Radiolab — Inside "Ouch!" (August 27, 2012)

Overview of the Episode

This episode of Radiolab, hosted by Jad Abumrad, Robert Krulwich, and (possibly) Lulu Miller, dives deep into the elusive and highly subjective experience of pain. The hosts set out to explore a fundamental challenge: can pain ever be measured, shared, or communicated reliably from one person to another? Through three interwoven stories—a biologist’s attempts to rate insect stings, a mid-century medical experiment in childbirth, and a writer’s reckoning with chronic pain—the episode investigates the scientific, historical, and personal attempts to "calibrate" pain.

Key Discussion Points and Insights

1. The Challenge of Describing and Measuring Pain

• Pain is notoriously hard to describe—words often fail to communicate its reality, making it a critical "empathy barrier" between people.
  • Quote, Lulu Miller (02:00):
    "It is really hard to put words to pain... It's like one of these classic empathy barriers, right?"
• The episode’s goal is to examine whether pain can be measured or quantified, thus enabling shared understanding.

2. Justin Schmidt and the Insect Sting Pain Scale

[03:06–11:23]

Meet Justin Schmidt

• Justin Schmidt, an entomologist in Tucson, Arizona, is best known for developing a numerical scale to rate the pain caused by insect stings.
• His journey began after a particularly painful harvester ant sting, which was "viscerally" different from bee or wasp stings.

Building a Pain Scale

• Realizing the need for a standardized reference, Schmidt created a five-point scale (0–4) based on comparative sting experiences.
  • Quote, Schmidt (09:01):
    "0 being that's essentially trivial... 4 being it really hurts."
• The honeybee sting, familiar to many, became the universal midpoint—a "2" on the scale.
  • Quote, Schmidt (09:42):
    "A middle point in this case was easier than a top or a bottom because I didn't know what the top or bottom were... So honeybee was...was that. And so you give that a two."
  • The scale uses vivid, often tongue-in-cheek descriptions.
    • 1.0: Sweat bee — "Light, ephemeral, almost fruity."
    • 1.8: Bullhorn acacia ant — "Like someone has fired a staple into your cheek."
    • 2.0: Bald-faced hornet — "Similar to getting your hand mashed in a revolving door."
    • 3: Red harvester ant — "Somebody's using a drill to excavate your ingrown toenail."
    • 4: Bullet ant — "Extreme, excruciating waves of burning pain... undiminished for 12 hours."
      • Quote, Schmidt (10:48):
        "It sends extreme, excruciating waves of burning pain... ascending pain and then decreasing. Even the decreasing to the lowest still hurts."

Reflections on the Scale

• The hosts note that the system, while clever, is specific to bug stings and also raises the problem of subjectivity—whose “4” is the real “4”?
• Memorable moment: The comedic horror as Schmidt recounts being stung hundreds of times, methodically recording his pain as his "hand [is] flapping" (08:48).

3. Pain Measurement in Childbirth: The Dolorometer

[12:27–18:15]

Historical Attempts at Quantifying Childbirth Pain

• In 1948, New York doctors Hardy and Javert tried to create a scientific, objective measurement of labor pain to test the efficacy of painkillers.
• Their apparatus, the "dolorometer," delivered controlled burns to a woman’s hand during labor contractions to calibrate pain scores, establishing the "dole" as a standard pain unit.

Ethical and Scientific Problems

• Patients endured additional burns on top of labor—the most "pain" recorded was 10.5 doles, which produced second-degree burns (16:11).
  • Quote, Paula Michaels (16:18):
    "Second degree burns were inflicted upon the hands of this patient by the four tests made at levels higher than 9. Doles."
  • Quote, Jad Abumrad (16:31):
    "I mean, I like what these guys are trying to do, but wow, that is sadistic."
• The experiment failed because the mathematical formula developed could not be replicated, mainly due to the flawed assumption that different kinds of pain (burns vs. contractions) could be directly compared.
• Quote, Jad Abumrad (17:12): "They were trying to compare pain in the abdomen to, you know, like a burning sensation on the arm. That’s a translation problem."

