Inside "Ouch!"

Summary

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.

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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).

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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..."

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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?

Transcript

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[Jad Abumrad]

Wait, you're listening. Okay.

[Co-host (possibly Lulu Miller)]

All right.

[Paula Michaels]

Okay.

[Co-host (possibly Lulu Miller)]

All right.

[Jad Abumrad]

You're listening to Radiolab. Radiolab shorts from WNYC.

[Co-host (possibly Lulu Miller)]

And npr.

[Jad Abumrad]

All right.

[Co-host (possibly Lulu Miller)]

Three, two, one. Hey, I'm Jad Abumrad.

[Jad Abumrad]

Okay.

[Robert Krulwich]

I'm Robert Krulwich.

[Jad Abumrad]

You're cheery today.

[Robert Krulwich]

I was cheery. This is Radiolab and this is our podcast version.

[Jad Abumrad]

Yes.

[Co-host (possibly Lulu Miller)]

And today on the podcast, stay in that cheery frame of mind because we're going to talk about pain today. So here's the quandary. It is really hard to put words to pain, like, to describe to somebody. I have this pain in my back and it feels like, like really hurting. It's like it's really difficult to describe to someone in a way that would let them feel it, too. It's like one of these classic empathy barriers, right?

[Robert Krulwich]

That's true.

[Co-host (possibly Lulu Miller)]

But if you could quantify it, measure it, if I could know exactly numerically what you're going through, maybe that would help. Maybe we could be better friends.

[Robert Krulwich]

If you could. Do you think you could? Is that what you know?

[Co-host (possibly Lulu Miller)]

We're gonna try. See, our producer, Tim Howard, over the last few months, has encountered three different people who in different ways are trying to measure pain. Share it.

[Robert Krulwich]

So we're going to do three episodes of pain calibration. Calibration.

[Co-host (possibly Lulu Miller)]

A triptych of pain calibration.

[Robert Krulwich]

Okay, bring it on.

[Jad Abumrad]

Here's Tim.

[Justin Schmidt]

Well, hi.

[Co-host (possibly Lulu Miller)]

Come on in.

[Eula Biss]

How you doing?

[Jad Abumrad]

I got started with all this when I met this guy.

[Justin Schmidt]

Yeah, I'm Justin Schmidt. I'm a research biologist, but he's really a bug guy. I like to try to get into the head of the stinging insect.

[Jad Abumrad]

He lives in Tucson, Arizona and works in this one story building on a residential street.

[Justin Schmidt]

Right now we're in my labor at Southwestern Biological Institute.

[Jad Abumrad]

Could we just take a quick, like, glance around?

[Justin Schmidt]

Yeah, yeah.

[Robert Krulwich]

This is.

[Jad Abumrad]

I'd love to just, like, know what it is that we're looking at.

[Justin Schmidt]

Underneath Those cabinets are 48 drawers of insect specimens. So these are.

[Jad Abumrad]

Oh, wow. He's got wasp.

[Justin Schmidt]

That's a poika. And it's a nocturnal wasp.

[Jad Abumrad]

That is terrifying. This one here. Different kinds of weird. What is this guy? Hornets.

[Justin Schmidt]

That's actually a flightless grasshopper.

[Jad Abumrad]

It's got a lot of ants. Wow. There's some little furry.

[Justin Schmidt]

Yeah, those are velvet ants.

[Jad Abumrad]

They're huge.

[Justin Schmidt]

If you pick up one of these things and get stung by, it's gonna feel like, oh, my goodness, that could kill a cow.

[Jad Abumrad]

Okay. So this all started for Justin back in the 70s when he was a grad student.

[Justin Schmidt]

And I just thought for a lark, I took a seminar course in entomology. We had one entomologist in the whole university.

[Co-host (possibly Lulu Miller)]

This is of course in bug science.

[Jad Abumrad]

Yeah, this was in Georgia. And he was outside one day in the field and he was trying to get a sample of a harvester ant. Harvester ant? What does that look like?

[Justin Schmidt]

They're about a third of an inch long and they're bright red. Pretty good sized ants, actually.

[Jad Abumrad]

And he was trying to get one into a jar and I got stung.

[Justin Schmidt]

By one and I kind of. Oh, it's odd.

[Jad Abumrad]

Didn't really hurt at first.

