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The Torturous History of Trying to Measure Pain

The Torturous History of Trying to Measure Pain

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How have medical professionals measured pain throughout history? Not very well, it turns out.

In one famous test in the late 1940s, two American male researchers performed pain experiments on pregnant women in labor. Whenever a woman had a contraction, they burned her hand with a machine, and asked how the pain of the burn compared to the pain of the contraction. It was a horrific, pointless exercise that risked the women’s health and safety. It was also one in a series of attempts to quantify and measure people’s pain.

Tune in to "Kings of Pain" on HISTORY Tuesdays, at 10/9c

Pain is hard to measure because, while it’s a universal human experience, it’s also highly subjective—and also because we don’t really know what it is. The combination of physical and psychological factors that cause pain remain somewhat mysterious, even with recent advances in brain imaging. In fact, the desire to measure pain appears to be a fairly modern concern in Europe and the United States.

“From medieval time onwards, people were much more interested in causing pain than in measuring it,” observes Stephen McMahon, a professor of physiology at King's College London and director of the Wellcome Trust Pain Consortium. “[René] Descartes, who famously described a mechanism for pain, didn’t describe how you measured it, no. And the Greeks, they didn’t even include pain in their basic sensations that they felt people could perceive. So no, I think it’s quite a modern endeavor, trying to evaluate [pain].”

READ MORE: Sting, Recover, Repeat: How One Scientist Measured Insect-Induced Pain

Testing pain points with horse hair

The 19th-century German school of “psychophysics” offered one early inquiry into how to measure pain. Its goal was to study the relationship between stimuli and sensation, and it led scientist Maximilian von Frey to develop a method of identifying what he called Schmerzpunkte, or pain points, with horse hair. Specifically, he’d select hairs of varying stiffness from a horse’s tail and attach them individually to sticks. Then he’d used the stick to press the hair against someone’s skin.

“The stiffer the hair, the more pressure it took for the hair to bend.” McMahon says. “Each would exert a different force before they bent… He used them to test the sensitivity of skin, and you can still find them today; they’re plastic today, they’re not made of horse hair.”

Using this method, Von Frey could record the amount of pressure at which a person started to feel pain from a particular hair. He and others involved in psychophysics also employed other methods of testing skin sensitivity, like hot or cold rods. Their research, McMahon says, “drove the development of a whole number of scales and techniques.”

READ MORE: 7 of the Most Outrageous Medical Treatments in History

The ‘dolorimeter’

One group of researchers influenced by these experiments were James Hardy, Helen Goodell and Harold Wolff. In 1940, they announced they’d invented a new device to measure pain thresholds called the “dolorimeter.” It used heat to inflict pain at various levels, and was strong enough to give people second-degree burns—which it did when Hardy and another researcher named Carl Javert tested it on pregnant women in labor several years later.

Hardy and Javert seemed to have little regard for the complaints of the pregnant women they tested the dolorimeter on, writing that one “patient became so hostile that attempts at further measurements were abandoned… [T]his failure to obtain valid measurements was due mainly to an unwillingness on the part of the patient to cooperate.” In their research, they published a graphic picture of what one woman’s hand looked like after they used the dolorimeter on her at its highest setting.

READ MORE: Heroin, Morphine and Opiates

Questionnaires and nonverbal assessments

As with Von Frey hairs, you can still buy modern versions of dolorimeters today. But since the 1950s, questionnaires and pain scales have overtaken them as the main way that doctors measure pain in their patients. Questionnaires ask patients a range of queries to get a sense of how they’re feeling and what might be wrong. Pain scales ask patients to rate their pain based on numbers, a series of increasingly distressed-looking cartoon faces or simply by pointing to a place on a straight line to indicate where their discomfort lies on a scale from “no pain” to “worst pain.”

There are also scales for infants and children or adults who are nonverbal, so that doctors can try to assess their pain. For example, the FLACC Behavioral Scale helps doctors look for signs of pain in children between two months and seven years. These signs include things such as a clenched jaw, intense and prolonged crying, kicking legs and rigid activity.

READ MORE: A Brief History of Bloodletting

The big shift between Von Frey hairs and dolorimeters on the one hand, and questionnaires and scales on the other, is that instead of inflicting pain on test subjects and then trying to study it, researchers today try to study pain that their patients already have. In McMahon’s work, he says he usually uses a visual analog scale of a straight line to ask his patients to assess their pain. Yet he emphasizes that there is no perfect method.

“The point to realize is that there is no objective measure of pain,” he says. “Pain is a subjective sensation… We can report on it, but we don’t have an objective machine that can assess it. And that’s true today, and it’s always been true.”

Watch full episodes of "Kings of Pain," now. Tune-in for new episodes on HISTORY Tuesdays at 10/9c.

What is the history of crucifixion?

Crucifixion was invented and used by other people groups, but it was “perfected” by the Romans as the ultimate execution by torture. The earliest historical record of crucifixion dates to c. 519 BC, when King Darius I of Persia crucified 3,000 of his political enemies in Babylon. Before the Persians, the Assyrians were known to impale people. The Greeks and Carthaginians later used crucifixion, as well. After the break-up of Alexander the Great’s empire, the Seleucid Antiochus IV Epiphanes crucified Jews who refused to accept Hellenization.

Crucifixion was meant to inflict the maximum amount of shame and torture upon the victim. Roman crucifixions were carried out in public so that all who saw the horror would be deterred from crossing the Roman government. Crucifixion was so horrible that it was reserved for only the worst offenders.

The victim of crucifixion was first severely scourged or beaten, an ordeal that was life-threatening by itself. Then he was forced to carry the large wooden crossbeam to the site of the crucifixion. Bearing this load was not only extremely painful after the beating, but it added a measure of shame as the victim was carrying the instrument of his own torture and death. It was like digging one’s own grave.

When the victim arrived at the place of crucifixion, he would be stripped naked to further shame him. Then he would be forced to stretch out his arms on the crossbeam, where they were nailed in place. The nails were hammered through the wrists, not the palms, which kept the nails from pulling through the hand. (In ancient times, the wrist was considered part of the hand.) The placement of the nails in the wrists also caused excruciating pain as the nails pressed on large nerves running to the hands. The crossbeam would then be hoisted up and fastened to an upright piece that would normally remain standing between crucifixions.

After fastening the crossbeam, the executioners would nail the victim’s feet to the cross as well&mdashnormally, one foot on top of the other, nailed through the middle and arch of each foot, with the knees slightly bent. The primary purpose of the nails was to inflict pain.

Once the victim was fastened to the cross, all his weight was supported by three nails, which would cause pain to shoot throughout the body. The victim’s arms were stretched out in such a way as to cause cramping and paralysis in the chest muscles, making it impossible to breathe unless some of the weight was borne by the feet. In order to take a breath, the victim had to push up with his feet. In addition to enduring excruciating pain caused by the nail in his feet, the victim’s raw back would rub against the rough upright beam of the cross.