Deeper Issue: The Limits of Objectification

• Jad suggests a "bigger translation issue": to talk about pain, you must observe it—but pain often overwhelms perspective.
• Quotes from listeners and guests:
  • Eula Biss (20:04): "I felt like I was drowning in this lake of pain..."
  • Listener (19:26): "It felt like there was a freight train bearing down on my vagina from inside my body..."

4. The Subjective Nature of Pain Scales: Eula Biss’s Story

[20:16–25:47]

Personal Experience with Chronic Pain

• Nonfiction writer Eula Biss recounts an episode of mysterious burning pain that overtook her life for months.
• When asked to rate her pain on a 0-10 numerical hospital scale, Eula was paralyzed by the ambiguity: is "10" the worst pain I myself have felt, or the worst pain possible?
  • Quote, Eula Biss (21:45):
    "The worst pain imaginable is kind of vague. Is this the worst pain you yourself can imagine, or is it the worst pain imaginable on earth?"
• Her moderate rating ("3") meant doctors dismissed her pain. Her physician father advised her to always say "8," regardless of reality.

What Would You Trade for Relief?

• Eula’s father proposes a scale based on the sacrifices you'd make for pain relief—a granularity much more personally meaningful.
  • Quote, Eula Biss (24:05):
    "When my father asked, would you accept a shorter lifespan at that point in time? I thought, yeah, I would..."
• Eula concludes that pain may simply not be quantifiable—a deeply lonely realization.
  • Quote, Eula Biss (25:18):
    "The idea that we cannot feel, cannot understand, and cannot imagine each other's pain is a really isolating thought."

Notable Quotes & Memorable Moments

• Justin Schmidt [07:09]:
  "Well, I don't like pain... But it usually happens."
• Co-host [12:31]:
  "Let me just put my cards on the table. Like childbirth... when we talk about the gap between two people feeling pain and being able to share pain? That's where the rubber meets the road."
• Paula Michaels [13:51]:
  "Childbirth is a completely painless experience, entirely psychological in origin."
• Jad Abumrad [17:12]: "They were trying to compare pain in the abdomen to, you know, like a burning sensation on the arm… that’s a translation problem."
• Eula Biss [25:18]: "The idea that we cannot feel, cannot understand, and cannot imagine each other's pain is a really isolating thought."

Timestamps for Important Segments

• [02:00] – Introduction of empathy barrier in pain
• [03:06] – Justin Schmidt introduces his bug pain scale
• [09:01] – Details of the numerical sting pain scale
• [10:48] – Description of the most excruciating sting (bullet ant)
• [12:27] – Childbirth pain: The dolorometer experiment
• [16:11] – The "ceiling": 10.5 doles results in second-degree burns
• [18:29] – Discussion: The translation problem and the separation needed to describe pain
• [19:25-20:16] – Listeners and guests use metaphors to describe childbirth pain
• [20:16] – Eula Biss's experience with chronic pain and the failings of the pain scale
• [21:45] – Dilemma of self-assessing pain numerically
• [24:05] – The "what would you trade?" scale
• [25:18] – The existential loneliness of subjective pain

Takeaways

• Attempts to quantify pain—be it through a bug sting index, mechanical devices, or hospital questionnaires—are always beset by subjectivity, translation, and the personal/relational context of suffering.
• Scientific optimism offers precision and comparison, but always bumps up against the unique, unshareable experience of pain.
• Connecting through metaphor (waves, drowning, freight trains), trade-offs, and empathy provides the closest semblance of understanding.
• The episode’s tone is wry, curious, and open-hearted, ultimately acknowledging both the value and the limitations of trying to share what hurts.

For Listeners Who Missed The Episode

This episode will leave you with a profound appreciation for the mysterious, isolating, and sometimes darkly humorous reality of pain's subjectivity. It’s a journey through science, history, and lived experience—never losing sight of the humanity behind the question: can anyone else ever really know how much it hurts?