[Justin Schmidt]

Okay. It sort of felt like somebody was using a dent syringe, a really fine needle, slowly injecting a little bit of water. It had this kind of crystalline feeling. It wasn't an immediate pain. This was a delayed thing. And so then I thought, oh, okay. But after about a minute, it started really hurting. I said, oh, this really hurts. It was this really deep sort of visceral pain. Something was going in and tearing out your nerves and your muscles and your tendons. What struck me was how dramatically different this was from anything that I'd experienced from a bumblebee, honeybee, sweat bee, yellow jacket, paper wasps.

[Jad Abumrad]

And once the pain subsided, he thought, man, I need to study that.

[Justin Schmidt]

Yeah.

[Jad Abumrad]

You know, he had all these kind of higher level science questions about, you know, evolution of pain in insects and how different stinging insects developed.

[Justin Schmidt]

But the problem was, oh, okay, pain. What do we do about measuring pain?

[Jad Abumrad]

If he was really going to get to the bottom of why one insect was more or less painful than another, he couldn't do that with just words like more or less.

[Justin Schmidt]

I need numbers.

[Jad Abumrad]

With numbers, he could do all kinds of research. Not to mention it would make working with other bug scientists just a lot easier.

[Justin Schmidt]

And I started looking into this and found out, oh, this wasn't anything new. Nobody really knows how to measure pain.

[Jad Abumrad]

Because, you know, no two people feel pain the same way.

[Justin Schmidt]

Some people have higher pain tolerance than others.

[Jad Abumrad]

On the other hand, that harvester ant was objectively way more painful than anything he'd ever been stung by.

[Justin Schmidt]

Oh, yeah.

[Jad Abumrad]

So Justin realized what I need is a universal insect sting pain scale. So Justin starts traveling all around the world and he's, you know, every time he hears about a bug, especially a stinging bug, he goes looking for it.

[Co-host (possibly Lulu Miller)]

In order to be stung by it.

[Justin Schmidt]

Well, I don't like pain.

[Jad Abumrad]

So he says he's not trying to get stung, but it usually happens. And as far as he's concerned, that a good thing.

[Justin Schmidt]

For example, I was petrified of this senica, which I call the warrior wasp.

[Jad Abumrad]

A senica is this black wasp with.

[Justin Schmidt]

This metallic sheen down in Central America.

[Jad Abumrad]

And they're known for this warning sound that they make with their nest.

[Justin Schmidt]

They have this big carton nest. Carton being kind of paper, kind of goes.

[Jad Abumrad]

Justin was there with another scientist. And they're tromping through the jungle and then they find a nest.

[Justin Schmidt]

Here we are at this nest and.

[Jad Abumrad]

It starts to make that sound.

[Justin Schmidt]

Well, sure enough, we eventually got a kamikaze that came out and nailed me.

[Jad Abumrad]

Where did he sting you?

[Justin Schmidt]

Kind of on my forehead. And I just sort of sat on the stump and said, oh, this really hurts. It hurt like a yellow jacket or a hornet, but it was just a whole lot more.

[Jad Abumrad]

And it kept hurting for an hour.

[Justin Schmidt]

And so I recorded what the feeling was for this hour.

[Jad Abumrad]

But you're sitting there on a stomp or something and your forehead is throbbing and you're taking notes.

[Justin Schmidt]

Well, what else can you do?

[Jad Abumrad]

He talks about getting stung by something that makes him hurt so much that he just starts screaming in pain for like an hour and lying on the ground because that'll make the pain less, I guess.

[Justin Schmidt]

And my left hand sitting here shaking, it's trembling, you know, it's going up and down. And I said, oh, darn hand.

[Lowe's Advertiser]

Stopp.

[Jad Abumrad]

Then with his other hand, he's taking notes about exactly how it feels.

[Justin Schmidt]

This left one's here flapping away and I'm.

[Jad Abumrad]

In any case, how many times has he been stung? He told me he's been stung by like 150 species and probably about a thousand times.

[Co-host (possibly Lulu Miller)]

What?

[Jad Abumrad]

And he's used all those experiences to build up a scale, which you could.

[Justin Schmidt]

Say is a five point scale. 0, 1, 2, 3 and 4. 0 being that's essentially trivial.

[Jad Abumrad]

And 4 being it really hurts.

[Co-host (possibly Lulu Miller)]

But wait, how does he deal with the whole subjectivity thing? Because like your four is gonna be different than my four.

[Jad Abumrad]

He did something pretty clever, which is that he took that one sting that we pretty much all know and decided I'm gonna use that as for reference.

[Justin Schmidt]

So I anchored it with the honeybee, which is. Ouch.

