threshold of inhibitory interneurons. The significant attributes of the concept of pain include unpleasant emotional and physical sensations, physical and psychological responses to a painful stimulus and that pain responses are influenced by emotion, thoughts and to some extent, personality. Positive thoughts and emotions help individuals cope with pain better (Treede, 2016) .
Empirical Referents
Because pain has an unpleasant feeling, the client’s own words offer reliable indicators of pain. Relying on the client’s words may not be reliable for all individuals. Some clients may have verbal restrictions, therefore, warranting other methods as indicators of pain (Richardson, Percy & Hughes, 2015) . The measurement of pain should include site, intensity, and quality of pain. Behavior can also be used to assess pain in patients, that is, crying, avoidance of movement and crying (Fuentes, Armijo Olivo, Magee, & Gross, 2016) .
Application
Gate control theory has influenced and explained why certain pain treatments are effective in managing pain. Transcutaneous electrical stimulation, spinal cord stimulation and peripheral nerve field stimulation give alternative irritation- a buzzing and tingling feeling- that compete with signals of chronic pain (Fuentes, Armijo Olivo, Magee, & Gross, 2016) . The same concept in these maneuvers is the same as the process of banging one’s head and rubbing it (Richardson, Percy, & Hughes, 2015) . The use of acupunctures- thin needles – activates small pain fibers designed to close the pain gates. Music therapy and auditory interventions allow the brain to send signals down the spinal cord tracts to close the pain gates by distraction (Fuentes, Armijo Olivo, Magee, & Gross, 2016) .
Conclusion
In summary, the pain concept in this paper was selected for concept analysis since pain is a serious problem in the patients as well as the health care providers. The theory has revolutionized the field of pain management and research greatly and has bred numerous studies that have an objective to have a pain free lifestyle for all patients who suffer from chronic illnesses that are characterized by chronic pain.
References
Fuentes, J. P., Armijo Olivo, S., Magee, D. J., & Gross, D. P. (2016). Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis. Physical therapy , 90 (9), 1219-1238.
Mendell, L. M. (2014). Constructing and deconstructing the gate theory of pain. PAIN® , 155 (2), 210-216.
Pereira, P. J., & Lerner, E. A. (2017). Gate control theory springs a leak. Neuron , 93 (4), 723-724.
Richardson, C., Percy, M., & Hughes, J. (2015). Nursing therapeutics: teaching student nurses care, compassion and empathy. Nurse Education Today , 35 (5), e1-e5.
Ropero Peláez, F. J., & Taniguchi, S. (2016). The gate theory of pain revisited: Modeling different pain conditions with a parsimonious neurocomputational model. Neural plasticity , 2016 .
Treede, R. D. (2016). Gain control mechanisms in the nociceptive system. Pain , 157 (6), 1199- 1204.