After taking a breath and in order to relieve some of the pain in his feet, the victim would begin to slump down again. This action put more weight on his wrists and again rubbed his raw back against the cross. However, the victim could not breathe in this lowered position, so before long the torturous process would begin again. In order to breathe and to relieve some of the pain caused by the wrist nails, the victim would have to put more weight on the nail in his feet and push up. Then, in order to relieve some of the pain caused by the foot nail, he would have to put more weight on the nails in his wrists and slump down. In either position, the torture was intense.

Crucifixion usually led to a slow, tortuous death. Some victims lasted as long as four days on a cross. Death was ultimately by asphyxiation as the victim lost the strength to continue pushing up on his feet in order to take a breath. In order to hasten death, the victim’s legs might be broken, which would prevent him from pushing up in order to breathe thus, asphyxiation would follow shortly after (see John 19:32).

Crucifixion was finally outlawed by the Roman Emperor Constantine in the fourth century.

The Neuroscience of Pain

On a foggy February morning in Oxford, England, I arrived at the John Radcliffe Hospital, a shiplike nineteen-seventies complex moored on a hill east of the city center, for the express purpose of being hurt. I had an appointment with a scientist named Irene Tracey, a brisk woman in her early fifties who directs Oxford University’s Nuffield Department of Clinical Neurosciences and has become known as the Queen of Pain. “We might have a problem with you being a ginger,” she warned when we met. Redheads typically perceive pain differently from those with other hair colors many also flinch at the use of the G-word. “I’m sorry, a lovely auburn,” she quickly said, while a doctoral student used a ruler and a purple Sharpie to draw the outline of a one-inch square on my right shin.

Wearing thick rubber gloves, the student squeezed a dollop of pale-orange cream into the center of the square and delicately spread it to the edges, as if frosting a cake. The cream contained capsaicin, the chemical responsible for the burn of chili peppers. “We love capsaicin,” Tracey said. “It does two really nice things: it ramps up gradually to become quite intense, and it activates receptors in your skin that we know a lot about.” Thus anointed, I signed my disclaimer forms and was strapped into the scanning bed of a magnetic-resonance-imaging (MRI) machine.

The machine was a 7-Tesla MRI, of which there are fewer than a hundred in the world. The magnetic field it generates (teslas are a unit of magnetic strength) is more than four times as powerful as that of the average hospital MRI machine, resulting in images of much greater detail. As the cryogenic units responsible for cooling the machine’s superconducting magnet clicked on and off in a syncopated rhythm, the imaging technician warned me that, once he slid me inside, I might feel dizzy, see flashing lights, or experience a metallic taste in my mouth. “I always feel like I’m turning a corner,” Tracey said. She explained that the magnetic field would instantly pull the proton in each of the octillions of hydrogen atoms in my body into alignment. Then she vanished into a control room, where a bank of screens would allow her to watch my brain as it experienced pain.

During the next couple of hours, I had needles repeatedly stuck into my ankle and the fleshy part of my calf. A hot-water bottle applied to my capsaicin patch inflicted the perceptual equivalent of a third-degree burn, after which a cooling pack placed on the same spot brought tear-inducing relief. Each time Tracey and her team prepared to observe a new slice of my brain, the machine beeped, and a small screen in front of my face flashed the word “Ready” in white lettering on a black background. After each assault, I was asked to rate my pain on a scale of 0 to 10.

Initially, I was concerned that I was letting the team down. The capsaicin patch hardly tingled, and I scored the first round of pinpricks as a 3, more out of hope than conviction. I needn’t have worried. The patch began to itch, then burn. By the time the hot-water bottle was placed on it, about an hour in, I was surely at an 8. The next set of pinpricks felt as if I were being run through with a hot metal skewer.

“You’re a good responder,” Tracey told me, rubbing her hands together, when I emerged, dazed. “And you’ve got a lovely plump brain—all my postdocs want to sign you up.” As my data were sent off for analysis, she pressed a large cappuccino into my hands and gently removed the capsaicin with an alcohol wipe.

Tracey didn’t need to ask me how it had gone. The imaging-analysis software, designed in her department and now used around the world, employs a color scale that shades from cool to hot, with three-dimensional pixels coded from blue through red to yellow, depending on the level of neural activity in a region. Tracey has analyzed thousands of these “blob maps,” as she calls them—scans produced using a technique called functional magnetic resonance imaging (fMRI). Watching a succession of fiery-orange jellyfish flaring up in my skull, she had seen my pain wax and wane, its outlines shifting as mild discomfort became nearly unbearable agony.

For scientists, pain has long presented an intractable problem: it is a physiological process, just like breathing or digestion, and yet it is inherently, stubbornly subjective—only you feel your pain. It is also a notoriously hard experience to convey accurately to others. Virginia Woolf bemoaned the fact that “the merest schoolgirl, when she falls in love, has Shakespeare or Keats to speak her mind for her but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.” Elaine Scarry, in the 1985 book “The Body in Pain,” wrote, “Physical pain does not simply resist language but actively destroys it.”

The medical profession, too, has often declared itself frustrated at pain’s indescribability. “It would be a great thing to understand Pain in all its meanings,” Peter Mere Latham, physician extraordinary to Queen Victoria, wrote, before concluding despairingly, “Things which all men know infallibly by their own perceptive experience, cannot be made plainer by words. Therefore, let Pain be spoken of simply as Pain.”

But, in the past two decades, a small number of scientists have begun finding ways to capture the experience in quantifiable, objective data, and Tracey has emerged as a formidable figure in the field. By scanning several thousand people, healthy and sick, while subjecting them to burns, pokes, prods, and electric shocks, she has pioneered experimental methods to survey the neural landscape of pain. In the past few years, her work has expanded from the study of “normal” pain—the everyday, passing experience of a stubbed toe or a burned tongue—to the realm of chronic pain. Her findings have already changed our understanding of pain now they promise to transform its diagnosis and treatment, a shift whose effects will be felt in hospitals, courtrooms, and society at large.

The history of pain research is full of ingenious, largely failed attempts to measure pain. The nineteenth-century French doctor Marc Colombat de l’Isère evaluated the pitch and rhythm of cries of suffering. In the nineteen-forties, doctors at Cornell University used a heat-emitting instrument known as a “dolorimeter” to apply precise increments of pain to the forehead. By noting whenever a person perceived an increase or decrease in sensation, they arrived at a pain scale calibrated in increments of “dols,” each of which was a “just-noticeable difference” away from the adjacent dols. Last year, scientists at M.I.T. developed an algorithm called DeepFaceLIFT, which attempts to predict pain scores based on facial expressions.