[Jad Abumrad]

Which you can talk about with anybody. Anybody's been stung by a honeybee.

[Co-host (possibly Lulu Miller)]

Yeah.

[Jad Abumrad]

It also doesn't hurt too much and it doesn't hurt too little.

[Co-host (possibly Lulu Miller)]

So it's like a midpoint.

[Justin Schmidt]

Exactly. And 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. There's no way to know what the top or the bottom is. So honeybee was. Was that. And so you give that a two.

[Jad Abumrad]

Two out of four. The prime meridian of pain. And every time he gets stung by a new bug, he'll ask himself, is.

[Justin Schmidt]

It more than a honeybee, less than a honeybee? About the same as a honeybee. A whole lot more, a whole lot less.

[Jad Abumrad]

Then he gives that sting its own number. Dig this. 1.0. Sweat bee. Light, ephemeral, almost fruity. 1.8. Bullhorn acacia ant. A rare piercing, elevated sort of pain. Someone has fired a staple into your cheek. 2.0. Bald faced hornet. Rich, hearty, slightly crunchy. Similar to getting your hand mashed in a revolving door.

[Eula Biss]

Ow.

[Jad Abumrad]

3. Red harvester. Bold and unrelenting. Somebody's using a drill to excavate your ingrown toenail.

[Eula Biss]

Ah.

[Co-host (possibly Lulu Miller)]

This is his pain scale.

[Jad Abumrad]

Justin calls this his tongue in cheek version.

[Justin Schmidt]

That was more fun.

[Jad Abumrad]

But yeah, these are some of the things that he's measured.

[Co-host (possibly Lulu Miller)]

And what's the, what's the worst? What's the top of the scale?

[Jad Abumrad]

The bullet ant.

[Justin Schmidt]

It sends extreme, excruciating waves of burning pain that are undiminished for 12 hours. And you get these pulsations. You get this pain crescendo that goes to you just about wanting to scream, and then it backs off a little bit, and so you say, ah. You kind of give it a little bit of a sigh of relief, and then it ascends back up and it keeps doing this. These hills and valleys of ascending pain and then decreasing. Even the decreasing to the lowest still hurts.

[Co-host (possibly Lulu Miller)]

So this scale works for him. I think he uses it to communicate with bug scientists.

[Jad Abumrad]

Yeah. Yeah.

[Paula Michaels]

Wow.

[Co-host (possibly Lulu Miller)]

Well, all right. That's kind of cool. But I gotta be honest.

[Jad Abumrad]

I.

[Co-host (possibly Lulu Miller)]

This is. I'm wanting more right now because I. I like the scale, but I'm thinking actually beyond bugs to, like. Let me just put my cards on the table. Like childbirth. Okay. Like, when we talk about the gap.

[Jad Abumrad]

Whoa.

[Co-host (possibly Lulu Miller)]

Okay. I know, but we talk about the gap between, like, two people feeling pain and being able to share pain. That's where the rubber meets the road.

[Robert Krulwich]

Well, it's used in a lot of marriages as a constant. You don't know. You don't know what, exactly.

[Co-host (possibly Lulu Miller)]

Thank you, Robert. Does Tamar use it the way Carla uses it?

[Robert Krulwich]

Well, I can't say that in a recording.

[Jad Abumrad]

No, not at all.

[Robert Krulwich]

Really? Never? I don't know. I wouldn't cross my mind.

[Co-host (possibly Lulu Miller)]

Carla, who's a very sort of understating lady when it comes to this subject. She'll be like, you have no idea. You don't even begin to know what you don't know about what we just went through.

[Jad Abumrad]

Well, that brings me to my second story.

[Paula Michaels]

Can I take it from the top for this one?

[Jad Abumrad]

We go back a few years, so.

[Paula Michaels]

We'Re in 1948. Who is this lady?

[Jad Abumrad]

This is Paula Michaels. She's a professor of the history of medicine.

[Paula Michaels]

I teach at the University of Iowa.

[Jad Abumrad]

And she told me this story that takes place in New York at New York Hospital in 1948.

[Paula Michaels]

Right. So there's James D. Hardy, there's Carl T. Javert.

[Jad Abumrad]

Hardy and Javert are doctors, and they're.

[Paula Michaels]

Trying to test drugs. You know, what drugs are going to be useful to alleviate the pain of childbirth. And in this period, there's a whole range of things that are being used.

[Jad Abumrad]

What are some of the ones that they're using?

