Hazards of Nociassociation

Discussion in 'Neurology' started by Green Xenon, Mar 24, 2007.

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  1. Green Xenon

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    [FONT=geneva,arial]Hi:

    Nociassociation is extremely dangerous and is something that all surgeons, doctors, patients must be made aware of.

    http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommonzSzdorlandszSzdorlandzSzdmd_n_09zPzhtm

    "nociassociation = the unconscious discharge of nervous energy under the stimulus of trauma, as in surgical shock."

    This means a patient who is totally-unconscious can still experience shock as a result of the nociception that results from the physical injuries that occur during the surgery.

    Nociception = a measurable physiological event of a type usually associated with pain and agony and suffering

    Nociceptor = sensory receptor that sends signals that cause the perception of pain in response to potentially damaging stimulus. Nociceptors are the nerve endings responsible for nociception.

    Just because you aren't aware of the pain doesn't mean it isn't significantly affecting your emotions and autonomic nervous system.

    Pain can kill even if the victim doesn't feel it. While may not be felt consciously, the unconscious still feels it. As a result, excruciating pain can screw-up the nervous system enough to cause shock -- and even death -- even if the victim is totally unconscious.

    Even during the deepest coma, emotions -- such as fear -- can remain active, it�s just that the patient isn't aware of it.

    Hence, when an unconscious patient is operated on, the nociception causes pain just as it would in a conscious individual. This pain causes tremendous emotional distress. The emotional distress causes neurogenic shock, even though the patient is not aware of -- and does not consciously feel -- the distress or the pain.

    These psychoneurophysiological effects of nociception can cause a potentially-fatal shock reaction even if:

    1. There is minimal or no bleeding
    2. No infection occurs
    3. The patient isn't aware of the pain or emotional distress cause by the pain
    4. There is no injury to any vital organ

    This shock is called nociassociation and cannot be prevented even by inducing the deepest coma.

    My point is that inducing unconsciousness might prevent the surgery-patient from consciously-perceiving the suffering caused by his/her injuries but this does not prevent the subconscious elements of the nervous system from feeling the agony. The subconscious parts of the nervous system -- which are concerned with emotions and regulate the circulatory system -- can still feel the intense emotional suffering caused by the nociception. The extreme emotional distress caused by the severe pain results in neurogenic shock. Nociassociative neurogenic shock is marked by the following extreme changes in the circulatory system:

    1. Force of the heart muscles' contractions decrease significantly
    2. Heart rate decreases dramatically.
    3. General increase in the heart muscles' relaxability
    4. Blood vessels throughout the body widen to total dilation

    The above 4 conspire to cause a lethal drop in blood pressure. As a result, vital organs are deprived of blood leading to multiple-organ-failure. This can rapidly kill the patient.

    This means, the subconscious parts of the nervous system must somehow be temporarily disconnected from pain perception prior to and during the surgical operation.

    In order for the surgery not to result in a likely-fatal nociassociation, the patient's entire autonomic nervous system [and their effectors], limbic system [emotion], his/her heart's natural pacemaker, smooth muscles, reflexes [all types; including reflexes not involved with the autonomic nervous system], endocrine and hormonal systems must be rendered totally unresponsive to the infliction of even the most excruciating pain, totally unresponsive to any type of injury [regardless of severity], and totally unresponsive to any emotions or psychological states [regardless of intensity].

    The best way to do this is to somehow anesthetize all sensory-receptors and sensory nerves at the site of the operation before the surgery and make sure they are completely numb throughout the surgery and for at least 15 minutes after the surgery is complete. After 15 minutes the sensory-receptors and sensory nerves at the affected site should be allowed to *gradually* resume activity. It should take at least an additional hour for these sensory receptors and nerves to regain complete "wakefulness". This will prevent the root-cause of nociassociation.

    Note: nociassociation is one of the major reasons that martial-arts relies on pain-sensitive areas of the body as targets. This is how a punch to the solar plexus can kill.

    General anesthesia usually involves giving a barbiturate -- or other CNS depressant -- which acts directly on the reticular formation and causes unconsciousness. The loss of consciousness has no mitigating effect on the limbic system or its connections with circulatory functions.