The most widely adopted tools rely on the subjective reports of sufferers. In the nineteen-fifties, a Canadian psychologist named Ronald Melzack treated “an impish, delightful woman in her mid-seventies” who suffered from diabetes and whose legs were both amputated. She was tormented by phantom-limb pain, and Melzack was struck by her linguistic resourcefulness in describing it. He began collecting the words that she and other patients used most frequently, organizing this vocabulary into categories, in an attempt to capture pain’s temporal, sensory, and affective dimensions, as well as its intensity. The result, published two decades later, was the McGill Pain Questionnaire, a scale comprising some eighty descriptors—“stabbing,” “gnawing,” “radiating,” “shooting,” and so on. The questionnaire is still much used, but there have been few surveys of its efficacy in a clinical setting, and it’s easy to see how one person’s “agonizing” could be another person’s “wretched.” Furthermore, a study by the sociologist Cassandra Crawford found that, after the questionnaire’s publication, clinical descriptions of phantom-limb pain shifted dramatically, implying that the assessment device was, to some extent, informing the sensations it was intended to measure.

Meanwhile, as the historian Joanna Bourke has shown, in her book “The Story of Pain,” attempts to translate the McGill Pain Questionnaire into other languages have revealed the extent to which cultural context shapes language, which, in turn, shapes perception. In mid-century Montreal, Melzack’s talkative diabetic might have described a migraine as lacerating or pulsing, but the Sakhalin Ainu traditionally rated the intensity of pounding headaches in terms of the animal whose footsteps they most resembled: a bear headache was worse than a musk-deer headache. (If a headache was accompanied by a chill, it was described with an analogy to sea creatures.)

“I feel like I have all this anger inside but no one special to share it with.”

By far the most common tool used today to measure pain is the one I employed in the scanner: the 0-to-10 numerical scale. Its rudimentary ancestor was introduced in 1948, by Kenneth Keele, a British cardiologist, who asked his patients to choose a score between 0 (no pain) and 3 (“severe” pain). Over the years, the scale has stretched to 10, in order to accommodate more gradations of sensation. In some settings, patients, rather than picking a number, place a mark on a ten-centimetre line, which is sometimes adorned with cheerful and grimacing faces.

In 2000, Congress declared the next ten years the “Decade of Pain Control and Research,” after the Supreme Court, rejecting the idea of physician-assisted suicide as a constitutional right, recommended improvements in palliative care. Pain was declared “the fifth vital sign” (alongside blood pressure, pulse rate, respiratory rate, and temperature), and the numerical scoring of pain became a standard feature of U.S. medical records, billing codes, and best-practice guides.

But numerical scales are far from satisfactory. In Tracey’s MRI machine, my third-degree burn felt five points more intense than the initial pinpricks, but was it really only two points less than the worst I could imagine? Surely not, but, having never given birth, broken any bones, or undergone serious surgery, how was I to know?

The self-reported nature of pain scores leads, inevitably, to their accuracy being challenged. “To have great pain is to have certainty,” Elaine Scarry wrote. “To hear that another person has pain is to have doubt.” That doubt opens the door to stereotyping and bias. The 2014 edition of the textbook “Nursing: A Concept-Based Approach to Learning” warned practitioners that Native Americans “may pick a sacred number when asked to rate pain,” and that the validity of self-reports will likely be affected by the fact that Jewish people “believe that pain must be shared” and black people “believe suffering and pain are inevitable.” Last year, the book’s publisher, Pearson, announced that it would remove the offending passage from future editions, but biases remain common, and study after study has shown shocking disparities in pain treatment. A 2016 paper noted that black patients are significantly less likely than white patients to be prescribed medication for the same level of reported pain, and they receive smaller doses. A group of researchers from the University of Pennsylvania found that women are up to twenty-five per cent less likely than men to be given opioids for pain.

In addition, once pain assessment became a standard feature of American medical practice, doctors found themselves confronted with an apparent epidemic of previously unreported agony. In response, they began handing out opioids such as OxyContin. Between 1997 and 2010, the number of times the drug was prescribed annually grew more than eight hundred per cent, to 6.2 million. The disastrous results in terms of addiction and abuse are well known.

Without a reliable measure of pain, physicians are unable to standardize treatment, or accurately assess how successful a treatment has been. And, without a means by which to compare and quantify the dimensions of the phenomenon, pain itself has remained mysterious. The problem is circular: when I asked Tracey why pain has remained so resistant to objective description, she explained that its biology is poorly understood. Other basic sensory perceptions—touch, taste, sight, smell, hearing—have been traced to particular areas of the brain. “We don’t have that for pain,” she said. “We still don’t know exactly how the brain constructs this experience that you absolutely, unarguably know hurts.”

Irene Tracey has lived in Oxford almost all her life. She was born at the old Radcliffe Infirmary, went to a local state school, and studied biochemistry at the university. Her husband, Myles Allen, is an Oxford professor, too, in charge of the world’s largest climate-modelling experiment, and they live in North Oxford, in a semidetached house comfortably cluttered with their children’s sports gear and schoolwork. In 1990, Tracey embarked on her doctorate at Oxford, using MRI technology to study muscle and brain damage in patients with Duchenne muscular dystrophy. At the time, the fMRI technique that she used to map my brain in action was just being developed. The technique tracks neural activity by measuring local changes associated with the flow of blood as it carries oxygen through the brain. A busy neuron requires more oxygen, and, because oxygenated and deoxygenated blood have different magnetic properties, neural activity creates a detectable disturbance in the magnetic field of an MRI scanner.

In 1991, a team at Massachusetts General Hospital, in Boston, showed its first, grainy video of a human visual cortex “lighting up” as the cortex turned impulses from the optic nerve into images. Captivated, Tracey applied for a postdoctoral fellowship at M.G.H., and began working there in 1994, using the MRI whenever she could. When Allen, at that time her boyfriend, visited from England one Valentine’s Day, she cancelled a trip they’d planned to New York to take advantage of an unexpected open slot on the scanner. Allen spent the evening lying inside the machine, bundled up to keep warm, while she gazed into his brain. He told me that he had intended to propose to Tracey that day, but saved the ring for another time.

It was toward the end of her fellowship in Boston that Tracey first began thinking seriously about pain. Playing field hockey in her teens, she’d had her first experience of severe pain—a knee injury that required surgery—but it was a chance conversation with colleagues in a pain clinic that sparked her scientific interest. “It was just one of those serendipitous conversations that you find yourself in, where this whole area is opened up to you,” she told me. “It was, like, ‘God, this is everything I’ve been looking for. It’s got clinical application, interesting philosophy, and we know absolutely nothing.’ I thought, Right, that’s it, pain is going to be my thing.”