[Paula Michaels]

Well, like morphine and scopolamine. Demerol is a big thing.

[Co-host (possibly Lulu Miller)]

Nice.

[Paula Michaels]

And heroin, which to me sounds completely crazy.

[Co-host (possibly Lulu Miller)]

They play around with crack, too.

[Jad Abumrad]

They would have if they knew about it. The problem is they want to be able to test all these drugs so that they can use them in a standard way. But they weren't actually sure how much pain women were really in.

[Co-host (possibly Lulu Miller)]

I guess you kind of have to know that in order to know how much drugs to give them.

[Jad Abumrad]

Yeah, they had no idea. And it was a source of a lot of debate.

[Eula Biss]

Yes.

[Paula Michaels]

One man, Grantly Dick Reid, a British physician, basically said straight out, it's in women's minds, not their bodies.

[Jad Abumrad]

What?

[Paula Michaels]

Childbirth is a completely painless experience, entirely psychological in origin.

[Jad Abumrad]

Wow, that is an incredibly bold thing for a man to say.

[Paula Michaels]

Yes, that's chutzpah.

[Jad Abumrad]

Now, Hardy and Javert didn't take it that far, but they wanted to get past the whole messy psychological part of.

[Paula Michaels]

Childbirth and eliminate that woman's subjective experience of pain from the calculation of whether these drugs are effective or not.

[Jad Abumrad]

And how are they going to do this?

[Paula Michaels]

Well, their method is pretty crazy. They had this apparatus called a dolorometer.

[Jad Abumrad]

It was this little wood box that had dials and knobs plugged into the wall and then was connected by a.

[Paula Michaels]

Wire to another part, what they called the exposure unit.

[Jad Abumrad]

That was like a heat gun, an aperture that can shoot out heat. Then they got some volunteers.

[Paula Michaels]

Some of them were nurses. Some of them were the wives of obstetricians or other physicians, all very pregnant.

[Jad Abumrad]

And they told these women, this might not be very pleasant, but by participating, you're gonna be making childbirth just so much better for every woman to follow.

[Paula Michaels]

That's right.

[Jad Abumrad]

And the women were excited to help.

[Paula Michaels]

And then when the woman went into.

[Jad Abumrad]

Labor, Hardy and Javert would show up bedside with the dolerometer, and they'd wait for the contraction to finish.

[Paula Michaels]

And then between contractions, during that pause.

[Jad Abumrad]

They take the heat gun, and they'd put it against the back of the woman's hand, and they'd say to her, all right, we want to know about that contraction, the one you just had. Yeah, we want to know how much it hurt.

[Paula Michaels]

They'd say, is it more like A or more like B? And then the woman would respond, guess B is closer. Then they would say, is it more like B or more like C? C. Maybe that was a way of then saying, okay, well, that was a contraction of three doles.

[Co-host (possibly Lulu Miller)]

Doles. What's a dole?

[Jad Abumrad]

The dole is their unit of pain, their standard unit that they use for everybody. And so over the course of labor, after every contraction, they would repeat this process. Same drill.

[Paula Michaels]

Is it more like A or more like B?

[Jad Abumrad]

Again a. B and again B or more like.

[Paula Michaels]

C. And again, over the course of her Whole labor.

[Co-host (possibly Lulu Miller)]

So wait, on top of all the labor pains, they're just cranking this heat up and up?

[Jad Abumrad]

Yeah.

[Co-host (possibly Lulu Miller)]

Wow.

[Jad Abumrad]

In the case of one patient who insisted on going the distance, a pain.

[Paula Michaels]

Intensity of 10 and a half doles was measured.

[Jad Abumrad]

Hardy and Javert called this the ceiling.

[Paula Michaels]

This is the most intense pain which can be experienced. Second degree burns were inflicted upon the hands of this patient by the four tests made at levels higher than 9. Dolls.

[Co-host (possibly Lulu Miller)]

Second degree burns?

[Jad Abumrad]

Yeah.

[Co-host (possibly Lulu Miller)]

I mean, I like what these guys are trying to do, but wow, that is sadistic.

[Paula Michaels]

It seems totally twisted, but it's in the name of science. It's for a greater good.

[Jad Abumrad]

All right, so then the doctors, they took all of the data from all of the women, and they start going through it, looking for patterns, looking for things in common. And then the most incredible part to me is that they converted all that information into a mathematical formula.

[Paula Michaels]

Doles of pain equals 10.5 minus 1.5 times contraction intervals in minutes.