    If general anesthesia acted on the peripheral tactile nerve-endings and put them in a relaxed state � and/or rendered the patient's entire autonomic nervous system [and their effectors], limbic system [emotion], his/her heart's natural pacemaker, smooth muscles, reflexes [all types; including reflexes not involved with the autonomic nervous system], endocrine and hormonal systems totally unresponsive to the infliction of even the most excruciating pain, totally unresponsive to any type of injury [regardless of severity], and totally unresponsive to any emotions or psychological states [regardless of intensity] --, then nociassociation would be something of no concern. However, general anesthesia does not do any such thing. Hence, tactile nerves and the limbic system are just as vulnerable during general anesthesia, as they would be, without anesthesia. General anesthesia prevents conscious awareness of the pain, injury, and emotional distress. However, it does not mitigate the pain or emotional trauma itself. Hence, neurocirculatory functions are not protected from the pain or the resulting unconscious mental distress. During the operation, the pain -- caused by the surgical injuries causes the unconscious mind to badly "want" to escape the inescapable. The unconscious psyche is extremely desperate to flee the painful situation. This causes extreme amounts of stress on the limbic system -- which is so closely connected to the neural control of circulatory functions. As a result, the autonomic nervous system is bombarded by signals from the limbic system and causes the muscles of the circulatory system to relax -- leading to bradycardia [abnormally slow heart rate] and vasodilation [widening of blood vessels]. This results in a severe drop in blood pressure, starving vital organs of the blood they need.

    .
    [FONT=geneva,arial]
    Thanks,

    Green
    .
     
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  3. Nerdoscience

    Nerdoscience Senior Member
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    Why is this posted on this forum? Is it supposed to be like a public announcement or something?
     
  4. Green Xenon

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    I am just posting it because I am interested in wierd and rare neurological findings.

    Don't you think nociassociation is something of concern? What if someone you care about is in an operating room dies of pain-induced shock even though that person is in a deep medically-induced coma while during the operation.

    Anesthesia is a two fold process.
    1) Anesthesia-inducing sleep for the procedure
    2) Amnesia-blocking memory formation so the patient does not remember the event.

    This state of deep coma and complete amnesia does not decrease the chance of a surgery patient dying from the neurogenic shock that results from the firing of sensory nerves at the site of the surgical wounds.
     
  5. ariwax

    ariwax Pocketful of DNR's
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    Actually, 'anesthesia' literally means 'inducing no-feeling." You literally block pain transmission to the CNS. Lidocaine, for instance, is an anesthetic which stabilizes nerve cell membranes and inhibits transmission of the sensation of pain (as well as touch, temperature, and probably vibration and proprioception, though I'm not 100% on that). Many anesthetic agents work in this way, peripherally or centrally, and the autonomic effects you seem to be talking about are routinely monitored during surgery. When a patient who's 'under' feels pain, their sympathetic nervous system kicks up, and their heart rate and blood pressure go UP, not down. That's a signal for the anesthetist to turn up the halothane.
     
  6. Green Xenon

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    Sometimes the "anesthesic" is really a barbituate to induce coma in the patient before surgery.

    As for autonomic functions, there are many cases where the infliction of pain will cause heart rate and blood pressure to decrease. This is partly due to extreme vasovagal activation.

    In addition, nociassociation does necessarily mean the patient is aware of the pain. The patient can be completely unconscious and unable to notice the pain, but this does not mean the emotional and neurocirculatory reactions to pain are any milder than they would be if the patient were conscious and aware of the pain.
     
  7. neurodoc

    neurodoc Neurologist
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    Well, Green, I found your comments a bit bizarre, but thought-provoking, kind of like the label on my Dr. Bronner's Pepperment Castile Soap bottle (I'm sure some fellow SDNers have used this wonderful product).

    Some surgeons ("to somehow anesthetize all sensory-receptors and sensory nerves at the site of the operation before the surgery") actually use local anesthesia with lidocaine before they cut into generally anesthetized patients, based on your argument. I don't know if this helps, but it probably does no harm.

    It is probably true that peripheral nociceptive reflexes (e.g. local tissue responses to painful stimuli) are active under general anesthesia. What this means for the patient's CNS is hard to say. It is still unclear exactly how general anesthesia "works." Your post seems to assume that general anesthesia is ineffective in blocking the "perception" of pain. I don't think this assumption has been proved. GA is certainly effective in blocking the conscious awareness and retreivable "memory" of pain. Heck, even Versed can do that. Whether or not some subconscious (limbic or subcortical) pain "perception" under GA is possible is very debatable and doubtful. There may be some subconscious "reaction" to pain under GA, that may be worth arguing about, but I think it would be wrong to call this "perception."

