Expert: Dr Ian Jackson - please note UK based - 3/24/2007

Question
Hi:

Does the following long message have any truth to it?

If this is beyond your expertise would you mind steering me to a person/forum who could answer my question?


Thanks,

Green



Message starts below:


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.jspzQzpgzEzzSzppdocszSzuszS...

"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[s]

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.

Answer
Hi there again.
Another slant on the same question as I answered on 13/12/06 - though with a bit more meat on the bones! I will repeat my original answer and then go further (so please read on)
A very interesting question. I have never come across this word in my time in medicine in the UK. A google search of UK sites revealed no hits and a medline search again revealed no hits. I have checked various dictionaries and they do not have this as a word.
So there you have it - in the UK it is a word that I have never come across and I do not believe that the word exists in our current usuage.
As to "the unconscious discharge of nervous energy under the stimulus of trauma, as in surgical shock"
This appears to be talking about the bodies reaction to trauma. This is well documented and much of this takes place via the autonomic nervous system which I assume is the "unconscious discharge" bit as it is not something we control with our conscious brain.

I have now searched again and found a few hits on google. It is interesting that these have occurred since your last question. Many (actually all are linked eventually) seems to be linked to a screen name 'Radium' who seems to have a bit of a thing about this. This person has also come up with how to manage the problem - amazing.
Having scanned the extensive text you have sent it seems the author has a particular issue about the autonomic nervous system and what happens under general anaesthesia. Funny how this has appeared since my last answer. However he/she seems to have little knowledge of how anaesthetists control pain pathways during anaesthesia and the article is written in an unfortunate sensationalist manner.
I would ask you - if this was a major problem then how would we have managed to hide this from the press and the public. How is it that we can now safely anaesthetise patients who are very unfit for quite major surgery OR how do we manage to protect the many young patients who suffer major trauma with multiple fractures or even extensive burns?
I'm glad to say that on the whole our bodies are well adapted to managing with the results of trauma or surgery - with the help of your anaesthetist.
I hope this helps.
Dr Ian Jackson