[Co-host (possibly Lulu Miller)]

What?

[Jad Abumrad]

Well, so they're saying if you tell us the amount of time between the contractions at any point in her labor, we can tell you exactly how much pain the woman is in. No more mystery, there's no more wondering.

[Co-host (possibly Lulu Miller)]

Problem solved.

[Jad Abumrad]

The code is cracked and what happens?

[Co-host (possibly Lulu Miller)]

Does this breakthrough sweep the medical establishment? I'm guessing it doesn't.

[Jad Abumrad]

Well, no.

[Paula Michaels]

Other people could not achieve the same results that they achieved using the Deloxe. I don't know why I can't. Using the dolorometer. They were not able to achieve the.

[Jad Abumrad]

Same results when other doctors tried to do it. The formula didn't seem to apply to the women that they looked at. Shocker. Obviously, there's a lot of problems with the entire approach these guys had, Right?

[Co-host (possibly Lulu Miller)]

No.

[Jad Abumrad]

Yeah. I mean, for starters, they were trying to compare pain in the abdomen to, you know, like a burning sensation on the arm.

[Co-host (possibly Lulu Miller)]

Yeah, I mean, that's like a translation problem.

[Jad Abumrad]

Yeah. Well, I mean, in my opinion, there's kind of a bigger translation issue happening, which is in order to talk about a pain you're feeling, you need to be able to observe it and kind of stand apart from it in your own head, if that makes sense.

[Co-host (possibly Lulu Miller)]

Sure.

[Jad Abumrad]

And when you hear women talk about the pain of childbirth. Hello, my name is Sarah.

[Listener (Tharice)]

I'm in Sacramento, California.

[Jad Abumrad]

We asked people to submit theirs through the Radiolab app. And when you listen to these different.

[Eula Biss]

Accounts, my experience of childbirth pain was.

[Jad Abumrad]

It sounds like there's a certain point where everything shifts. And one woman said it was at about, like, 7 centimeters dilated and that's.

[Co-host (possibly Lulu Miller)]

When you lose your mind, and you.

[Eula Biss]

Can'T think, you can't talk.

[Jad Abumrad]

Suddenly, the pain becomes so great, so bad. There's no more reference point. I just remember there's no more objective distance making these noises that were just unearthly. And in these submissions, it's usually at this point in the story where the woman either just draws a blank. Wow. Or resorts to some crazy analogy.

[Co-host (possibly Lulu Miller)]

It felt like there was a freight.

[Paula Michaels]

Train bearing down on my vagina from inside my body, and that I could almost hear it building.

[Eula Biss]

I felt like I was being dragged out to sea.

[Jad Abumrad]

That's one I actually heard a couple times. Waves. Waves of pain. And it was kind of like that for Paula, too.

[Paula Michaels]

I turned very much inward in a way that made time feel like it stopped. I was drowning.

[Eula Biss]

Drowning in this lake of pain. And there was a horizon. And when the contractions were intense, I would swim towards the horizon.

[Jad Abumrad]

This is Eula.

[Eula Biss]

I'm Eula Biss.

[Jad Abumrad]

I'm a nonfiction writer, and she's our third pain calibrator. And for me, Eula kind of gets the closest at finding a way to communicate pain. If I could say you have a relationship with pain, when did that start for you?

[Eula Biss]

Let's see. About. Almost 10 years ago, I think. I was about 26 at the time.

[Jad Abumrad]

Eula was a grad student in Iowa.

[Eula Biss]

And I just woke up one morning in the fall, and I had a terrible pain in the side of my neck, upper back, side of my face.

[Jad Abumrad]

She had no idea what it was. It was a burning pain with this nauseating tingling sensation.

[Eula Biss]

I've really never felt anything else like it. And months passed, and it didn't go away, and it was making it very difficult for me to sleep. It started to interfere with my thinking, too. I couldn't concentrate.

[Jad Abumrad]

So one day she went to the hospital, and by this point, she was a total mess.

[Eula Biss]

So I was kind of teary and shaking, and I said, you need to give me something to help me with this.

[Jad Abumrad]

And so the doc said, all right, well, take a look at this thing up here on the wall. This is called the pain scale.

[Eula Biss]

It had the numbers 0 to 10. At one end it said, no pain. At the other end, it said, the worst pain imaginable.

[Jad Abumrad]

And the doctor says to her, okay, what number is your pain? Eula starts to think about it.

[Eula Biss]

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?

[Jad Abumrad]

Hmm.

