How a 67-Year-Old Review Shaped the Science of Pain
The quest to quantify human suffering is one of medicine's greatest challenges.
If you've ever visited a doctor and been asked, "On a scale of 1 to 10, how would you rate your pain?" you've encountered one of the most persistent problems in medicine: the fundamental challenge of measuring a subjective experience. This deceptively simple question masks a complex scientific puzzle that has troubled clinicians and researchers for over a century.
In 1957, a groundbreaking scientific review titled "The Measurement of Pain: Prototype for the Quantitative Study of Subjective Responses" attempted to bring order to this chaos. Surveying 106 years of conflicting research, its author sifted through mountains of data to draw conclusions that would reshape how science approaches subjective experiences 1 . Decades later, this seminal work continues to influence how researchers strive to transform pain from a private agony into a quantifiable, treatable phenomenon.
The 1957 review analyzed pain research spanning over a century, from 1851 to 1957, creating a foundation for modern pain science.
The 1957 review was remarkable not for presenting new experimental data, but for its comprehensive synthesis of a century's worth of pain research. In what the author described as a "rather formidable length of presentation of data," the review grappled with opposing views on nearly every aspect of pain measurement 1 . From this exhaustive analysis emerged several revolutionary concepts that continue to resonate in modern pain science.
The review began with a humbling admission: "Pain cannot be satisfactorily defined, except as every man defines it introspectively for himself" 1 .
After examining the evidence, the author concluded that "No convincing demonstration has yet been given that the pain threshold is a constant from man to man" 1 .
Analgesic agents appear to exert their principal effect on the 'reaction component' rather than on the 'original sensation' 1 .
| Concept | Conclusion | Modern Significance |
|---|---|---|
| Defining Pain | Cannot be satisfactorily defined except individually | Recognizes pain as a personal, subjective experience |
| Pain Threshold | Not constant between people or across time | Explains why standardized treatments fail |
| Experimental vs. Pathological Pain | Differ greatly in quantitative representation | Critical for designing valid drug trials |
| Analgesic Mechanism | Primarily affects reaction component, not original sensation | Shifted focus to combination therapies |
"Analgesic agents appear to exert their principal, if not entire, effect on the 'reaction component' rather than on the 'original sensation'" 1 .
For decades after the 1957 review, pain assessment relied almost exclusively on self-reporting tools like the Numeric Rating Scale (0-10) or the Wong-Baker FACES scale 4 . While useful, these tools remain subjective and limited, particularly for infants, older adults with dementia, or critically ill patients who cannot effectively communicate their experience 3 .
Try hovering over the different pain levels:
| Physiological Signal | Measurement Method | Utility in Pain Detection |
|---|---|---|
| Facial Expressions (FE) | Video analysis with computer vision |
|
| Electroencephalography (EEG) | Enobio 32 wireless sensor |
|
| Skin Conductance (SC) | FlexComp Infiniti system |
|
| Blood Volume Pulse (BVP) | FlexComp Infiniti system |
|
| Electromyography (EMG) | FlexComp Infiniti system |
|
The study demonstrated that combining multiple sensors improved accuracy, creating a more comprehensive picture of the pain experience 3 .
Facial expressions effectively distinguished pain states
EEG showed clear brain activity changes
Skin conductance indicated arousal
Multimodal approach increased accuracy
The 1957 review served as a "prototype for the quantitative study of subjective responses," arguing that "Quantitative work with pain is possible and rewarding" 1 . This vision has inspired generations of researchers to develop increasingly sophisticated tools for pain measurement.
Primary Tools: Basic thermal & pressure stimulators, subjective reports
Limitations: Poorly controlled factors, conflicting results
Advances: Systematic review of evidence
Primary Tools: Standardized scales (NRS, VAS, McGill Pain Questionnaire)
Limitations: Subjectivity, limited comparability between patients
Advances: Validated, standardized tools
Primary Tools: Single-modality sensors (EEG, ECG, EMG)
Limitations: Incomplete picture of pain experience
Advances: Individual physiological correlates
Primary Tools: Multimodal sensor fusion, machine learning, monetary measures
Limitations: Complexity, cost, computational demands
Advances: Comprehensive, objective, comparable data
Modern fMRI and EEG studies can now visualize brain activity associated with pain processing, providing objective correlates of subjective pain experiences.
fMRI EEG PETA 2025 study introduced a novel approach asking participants how much money they would require to endure pain again, creating a "shared frame of reference" 7 .
Innovation EconomicsThe 1957 review's conclusion that "Quantitative study of the psychological effects of drugs is an urgent need" 1 has found resonance in today's multidisciplinary approach to pain management. The recognition that pain involves both sensory and emotional components has led to more holistic treatment strategies that address the whole person, not just their symptoms.
The International Association for the Study of Pain (IASP) now emphasizes comprehensive assessment considering cultural factors 9 .
Treatment strategies now address both sensory and emotional components, acknowledging pain as a multidimensional experience.
The framework established for pain measurement has been applied to other subjective experiences like depression and anxiety.
"Experience with pain has already served as a prototype to guide work with other subjective responses" 1 .
The 1957 review on pain measurement represented a turning point in how science approaches one of humanity's most universal yet personal experiences. While we still cannot perfectly measure pain, the journey from relying solely on "rate your pain from 1 to 10" to multimodal objective assessment reflects tremendous progress.
The review's most profound insight—that we must account for both the sensory and reaction components of pain—has paved the way for more effective and comprehensive pain management strategies. As research continues to refine our ability to measure pain, we move closer to a future where no patient's suffering is underestimated or inadequately treated because we lacked the tools to understand their experience.
The next time you're asked to rate your pain on that familiar 0-10 scale, remember that behind this simple question lies a rich scientific history—one that began with a comprehensive review over six decades ago and continues to evolve as researchers develop increasingly sophisticated ways to bridge the gap between private experience and public measurement.