    Nick
     
  8. Green Xenon

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    Okay, maybe I did go to far in calling it "perception" but the fact is that the unconscious psyche and its effects on autonomic functions are still active during unconsciousness. So even if the pain is not "perceived" [consciously, that is], it is still stressing-out the unconscious mind, and therefore can slow circulatory functions as a reflex. One of the autonomic nervous system's natural responses to trauma is to stimulate a vasovagal reaction which is partially responsible for the bradycardia and vasodilation that occur in response to intense stimulation of nociceptors. This is one reason why a punch to the stomach [as seen in many martial arts cases] can kill the victim -- even if the punch is delivered when he/she is unconscious and not perceiving the pain.

    As you correctly state, "GA is certainly effective in blocking the conscious awareness and retreivable "memory" of pain." However, this doesn't do much to mitigate the parasympthetic circulatory response to the pain. It is this response that is the usual fatality is cases of extreme nociception -- even if the individual concerned does not perceive the pain.

    Even during a deep coma, the affective-motivational aspect of pain can still scramble the signals involved in communication between the nervous and circulatory system. Agreed, though, that the patient does consciously suffer from the pain if unconscious.
     
  9. Green Xenon

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    Okay, maybe I did go to far in calling it "perception" but the fact is that the unconscious psyche and its effects on autonomic functions are still active during unconsciousness. So even if the pain is not "perceived" [consciously, that is], it is still stressing-out the unconscious mind, and therefore can slow circulatory functions as a reflex. One of the autonomic nervous system's natural responses to trauma is to stimulate a vasovagal reaction which is partially responsible for the bradycardia and vasodilation that occur in response to intense stimulation of nociceptors. This is one reason why a punch to the stomach [as seen in many martial arts cases] can kill the victim -- even if the punch is delivered when he/she is unconscious and not perceiving the pain.

    As you correctly state, "GA is certainly effective in blocking the conscious awareness and retreivable "memory" of pain." However, this doesn't do much to mitigate the parasympthetic circulatory response to the pain. It is this response that is the usual fatality is cases of extreme nociception -- even if the individual concerned does not perceive the pain.

    Even during a deep coma, the affective-motivational aspect of pain can still scramble the signals involved in communication between the nervous and circulatory system. Agreed, though, that the patient does consciously suffer from the pain if unconscious.
     
  10. Green Xenon

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    Sorry for the multi-posts
     
  11. llogg

    llogg New Member
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    Isn't the autonomic response to pain generally sympathetic, i.e., increased heart rate and BP?
     
  12. Green Xenon

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    It could go one way or another. But usually in cases of extreme nociception of the A-delta nerves, the neurocirculatory system goes into relaxation instead of excitement.

    Check out the attachment. Is it about a high-tech form of capital punishment and discusses how the neurological reactions would be fatal yet without any suffering. Please don't be offended, as I do not support the death penalty.
     

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  13. Green Xenon

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    Why has this thread suddenly gone silent? I notice that my attachment had 3 views. For those of you that read it, what do you think about the massive A-delta excitement described in the document? Do you think it makes neurological sense?

    I thank anyone for their input on the stuff described in the attachment.
     
  14. neurodoc

    neurodoc Neurologist
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    Well, I read the attachment. Again, it was interesting...and a bit strange...again like reading the label on Dr. Bronner's famous castile soap.

    What's your point? I don't really doubt that some sort of "neurogenic autonomic shock" can be induced by "subconscious" painful stimuli. And I'm aware of the arcane martial arts literature that describes mysterious lethal injuries attributed to certain blows to various body parts, sometimes after a considerable period of delay. And of course there are some people who die for unclear reasons while undergoing surgery under GA. Could they have succumbed to "nociassociation?" Maybe... Could this be prevented by using local anesthesia in addition to GA? Maybe...

    As regards using "nociassociation" as some sort of kinder and gentler and "more humane" way of execution (legal killing), again my response is "maybe"...

