Dr. Peter Attia

Is consciousness necessary for the internalization of this full gamut of pain?

Is consciousness necessary for the internalization of this full gamut of pain?

Yes. And I just want to point out, and this shows you how long I haven't been in surgery, but 20 years ago, my recollection is an anesthesiologist was giving not just one medication, but several. Yes. So they were giving something like halothane, which to my understanding, we didn't know how it worked then. Do we have any idea how it works today? Better.

Yes. And I just want to point out, and this shows you how long I haven't been in surgery, but 20 years ago, my recollection is an anesthesiologist was giving not just one medication, but several. Yes. So they were giving something like halothane, which to my understanding, we didn't know how it worked then. Do we have any idea how it works today? Better.

The anesthesiologist still had to give typically a narcotic. They were still typically giving something like fentanyl, even though the patient was unconscious. They were also often giving an amnesiac so that they wouldn't have any recollection of what was going on. But of course, we all hear the horror stories of the patient. And a paralytic on top of all that, right?

The anesthesiologist still had to give typically a narcotic. They were still typically giving something like fentanyl, even though the patient was unconscious. They were also often giving an amnesiac so that they wouldn't have any recollection of what was going on. But of course, we all hear the horror stories of the patient. And a paralytic on top of all that, right?

So you hear these horrible stories of the patient who is paralyzed, but somehow conscious. You can miss on this state sort of thing. But just to make sure I understand, in theory, a paralytic and an inhaled anesthetic should be sufficient to eliminate the perception of pain in a patient who is being cut. Yeah.

So you hear these horrible stories of the patient who is paralyzed, but somehow conscious. You can miss on this state sort of thing. But just to make sure I understand, in theory, a paralytic and an inhaled anesthetic should be sufficient to eliminate the perception of pain in a patient who is being cut. Yeah.

Got it. So in other words, you give the inhaled anesthetic just to get unconsciousness, but not to fully suppress the nociceptic system. Instead, you bring on the opioid to do the remainder of that work.

Got it. So in other words, you give the inhaled anesthetic just to get unconsciousness, but not to fully suppress the nociceptic system. Instead, you bring on the opioid to do the remainder of that work.

So does that mean we are seeing a cortisol surge? We're seeing whatever one would expect a conscious person to experience with epinephrine, norepinephrine, cortisol, all those things still surging out in response to pain.

So does that mean we are seeing a cortisol surge? We're seeing whatever one would expect a conscious person to experience with epinephrine, norepinephrine, cortisol, all those things still surging out in response to pain.

Arguably more than you would ever experience. Think about what we do in surgery. My God. Take a scalpel and then take an electrocautery and start burning tissue. I mean, there's no level of nociception you could ever experience like that while being awake, unless you're in a burning car. Absolutely.

Arguably more than you would ever experience. Think about what we do in surgery. My God. Take a scalpel and then take an electrocautery and start burning tissue. I mean, there's no level of nociception you could ever experience like that while being awake, unless you're in a burning car. Absolutely.

So let's go back to something you said at the outset from an evolutionary perspective, which is pain and pleasure have been the driving factors that have been the engine of natural selection. But clearly those things have had to work in pre-conscious models. So that means that whatever we're defining as pain there did not include a perception of pain.

So let's go back to something you said at the outset from an evolutionary perspective, which is pain and pleasure have been the driving factors that have been the engine of natural selection. But clearly those things have had to work in pre-conscious models. So that means that whatever we're defining as pain there did not include a perception of pain.

Right. Does a goldfish experience pain?

Right. Does a goldfish experience pain?

So how does everything you just said differ or overlap with neuropathic pain or that sort of burning pain that I'm sure some people are familiar with? Certainly I was familiar with it for several years. Yeah. Is that simply a subset of this? Are there various different types of pain that don't have a clear cause-effect relation to tissue damage?

So how does everything you just said differ or overlap with neuropathic pain or that sort of burning pain that I'm sure some people are familiar with? Certainly I was familiar with it for several years. Yeah. Is that simply a subset of this? Are there various different types of pain that don't have a clear cause-effect relation to tissue damage?