[Eula Biss]

You know, this was around the time That I think a man had died being dragged behind a truck in Texas. And I remember sitting in the exam room thinking about that. And then I was trying to do some rudimentary mathematics. If being dragged behind a truck to your death is the worst pain imaginable, what. What proportion of that do I feel? And I thought, you know, a third of that seemed pretty significant to me.

[Jad Abumrad]

So she says, three, I guess. And the doc's like, all right. And he does some tests. He tries to figure out exactly what's going on. Can't really. But since she said three anyway, he's like, all right, well, you know, have some aspirin, go home. And this happened a few times. She wasn't getting any better. So at a certain point, she calls up her dad, who's also a doctor, and she starts complaining.

[Eula Biss]

I was telling him how frustrated I was that the doctors didn't seem to be taking this very seriously. And he said, well, when they ask you to rate your pain, what do you tell them? And I said, I usually say three. And he said, well, there's your problem.

[Jad Abumrad]

Her dad tells her, you should say eight, even if you're not feeling it. That's what you got to say. And Eula thinks this is ridiculous. Why do we even have a pain scale if I'm not supposed to take the numbers seriously?

[Eula Biss]

And he said, in part, it's a tool that's meant to protect practitioners because it's emotionally difficult to have someone say to you, it feels like someone's jamming a red hot poker through my eyeball rather than, I've got a nine.

[Jad Abumrad]

But then he made a suggestion which I think is really clever.

[Eula Biss]

He suggested one scale where it would measure what you're willing to do to get rid of your pain. What would you trade for pain relief? Would you give up your sense of sight for five years? Would you relinquish your ability to walk?

[Jad Abumrad]

Did you come up with any answers at that point?

[Eula Biss]

I did. They were disturbing answers. You know, when my father asked, would you accept a shorter lifespan at that point in time? I thought, yeah, I would.

[Jad Abumrad]

By how many years?

[Eula Biss]

I was thinking I'd take 10 years off my life.

[Co-host (possibly Lulu Miller)]

Wow.

[Jad Abumrad]

For me, that was basically the first time I felt like I understood her pain.

[Eula Biss]

But, you know, I was 26, and life seems really long when you're 26. Now I'm in a much different spa. My pain is not nearly as bad as it was then. So now I'm not really in the bargaining mood anymore.

[Jad Abumrad]

I bet. Like, how about a bad haircut Would you take a really bad haircut? A Mohawk?

[Eula Biss]

Huh? Okay. Yeah, actually, I would.

[Jad Abumrad]

And these days, Eula's kind of pessimistic about the idea that we're ever gonna really have a useful pain scale.

[Eula Biss]

At the end of the day, I'm not sure pain is a quantity that is measurable.

[Jad Abumrad]

Thinking that kind of bums her out.

[Eula Biss]

Because part of me wanted to believe in the project of quantification.

[Jad Abumrad]

Why?

[Eula Biss]

I'm not sure. I think because not believing in it is a little bit lonelier. The idea that we cannot feel, cannot understand, and cannot imagine each other's pain is a really isolating thought.

[Co-host (possibly Lulu Miller)]

By the way, what was her pain from? Did she get a diagnosis?

[Jad Abumrad]

Well, her doctor tried a lot of stuff, actually. They did a brain scan, they checked for a spinal infection, and ultimately he.

[Eula Biss]

Said, you know, unfortunately, we don't know what causes this. We don't know how to treat it. We don't know if it will ever get better, but we do know it's real. And that was my final conversation with him. And he said, good luck out there.

[Co-host (possibly Lulu Miller)]

Thanks to producer Tim Howard, Justin Schmidt, Paula Michaels, and Eula Bis. I'm Jad Abumran.

[Robert Krulwich]

I'm Robert Krulwich.

[Co-host (possibly Lulu Miller)]

Thanks for listening.

[Eula Biss]

Hi, guys.

[Listener (Tharice)]

I just called and I think I messed up, so I want to try it again, okay?

[Co-host (possibly Lulu Miller)]

Okay.

[Listener (Tharice)]

Hi, this is Tharice. I am a Radiolab listener in Jamaica Plain, Massachusetts, and here are the credits. Radiolab is supported in part by the National Science foundation and by the Alfred P. Sloan Foundation. Enhancing public understanding of science and technology in the modern world. More information about [e-mail]. i think that one was better. Thanks, y'.

[Paula Michaels]

All.

[Listener (Tharice)]

Bye. End of message.