By then, Tracey had been recruited to return home and help found the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain. Scientists had already largely given up on the idea of finding a single pain cortex: in the handful of fMRI papers that had been published describing brain activity when a person was burned or pricked with needles, the scans seemed to show that pain involved significant activity in many parts of the brain, rather than in a single pocket, as with hearing or sight. Tracey’s plan was to design a series of experiments that picked apart this larger pattern of activity, isolating different aspects of pain in order to understand exactly what each region was contributing to the over-all sensation.

In 1998, while her lab was being built, she took her first doctoral student, a Rhodes Scholar named Alexander Ploghaus, to Canada, their scientific equipment packed in their suitcases, to use a collaborator’s MRI machine for a week. Their subjects were a group of college students, including several ice-hockey players, who kept bragging about how much pain they could take. While each student was in the scanner, Tracey and Ploghaus used a homemade heating element to apply either burns or pleasant heat to the back of the left hand, as red, green, and blue lights flashed on and off. The lights came on in a seemingly random sequence, but gradually the subjects realized that one color always presaged pain and another was always followed by comfortable warmth. The resulting scans were striking. Throughout the experiment, the subjects’ brain-activity patterns remained consistent during moments of pain, but, as they figured out the rules of the game, the ominous light began triggering more and more blood flow to a couple of regions—the anterior insula and the prefrontal cortices. These areas, Tracey and Ploghaus concluded, must be responsible for the anticipation of pain.

Showing that the experience of pain could be created in part by anticipation, rather than by actual sensation, was the first experimental step in breaking the phenomenon down into its constituent elements. “Rather than just seeing that all these blobs are active because it hurts, we wanted to understand, What bit of the hurt are they underpinning?” Tracey said. “Is it the localization, is it the intensity, is it the anticipation or the anxiety?” During the next decade, she designed experiments that revealed the roles played by various brain regions in modulating the experience of pain. She took behavioral researchers’ finding that distraction reduces the perception of pain—as when a doctor tells a child to count backward from ten while receiving an injection—and made it the basis of an experiment that showed that concentrating on a numerical task suppressed activity in several regions that normally light up during pain. She examined the effects of depression on pain perception—people suffering from depression commonly report feeling more pain than other people do from the same stimulus—and demonstrated that this, too, could change the distribution and the magnitude of neural activity.

One of her most striking experiments tested the common observation that religious faith helps people cope with pain. Comparing the neurological responses of devout Catholics with those of atheists, she found that the two groups had similar baseline experiences of pain, but that, if the subjects were shown a picture of the Virgin Mary (by Sassoferrato, an Italian Baroque painter) while the pain was administered, the believers rated their discomfort nearly a point lower than the atheists did. When the volunteers were shown a secular painting (Leonardo da Vinci’s “Lady with an Ermine”), the two groups’ responses were the same. The implications are potentially far-reaching, and not only because they suggest that cultural attitudes may have a neurological imprint. If faith engages a neural mechanism with analgesic benefits—the Catholics showed heightened activity in an area usually associated with the ability to override a physical response—it may be possible to find other, secular ways to engage that circuit.

Tracey’s research had begun to explain why people experience the same pain differently and why the same pain can seem worse to a single individual from one day to the next. Many of her findings simply reinforced existing psychological practices and common sense, but her scientific proof had clinical value. “Countless people who work in cognitive behavioral therapy come up at the end of talks or write to me,” Tracey told me. “They say how helpful it has been to empower their education of the patient by saying that, if you’re more anxious about your pain, or more sad, look, here’s a picture telling you it gets worse.”

These early experiments repeatedly demonstrated that pain is neurologically complex, involving responses generated throughout the brain. Nonetheless, by identifying regions that control ancillary factors, such as anticipation, Tracey and her team were gradually able to zero in on the regions that are most fundamental. In 2007, Tracey published a survey of existing research and identified what she called “the cerebral signature of pain”—the distinctive patterns produced by a set of brain regions that reliably act in concert during a painful experience. Some of these regions are large, and accommodate many different functions. None are specific to pain. But, as we stared at the orange blobs of an fMRI scan on her laptop screen, Tracey rattled off the names of half a dozen areas of the brain and concluded, “With a decent poke, you’d activate all of that.”

In 2013, Tor Wager, a neuroscientist at the University of Colorado, Boulder, took the logical next step by creating an algorithm that could recognize pain’s distinctive patterns today, it can pick out brains in pain with more than ninety-five-per-cent accuracy. When the algorithm is asked to sort activation maps by apparent intensity, its ranking matches participants’ subjective pain ratings. By analyzing neural activity, it can tell not just whether someone is in pain but also how intense the experience is. “What’s remarkable is that basic pain signals seem to look pretty much the same across a wide variety of people,” Wager said. “But, within that, different brain systems are more, or less, significant, depending on the individual.”

Among the brain’s many pain-producing patterns, however, there is only one region that is consistently active at a high level: the dorsal posterior region of the insula. Using a new imaging technique, Tracey and one of her postdoctoral fellows, Andrew Segerdahl, recently discovered that the intensity of a prolonged painful experience corresponds precisely with variations in the blood flow to this particular area of the brain. In other words, activity in this area provides, at last, a biological benchmark for agony. Tracey described the insula, an elongated ridge nestled deep within the Sylvian fissure, with affection. “It’s just this lovely island of cortex hidden in the middle, deep in your brain,” she said. “And it’s got all these amazing different functions. When you say, ‘Actually, I feel a bit cold, I need to put a sweater on,’ what’s driving you to do that? Probably this bit.”

The importance of the dorsal posterior insula had previously been highlighted in a somewhat horrifying experiment conducted by Laure Mazzola, a neurologist at the Lyon Neuroscience Research Center, in France. It is common for surgeons treating patients with drug-resistant epilepsy to disable the portions of the brain in which the seizures are occurring. Before surgery, neurologists often stimulate the area and its surroundings with an electrical probe, to make sure they’re on target. Taking advantage of this opportunity, Mazzola stimulated various parts of the posterior insula in pre-surgical patients and recorded their responses. When she reached the dorsal region, Tracey told me, the patients “were leaping off the bed.” The presence of a probe in the brain shouldn’t in itself hurt, because there are no pain receptors there. Yet activating this area was apparently enough to create a brutally convincing synthetic pain.

The day after my fMRI scan, Tracey took me to her department’s Clinical Pain Testing lab, a room that she refers to as her “torture chamber.” A red illuminated sign blinked “Do Not Enter,” and Tracey removed a retractable belt blocking the door. Inside were all the devices that she and her team use to hurt people scientifically. As I reclined in a blue dentist-style chair under the room’s lone fluorescent light, she and a couple of her colleagues burned the back of my hand with a laser. Someone pressed a device about the size of a camera’s memory card against my forearm. It was rippled with heating elements, which were covered with a thin layer of gold foil to conduct the heat to the skin. “We can raise the temperature by thirty degrees in under a second,” Tracey said.

