Does Pain Always Hurt By Moshe Lax

By Author: MosheLax
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Chassidim tell the story of the great Rebbe Rabbi Yisroel Taub (1849-1920), known as the Modzhitzer Rebbe. He suffered from diabetes and in 1913 he travelled to Professor Israel in Berlin for treatment. The only way to save his life was by amputating his gangrenous leg. Before the operation, the Rebbe observed the beautiful Berlin architecture, which upset him by comparison with the desolation of the holy city of Jerusalem. He asked to stay awake during the operation and he composed his epic masterpiece based on the words of Ezkera recited on Yom Kippur. With the total concentration of his love for Hashem and his holy land he basically sang away his physical pain. In previous articles we discussed how perception of a physical emotion is a separate system and it is the mind’s perception that turns it into a feeling.

Pain is not really an emotion. Pain is the consequence of a state of local dysfunction in a living tissue, the consequence of a stimulus—impending or actual tissue damage—which causes the sensation of pain but also causes regulatory responses such as reflexes, and may only then induce emotions on its ...
... own. In other words, emotions can be caused by the same stimulus that causes pain, but they are a different result from the same cause. Subsequent to the stimulus, we can come to know that we have pain and that we are having an emotion associated with it.

Knowing that you have pain requires something else that occurs after the neural patterns that correspond to the substrate of pain—the nociceptive signals—are displayed in the appropriate areas of the brain stem, thalamus, and cerebral cortex and generate an image of pain, a feeling of pain. Tissue damage causes neural patterns on the basis of which the organism is in a state of pain. If you are conscious, those same patterns can also allow you to know you have pain. But whether or not you are conscious, tissue damage and the ensuing sensory patterns also cause the variety of automated responses outlined above, from a simple limb withdrawal to a complicated negative emotion. In short, pain and emotion are not the same thing. Dr. Antonio Damasio repeats this story that occurred in his practice: “[A] patient suffering from a severe case of refractory trigeminal neuralgia.… This is a condition involving the nerve that supplies signals for face sensation in which even innocent stimuli, such as a light touch of the skin of the face or a sudden breeze, trigger an excruciating pain.… As a last resort, the neurosurgeon Almeida Lima, offered to operate on him, based on evidence that producing small lesions in a specific sector of the frontal lobe can alleviate pain…two days after the operation…he had become an entirely different person, relaxed, happily absorbed in a game of cards with a companion in his hospital room.

“When Lima asked him about the pain, he looked up and said quite cheerfully that ‘the pains were the same,’ but that he felt fine now. It was amazing to see how the operation had done little or nothing to the sensory patterns corresponding to local tissue dysfunction that were being supplied by the trigeminal system. The mental images of that tissue dysfunction were not altered and that is why the patient could report that the pains were the same. And yet the operation had been a success. It had certainly abolished the emotional reactions that the sensory patterns of tissue dysfunction had been engendering. Suffering was gone. The facial expression, the voice, and the general deportment of this man were not those one associates with pain.”

This was the first known case to actually prove how the sensation of pain and the emotion and feeling of pain following it are separable and not the same thing. The Gemara (Berachos 61b) says that when Rabbi Akiva was taken out for execution, it was the hour for the recital of the Shema, and while they combed his flesh with iron combs, he was accepting upon himself the kingship of heaven. His disciples said to him, “Our teacher, even to this point?” He said to them: “All my days I have been troubled by this verse, ‘with all thy soul,’ which we interpret to mean ‘even if He takes thy soul.’ I said: When shall I have the opportunity of fulfilling this? Now that I have the opportunity shall I not fulfill it?” Rebbe Akiva explained to his disciples clearly how they should not mistake his physical pain with where his emotional feeling really was. How beautiful are the words of Chazal in Berachos 5a that when Hashem grants someone “pain of love”—yesurim shel ahava—it does not keep the recipient back from any Torah learning or prayers.

Moshe Lax is the President and CEO of Diamond Dynamics LLC, one of the largest diamond manufacturing businesses and wholesalers of loose stones to the luxury market in the United States.