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efferent neural impulses that descend from the brain They suggested that a specialized system of large-diameter, rapidly conducting bers (the central control trigger) activate selective cognitive processes that then in uence, by way of descending bers, the modulating properties of the spinal gating mechanism Melzack and Wall speculated that the brain stem reticular formation functions as a central biasing mechanism, inhibiting the transmission of pain signals at multiple synaptic levels of the somatosensory system The GCT maintains that loss of sensory input to this complex neural system, such as occurs in neuropathies, causalgia, and phantom limb pain, tends to weaken inhibition and lead to persistent pain Herniated disc material, tumors, and other factors that exert pressure on these neural structures may operate through such losses of sensory input Emotional stress and medication may also alter the biasing mechanisms and thus intensity of pain.

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From the GCT perspective, the experience of pain is an ongoing sequence of activities, largely re exive in nature at the outset, but modi able even in the earliest stages by a variety of excitatory and inhibitory in uences, and by the integration of ascending and descending nervous system activity The process results in overt expressions communicating pain and strategies to terminate the pain In addition, considerable potential for shaping of the pain experience is implied because the GCT invokes continuous interaction of multiple systems (sensory-physiological, affect, cognition, and, ultimately, behavior) The GCT describes the integration of peripheral stimuli with cortical states, such as anxiety, in the perception of pain This model contradicts the notion that pain is either somatic or psychogenic and instead postulates that both factors have either potentiating or moderating effects on pain perception.

In this model, for example, pain is not understood to be the result of depression or vice versa, but rather the two are seen as evolving simultaneously Any signi cant change in mood or pain will necessarily alter the others The GCT s emphasis on the modulation of inputs in the dorsal horns and the dynamic role of the brain in pain processes resulted in the integration of psychological variables such as past experience, attention, and other cognitive activities into research and therapy on pain Prior to this formulation, psychological processes were largely dismissed as reactions to pain This new model suggested that cutting nerves and pathways was inadequate because a host of other factors modulated the input Perhaps the major contribution of the GCT was that it highlighted the central nervous system as an essential component in pain processes and perception.

The physiological details of the GCT have been challenged, and it has been suggested that the model is incomplete As.

In the Sound Properties dialog box, choose ADPCM from the Compression menu. For Preprocessing, select Convert Stereo to Mono to convert mixed stereo sounds to mono (monaural). (Mono sounds are unaffected by this option.) For Sample Rate, select an option to control sound fidelity and file size. Lower rates decrease file size but can also degrade sound quality. Rate options are as follows:

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