Each of the methods has a particular use. Lasers and electrodes can deliver precise increments of pain in experiments requiring a quick transition between different levels of stimulation. Capsaicin, because it sensitizes the central nervous system, is best for simulating chronic pain. Inflatable rectal balloons mimic the distinctive pain caused by damage to internal organs. All of them have been designed with the aim of reliably producing in laboratory conditions sensations that hurt enough to mirror real life but don’t cause lasting harm, which would be unethical. A scientist hoping to gather publishable data can’t just hit someone with a hammer and hope that each blow is as hard as the last one, even if an institutional ethics committee would permit such a thing.

Tracey has developed protocols to inflict the maximum amount of pain with the minimum amount of tissue damage. Using psychological tricks and carefully choreographed shifts in intensity, she has also devised ways of heightening a subject’s perception of pain. At the same time, research identifying the regions most crucial to the experience of pain has inadvertently pointed the way to the creation of artificial pain purely through targeted neurostimulation. It does not take much imagination to discern the potential for misuse of this kind of knowledge. For this reason, the International Association for the Study of Pain (I.A.S.P.) has a code of ethics, and its members are pledged not to inflict or increase pain except in an experimental setting.

A more nuanced ethical issue involves the potential use of neuroimaging as a sort of lie detector—to expose malingerers or increase payouts in injury-compensation suits. “Pain is enormously important in law,” Henry Greely, the director of the Center for Law and the Biosciences, at Stanford University, told me. “It’s the subject of hundreds of thousands of legal disputes every year in the United States.” Many are personal-injury cases others involve Social Security and private-insurance disability. Greely pointed out that the lack of an objective test for pain means not only that people who deserve compensation miss out (and vice versa) but also that millions of billable hours are spent on these suits. With an agreed-upon empirical metric for pain, he estimates, the vast majority of cases would be settled rather than litigated.

4. Glasgow Smile

If you’ve ever seen The Dark Knight, you may have left the theater pondering the unanswered question: What was the deal with the Joker’s permanent smile? We have a pretty good guess as to what caused it. The Glasgow smile, also known as the Cheshire grin among London street gangs, originated in its namesake Glasgow, Scotland. Two small incisions were made on both corners of the victim’s mouth. As the victim was beat or stabbed, muscle contractions in the face would cause the wounds to extend upward toward the ears. While many victims were left with a permanent ear-to-ear smile, if left untreated, some would die as the result of a severe infection or exsanguination (acute blood loss).

The Torturous History of Trying to Measure Pain - HISTORY

Wikimedia Commons The unsuspecting leaf of the gympie-gympie stinging tree.

Although the leaves of the gympie-gympie plant may look soft and fuzzy, one touch will make anybody regret they ever saw it.

That’s because this stinging bush delivers one of nature’s most painful experiences. In fact, this native to the Australian rainforest has a sting that’s so intense, it’s driven soldiers to suicide ⏤ and the British government once considered using it as a biological weapon of war.

Discover the deceptively downy gympie-gympie below, though from a safe distance.

Laboratory Tests

Laboratory tests generally are not necessary in the initial evaluation of acute low back pain. If tumor or infection is suspected, a complete blood cell count and erythrocyte sedimentation rate should be obtained.1 Other blood studies, such as testing for HLA-B27 antigen (present in ankylosing spondylitis) and serum protein electrophoresis (results abnormal in multiple myeloma), are not recommended unless clinically warranted. Additional laboratory tests, such as urinalysis, should be tailored to the possible diagnoses suggested by the history and physical findings.

Therapy Essential Reads

4 Pillars of Change in Effective Therapy

10 Ways to Get More Out of Therapy

For a more thorough history of electroconvulsive therapy, see Jeffrey Lieberman's excellent book Shrinks: The Untold Story of Psychiatry.

Leiknes, K. A., Jarosh-von Schweder, L., & Høie, B. (2012). Contemporary use and practice of electroconvulsive therapy worldwide. Brain and Behavior, 2(3), 283-344.

Lieberman, J. A., & Ogas, O. (2015). Shrinks: The untold story of psychiatry. New York: Little, Brown and Company.


Throughout history, some individuals, like Leonardo da Vinci for example, who once purchased caged birds in order to set them free, [1] [2] were concerned about cruelty to animals. His notebooks also record his anger with the fact that humans used their dominance to raise animals for slaughter. [3] According to contemporary philosopher Nigel Warburton, for most of human history the dominant view has been that animals are there for humans to do with as they see fit. [1]

René Descartes believed that non-humans are automata⁠ ⁠— complex machines with no soul, mind, or reason. [4] In Cartesian dualism, consciousness was unique to human among all other animals and linked to physical matter by divine grace. However, close analysis shows that many human features such as complex sign usage, tool use, and self-consciousness can be found in some animals. [5]

Charles Darwin, by presenting the theory of evolution, revolutionized the way that humans viewed their relationship with other species. Darwin believed that not only did human beings have a direct kinship with other animals, but the latter had social, mental and moral lives too. Later, in The Descent of Man (1871), he wrote: "There is no fundamental difference between man and the higher mammals in their mental faculties." [6]

Modern philosophers and intellectuals, such as Peter Singer and Tom Regan, have argued that animals' ability to feel pain as humans do makes their well-being worthy of equal consideration. [7] There are many precursors of this train of thought. Jeremy Bentham, the founder of utilitarianism, famously wrote in his An Introduction to the Principles of Morals and Legislation (1789): [8]

"The question is not, can they reason nor can they talk? but, can they suffer?"

These arguments have prompted some to suggest that animals' well-being should enter a social welfare function directly, not just indirectly via its effect only on human well-being. [9] Many countries have now formally recognized animal sentience and animal suffering, and have passed anti-cruelty legislation in response.

Animal cruelty can be broken down into two main categories: active and passive. Passive cruelty is typified by cases of neglect, in which the cruelty is a lack of action rather than the action itself. Oftentimes passive animal cruelty is accidental, born of ignorance. In many cases of neglect in which an investigator believes that the cruelty occurred out of ignorance, the investigator may attempt to educate the pet owner, then revisit the situation. In more severe cases, exigent circumstances may require that the animal be removed for veterinary care. [10]

Industrial animal farming Edit

Farm animals are generally produced in large, industrial facilities that house thousands of animals at high densities these are sometimes called factory farms. The industrial nature of these facilities means that many routine procedures or animal husbandry practices impinge on the welfare of the animals and could be considered as cruelty, with Henry Stephen Salt claiming in 1899 that "it is impossible to transport and slaughter vast numbers of large and highly-sensitive animals in a really humane manner". [11] It has been suggested the number of animals hunted, kept as companions, used in laboratories, reared for the fur industry, raced, and used in zoos and circuses, is insignificant compared to farm animals, and therefore the "animal welfare issue" is numerically reducible to the "farm animal welfare issue". [12] Similarly, it has been suggested by campaign groups that chickens, cows, pigs, and other farm animals are among the most numerous animals subjected to cruelty. For example, because male chickens do not lay eggs, newly hatched males are culled using macerators or grinders. [13] [14] Worldwide meat overconsumption is another factor that contributes to the miserable situation of farm animals. [15] Many undercover investigators have exposed the animal cruelty taking place inside the factory farming industry and there is evidence to show that consumers provided with accurate information about the process of meat productions and the abuse that accompanies it has led to changes in their attitudes. [16]

