Pain exists because electrical impulses travel along a series of nerves from "where it hurts" through the gate in the spinal cord and through the thalamus to the areas of the brain where thinking, feeling, and action are controlled. Along this path are several "switches" that can adjust the pain, or turn it down as one would the volume of a radio. Figure 5 summarizes the interventions that have been discussed in this article in relation to these four switches. One can use a moderate to large amount of a single intervention (such as medication) to shut off the pain; or one can use small to moderate amounts of a combination of interventions to accomplish the same or greater level of comfort. In most situations, a combined approach provides the patient with better control of pain, a more active role in his care, fewer side effects, and less dependence on others.