    The use of "nanobots" for this purpose seems very bizarre. If you believe in capital punishment (I don't), a less bizarre way to do it "humanely" seems to be lethal injection under some for of GA, without any need to resort to "nanobots" or any goofy theory of nociassociational death. Induce GA in the condemned person just as you would induce GA (including neuromuscular blockade) for a patient undergoing surgery. Then slip him a whopping dose of KCl to stop his heart. He'll never wake up. I can't think of a more "humane" and sure way to kill someone. :eek:

    Nick
     
  15. Green Xenon

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    As a neurodoctor, do you agree with following?:

    " .2. The a-delta excitation simulates SEVERE injury and causes the brain to releases cascades of endorphins.
    3. A psychogenic* blackout will occur due to the *extreme* psychic trauma caused by the a-delta excitation. 4. Pain-induced coma caused by alteration of the signals of RAS [Reticular Activation System], as mentioned on http://www.internetarmory.com/self_defense.htm

    Quote from http://www.internetarmory.com/self_defense.htm :

    "It is speculated that various organs of the body can send pain impulses to the brain stem indicating a severe or overwhelming bodily injury. The reticular activating system responds by producing a functional "shut down", which results in loss of consciousness within a second or two."

    .*Along with the endorphins and hypotension, the a-delta excitation causes ACUTE psychological trauma. Due to this, the executionee won't feel the pain, even if the hypotension, pain-induced RAS coma, and endorphins don't kick in. This is because extreme mental trauma causes blackouts even if no mechanical injury has occurred. Such blackouts are common in war veterans, prisoners, victims of natural disasters, those who have lost a loved one, witnessing a tragedy, as well as those subjected to childhood abuse or molestation. These blackouts are known to occur even in the complete absence of bleeding, head-injuries, pain-induced RAS coma, seizures, endorphins, or circulatory disturbances. The brain automatically prevents the traumatized individual from consciously perceiving the emotional agony. Its a protective mechanism for the psyche.." .
    .
     
  16. Green Xenon

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    Why is everyone ignoring me?
     
  17. llogg

    llogg New Member
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    Because no one is interested. Get a grip.
     
  18. Green Xenon

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    No offense but I asked a neurological question in a neurology forum. So I thought, readers would be interested.
     
  19. Green Xenon

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    For those who read my attachment, I desperately request that they please answer the following question. Sorry if this message annoys anyone.

    Do any of the neurologists/neuroscientists agree with the following quotes from the attachment and the martial-arts website? :

    "2. The a-delta excitation simulates SEVERE injury and causes the brain to releases cascades of endorphins

    3. A psychogenic* blackout will occur due to the *extreme* psychic trauma caused by the a-delta excitation.

    4. Pain-induced coma caused by alteration of the signals of RAS [Reticular Activation System], as mentioned on http://www.internetarmory.com/self_defense.htm

    Quote from http://www.internetarmory.com/self_defense.htm :

    "It is speculated that various organs of the body can send pain impulses to the brain stem indicating a severe or overwhelming bodily injury. The reticular activating system responds by producing a functional "shut down", which results in loss of consciousness within a second or two."

    *Along with the endorphins and hypotension, the a-delta excitation causes ACUTE psychological trauma. Due to this, the executionee won't feel the pain, even if the hypotension, pain-induced RAS coma, and endorphins don't kick in. This is because extreme mental trauma causes blackouts even if no mechanical injury has occurred. Such blackouts are common in war veterans, prisoners, victims of natural disasters, those who have lost a loved one, witnessing a tragedy, as well as those subjected to childhood abuse or molestation. These blackouts are known to occur even in the complete absence of bleeding, head-injuries, pain-induced RAS coma, seizures, endorphins, or circulatory disturbances. The brain automatically prevents the traumatized individual from consciously perceiving the emotional agony. It's a protective mechanism for the psyche."
     
  20. GopherBrain

    GopherBrain MARK IT ZERO!!
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    Thread Closed. Reasons:

    #1 - This is a forum for medical students and neurologists in training to share information. This in not a place to ask for medical advice or opinions. It is especially not intended as a place to trade ideas on pseudo-scientific statements pulled from pro-gun websites.

    #2 - This thread has not turned into a real conversation, it is more of a one-sided rant.

    #3 - I clicked in the link, and the 1996-style animated GIF background image is very annoying.
     
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