The American Veterinary Medical Association accepts maceration subject to certain conditions, but recommends alternative methods of culling as more humane. [17] [18] Egg-laying hens are then transferred to "battery cages" where they are kept in high densities. Matheny and Leahy attribute osteoporosis in hens to this caging method. [12] Broiler chickens suffer similar situations, in which they are fed steroids to grow at a super-fast speed, so fast that their bones, heart and lungs often cannot keep up. Broiler chickens under six weeks old suffer painful crippling due to fast growth rates, whilst one in a hundred of these very young birds dies of heart failure. [19]

To reduce aggression in overcrowded conditions, shortly after birth piglets are castrated, their tails are amputated, and their teeth clipped. [5] Calves are sometimes raised in veal crates, which are small stalls that immobilize calves during their growth, reducing costs and preventing muscle development, making the resulting meat a pale color, preferred by consumers. [12]

Animal cruelty such as soring, which is illegal, sometimes occurs on farms and ranches, as does lawful but cruel treatment such as livestock branding. Since Ag-gag laws prohibit video or photographic documentation of farm activities, these practices have been documented by secret photography taken by whistleblowers or undercover operatives from such organizations as Mercy for Animals and the Humane Society of the United States posing as employees. Agricultural organizations such as the American Farm Bureau Federation have successfully advocated for laws that tightly restrict secret photography or concealing information from farm employers. [20]

Welfare concerns of farm animals Edit

The following are lists of invasive procedures which cause pain, routinely performed on farm animals, and housing conditions that routinely cause animal welfare concerns. In one survey of United States homeowners, 68% of respondents said they consider the price of meat a more important issue. [9]

  • High stocking density
  • Restricted movement
  • Tongue resection (calves)
  • High stocking density (feedlots)
  • Restricted movement (feedlots) crates
  • High stocking density
  • Restricted movement
  • Separation from born child (calves)
  • Bounded by milk machines
  • High stocking density
  • Restricted movement
  • High stocking density [29]
  • Restricted movement [28]
  • High stocking density
  • Restricted movement
  • High stocking density
  • Restricted movement
  • High stocking density (fine wool industry, live export)
  • Restricted movement (fine wool industry, live export)
  • High stocking density
  • Restricted movement
  1. ^ 'Desnooding' is the removal of the snood, a fleshy appendage on the forehead of turkeys.
  2. ^ 'Blinders' or 'spectacles' are included as some versions require a pin to pierce the nasal septum.
  3. ^ 'Dubbing' is the procedure of removing the comb, wattles and sometimes earlobes of poultry. Removing the wattles is sometimes called "dewattling".
  4. ^ 'Marking' is the simultaneous mulesing, castration and tail docking of lambs.
  5. ^ 'Mulesing' is the removal of strips of wool-bearing skin from around the breech (buttocks) of a sheep to prevent flystrike (myiasis)

Fur industry Edit

Animal welfare activists suggest a total ban on fur production due to the suffering inflicted on animals, especially minks. It has been suggested that fur production is immoral as fur clothes are luxury items. Minks are solitary and territorial animals however, in fur farms, they are raised in cages and skinned after being killed either by breaking their necks or using lethal gas. [32]

Alleged link to human violence and psychological disorders Edit

There are studies providing evidence of a link between animal cruelty and violence towards humans. [33] [34] [35] [36] A 2009 study found that slaughterhouse employment increases total arrest rates, arrests for violent crimes, arrests for rape, and arrests for other sex offenses in comparison with other industries. [37]

A history of torturing pets and small animals, a behavior known as zoosadism, is considered one of the signs of certain psychopathologies, including antisocial personality disorder, also known as psychopathic personality disorder. According to The New York Times, "[t]he FBI has found that a history of cruelty to animals is one of the traits that regularly appears in its computer records of serial rapists and murderers, and the standard diagnostic and treatment manual for psychiatric and emotional disorders lists cruelty to animals a diagnostic criterion for conduct disorders." [38] "A survey of psychiatric patients who had repeatedly tortured dogs and cats found all of them had high levels of aggression toward people as well, including one patient who had murdered a young boy." [38] Robert K. Ressler, an agent with the Federal Bureau of Investigation's behavioral sciences unit, studied serial killers and noted, "Murderers like this (Jeffrey Dahmer) very often start out by killing and torturing animals as kids." [39]

Acts of intentional animal cruelty or non-accidental injury may be indicators of serious psychological problems. [40] [41] According to the American Humane Association, 13% of intentional animal abuse cases involve domestic violence. [42] As many as 71% of pet-owning women seeking shelter at safe houses have reported that their partner had threatened and/or hurt or killed one or more of their pets 32% of these women reported that one or more of their children had also hurt or killed pets. Battered women report that they are prevented from leaving their abusers because they fear what will happen to the animals in their absence. Animal abuse is sometimes used as a form of intimidation in domestic disputes. [43]

Cruelty to animals is one of the three components of the Macdonald triad, behavior considered to be one of the signs of violent antisocial behavior in children and adolescents. According to the studies used to form this model, cruelty to animals is a common (but not universal) behavior in children and adolescents who grow up to become serial killers and other violent criminals. It has also been found that children who are cruel to animals have often witnessed or been victims of abuse themselves. [44] In two separate studies cited by the Humane Society of the United States, roughly one-third of families suffering from domestic abuse indicated that at least one child had hurt or killed a pet. [45]

Cultural rituals Edit

Many times, when Asiatic elephants are captured in Thailand, handlers use a technique known as the training crush, in which "handlers use sleep-deprivation, hunger, and thirst to 'break' the elephants' spirit and make them submissive to their owners" moreover, handlers drive nails into the elephants' ears and feet. [46]

The practice of cruelty to animals for divination purposes is found in ancient cultures, and some modern religions such as Santeria continue to do animal sacrifices for healing and other rituals. Taghairm was performed by ancient Scots to summon devils.

Television and filmmaking Edit

Animal cruelty has long been an issue with the art form of filmmaking, with even some big-budget Hollywood films receiving criticism for allegedly harmful—and sometimes lethal—treatment of animals during production. Court decisions have addressed films that harm animal such as videos that in part depict dog fighting. [47]

The American Humane Association (AHA) has been associated with monitoring American film-making since after the release of the film Jesse James (1939), in which a horse was pushed off a plank and drowned in a body of water after having fallen 40 feet into it. [48] Initially, monitoring of animal cruelty was a partnership between the AHA and officials in the Hays Office through the Motion Picture Production Code. Provisions in the code discouraged "apparent cruelty to children and animals", and because the Hays Office had the power to enforce this clause, the American Humane Association (AHA) often had access to sets to assess adherence to it. However, because the American Humane Association's Hollywood office depended on the Hays Office for the right to monitor sets, the closure of the Hays Office in 1966 corresponded with an increase in animal cruelty on movie sets. [49]

In addition, other animal welfare organizations worldwide, have also monitored the use of animals in film.

By 1977, a three-year contract was in place between the Screen Actors Guild (SAG) and the American Federation of Television and Radio Artists which specified that the American Humane Association should be "consulted in the use of animals 'when appropriate'", but the contract did not provide a structure for what "appropriate" meant, and had no enforcement powers. This contract expired in 1980. [50]

One of the most infamous examples of animal cruelty in film was Michael Cimino's flop Heaven's Gate (1980), in which numerous animals were brutalized and even killed during production. Cimino allegedly killed chickens and bled horses from the neck to gather samples of their blood to smear on actors for Heaven's Gate, and also allegedly had a horse blown up with dynamite while shooting a battle sequence, the shot of which made it into the film. This film played a large part in renewed scrutiny of animal cruelty in films, and led to renewed official on-set jurisdiction to monitor the treatment of animals by the AHA in 1980. [48]

After the release of the film Reds (1981), the star and director of the picture, Warren Beatty apologized for his Spanish film crew's use of tripwires on horses while filming a battle scene, when Beatty was not present. Tripwires were used against horses when Rambo III (1988) and The 13th Warrior (1999) were being filmed. An ox was sliced nearly in half during production of Apocalypse Now (1979), while a donkey was bled to death for dramatic effect for the Danish film Manderlay (2005), in a scene later deleted from the film.

There is a case of cruelty to animals in the South Korean film The Isle (2000), according to its director Kim Ki-Duk. [51] In the film, a real frog is skinned alive while fish are mutilated. Seven animals were killed for the camera in the controversial Italian film Cannibal Holocaust (1980). [52] The images in the film include the slow and graphic beheading and ripping apart of a turtle, a monkey being beheaded and its brains being consumed by natives and a spider being chopped apart. Cannibal Holocaust was only one film in a collective of similarly themed movies (cannibal films) that featured unstaged animal cruelty. Their influences were rooted in the films of Mondo filmmakers, which sometimes contained similar content. In several countries, such as the United Kingdom, Cannibal Holocaust was only allowed for release with most of the animal cruelty edited out. [ citation needed ]

More recently, the video sharing site YouTube has been criticized for hosting thousands of videos of real life animal cruelty, especially the feeding of one animal to another for the purposes of entertainment and spectacle. Although some of these videos have been flagged as inappropriate by users, YouTube has generally declined to remove them, unlike videos which include copyright infringement. [53] [54]

The Screen Actors Guild (SAG) has contracted with the American Humane Association (AHA) for monitoring of animal use during filming or while on the set. [55] Compliance with this arrangement is voluntary and only applies to films made in the United States. Films monitored by the American Humane Association may bear one of their end-credit messages. Many productions, including those made in the United States, do not advise AHA or SAG of animal use in films, so there is no oversight. [56]

Simulations of animal cruelty exist on television, too. On the 23 September 1999 edition of WWE Smackdown!, a plotline had professional wrestler Big Boss Man trick fellow wrestler Al Snow into appearing to eat his pet chihuahua Pepper. [58] [59]

Circuses Edit

The use of animals in the circus has been controversial since animal welfare groups have documented instances of animal cruelty during the training of performing animals. Animal abuse in circuses has been documented such as small enclosures, lack of veterinary care, abusive training methods, and lack of oversight by regulating bodies. [60] [61] Animal trainers have argued that some criticism is not based on fact, including beliefs that shouting makes the animals believe the trainer is going to hurt them, that caging is cruel and common, and the harm caused by the use of whips, chains or training implements. [62]

Bolivia has enacted what animal rights activists called the world's first ban on all animals in circuses. [63]

Bullfighting Edit

Bullfighting is criticized by animal rights or animal welfare activists, referring to it as a cruel or barbaric blood sport in which the bull suffers severe stress and a slow, torturous death. [64] [65] A number of activist groups undertake anti-bullfighting actions in Spain and other countries. In Spanish, opposition to bullfighting is referred to as antitaurismo.

The Bulletpoint Bullfight warns that bullfighting is "not for the squeamish", advising spectators to "be prepared for blood". It details prolonged and profuse bleeding caused by horse-mounted lancers, the charging by the bull of a blindfolded, armored horse who is "sometimes doped up, and unaware of the proximity of the bull", the placing of barbed darts by banderilleros, followed by the matador's fatal sword thrust. It stresses that these procedures are a normal part of bullfighting and that death is rarely instantaneous. It further warns those attending bullfights to "be prepared to witness various failed attempts at killing the animal before it lies down." [66]

Toro embolado Edit

The "Toro Jubilo" or Toro embolado in Soria, Medinaceli, Spain, is a festival associated with animal cruelty. During this festival, balls of pitch are attached to a bull's horns and set on fire. The bull is then released into the streets and can do nothing but run around in pain, often smashing into walls in an attempt to douse the fire. These fiery balls can burn for hours, and they burn the bull's horns, body, and eyes – all while spectators cheer and run around the victim. The animal rights group PACMA has described the fiesta as "a clear example of animal mistreatment". [67]

Rattlesnake round-ups Edit

Rattlesnake round-ups, also known as rattlesnake rodeos, are annual events common in the rural Midwest and Southern United States, where the primary attractions are captured wild rattlesnakes which are sold, displayed, killed for food or animal products (such as snakeskin) or released back into the wild. The largest rattlesnake round-up in the United States is held in Sweetwater, Texas. Held every year since 1958, the event currently attracts approximately 30,000 visitors per year and in 2006 each annual round-up was said to result in the capture of 1% of the state's rattlesnake population. [68] Rattlesnake round-ups became a concern by animal welfare groups and conservationists due to claims of animal cruelty and excessive threat of future endangerment. [69] [70] [71] In response, some round-ups impose catch-size restrictions or releasing captured snakes back into the wild. [72] [73]

Warfare Edit

Military animals are creatures that have been employed by humankind for use in warfare. They are a specific application of working animals. Examples include horses, dogs and dolphins. Only recently has the involvement of animals in war been questioned, and practices such as using animals for fighting, as living bombs (as in the use of exploding donkeys) or for military testing purposes (such as during the Bikini atomic experiments) may now be criticised for being cruel. [74]

Princess Anne, the Princess Royal, the patron of the British Animals in War Memorial, stated that animals adapt to what humans want them to do, but that they will not do things that they do not want to, even with training. [75] Animal participation in human conflict was commemorated in the United Kingdom in 2004 with the erection of the Animals in War Memorial in Hyde Park, London. [76]

In 2008 a video of US Marine David Motari throwing a puppy over a cliff during the Iraq conflict was popularised as an internet phenomenon and attracted widespread criticism of the soldier's actions for being an act of cruelty. [77]

Unnecessary scientific experiments or demonstrations Edit

Under all three of the conceptual approaches to animal cruelty discussed above, performing unnecessary experiments or demonstrations upon animals that cause them substantial pain or distress may be viewed as cruelty. Due to changes in ethical standards, this type of cruelty tends to be less common today than it used to be in the past. For example, schoolroom demonstrations of oxygen depletion routinely suffocated birds by placing them under a glass cover, [78] and animals were suffocated in the Cave of Dogs [79] [80] [81] to demonstrate the density and toxicity of carbon dioxide to curious travelers on the Grand Tour.

No pet policies and abandonment Edit

Many apartment complexes and rental homes institute no pet policies. No pet policies are a leading cause of animal abandonment, which is considered a crime in many jurisdictions. In many cases, abandoned pets have to be euthanized due to the strain they put on animal shelters and rescue groups. Abandoned animals often become feral or contribute to feral populations. In particular, feral dogs can pose a serious threat to pets, children, and livestock. [82]

In Ontario, Canada, no pet policies are outlawed under the Ontario Landlord and Tenant Act and are considered invalid even when a tenant signs a lease that includes a no pets clause. [83] Similar legislation has also been considered in Manitoba. [84]

Many jurisdictions around the world have enacted statutes which forbid cruelty to some animals but these vary by country and in some cases by the use or practice.

Africa Edit

Egypt Edit

Egyptian law states that anyone who inhumanely beats or intentionally kills any domesticated animal may be jailed or fined. [85] The Egyptian Society for the Prevention of Cruelty to Animals was established by the British over a hundred years ago, and is currently administered by the Egyptians. The SPCA was instrumental in promoting a 1997 ban on bullfighting in Egypt. [86]

In ancient Egyptian law, the killers of cats or dogs were executed. [87] [88]

South Africa Edit

The Animal Protection Act No 71 of 1962 in South Africa covers "farm animals, domestic animals and birds, and wild animals, birds, and reptiles that are in captivity or under the control of humans."

The Act contains a detailed list of prohibited acts of cruelty including overloading, causing unnecessary suffering due to confinement, chaining or tethering, abandonment, unnecessarily denying food or water, keeping in a dirty or parasitic condition, or failing to provide veterinary assistance. There is also a general provision prohibiting wanton, unreasonable, or negligible commission or omission of acts resulting in unnecessary suffering. The Department of Agriculture, Forestry and Fisheries for 2013/14 to 2016/17 mentions updating animal protection legislation. [89]

The NSPCA is the largest and oldest animal welfare organisation in South Africa that enforces 90% of all animal cruelty cases in the country by means of enforcing the Animals Protection Act.

South Sudan Edit

The Criminal Code of South Sudan has laws against maltreatment of animals. The laws read: [90]

196. Ill-treatment of Domestic Animal.

Whoever cruelly beats, tortures or otherwise willfully ill-treats any tame, domestic or wild animal, which has previously been deprived of its liberty, or arranges, promotes or organizes fights between cocks, rams, bulls or other domestic animals or encourages such acts, commits an offence, and upon conviction, shall be sentenced to imprisonment for a term not exceeding two months or with a

197. Riding and Neglect of Animal.

Whoever wantonly rides, overdrives or overloads any animal or intentionally drugs or employs any animal, which by reason of age, sickness, wounds or infirmity is not in a condition to work, or neglects any animal in such a manner as to cause it unnecessary suffering, commits an offence, and upon conviction, shall be sentenced to imprisonment for a term not exceeding one month or with a fine or with both.

Americas Edit

Argentina Edit

In Argentina, National Law 14346 sanctions with from 15 days to one year in prison those who mistreat or inflict acts of cruelty on animals. [91]

Brazil Edit

Canada Edit

In Canada, it is an offence under the Criminal Code to intentionally cause unnecessary pain, suffering or injury to an animal. [92] Poisoning animals is specifically prohibited. [92] [93] It is also an offence to threaten to harm an animal belonging to someone else. [94] Most provinces and Territories also have their own animal protection legislation. [95] However, it is not explicitly illegal in Canadian law to kill a dog or cat for consumption. [96]

The Animal Legal Defense Fund releases an annual report ranking the animal protection laws of every province and territory based on their relative strength and general comprehensiveness. In 2014, the strongest four jurisdictions were Manitoba, British Columbia, Ontario and Nova Scotia. The weakest four were Saskatchewan, Northwest Territories, Quebec, and Nunavut. [97]

Chile Edit

Law 20380 established sanctions including fines, from 2 to 30 Mensual Tributary Units, and prison, from 541 days to 3 years, for those involved in acts of animal cruelty. Also, it promotes animal care through school education, and establishes a Bioethics Committee to define policies related to experiments with animals. [98]

Colombia Edit

In Colombia, there is little control over cruel behaviors against animals, and the government has proposed that bullfighting be declared a "Cultural Heritage" other cruel activities like cockfighting are given the same legal treatment. [99]

Costa Rica Edit

In 2017, after many years of legal wrangling, Costa Rica passed their Animal Welfare Law. It includes prison sentences of 3 months to one year for harming or killing a domesticated animal or for conducting animal fights. There are monetary fines for those who mistreat, neglect or abandon animals, for breeding or training animals for fighting, or violating regulations on animal experimentation. The law doesn't cover agricultural practices, aquaculture, zootechnical or veterinary activities, killing of animals for consumption, for sanitary or scientific reasons, or for reproductive control. Wild animals are covered under the Wild Life Act. [100] [101]

The bill had stalled its motion through the legislature until an injured toucan was found which had lost the top half of its beak. News and images of the injured bird, now named Grecia, raised enough contributions to create a 3D printed prosthesis for her, and helped spur the bill's progress. [102]

Mexico Edit

The current policy of Mexico, in civil law, condemns physical harm to animals as property damage to the owners of the abused animal, considering the animals as owned property.

In criminal law, the situation is different. In December 2012, the Legislative Assembly of the Federal District reformed the existing Penal Code of Mexico City, establishing abuse and cruelty to animals as criminal offenses, provided the animals are not deemed to be plagues or pests. Abandoned animals are not considered to be plagues. A subsequent reform was entered into force on 31 January 2013, by a decree published in the Official Gazette of the Federal District. The law provides penalties of 6 months to 2 years imprisonment, and a fine of 50 to 100 days at minimum wage, to persons who cause obvious injury to an animal, and the penalty is increased by one half of those injuries endanger its life. The penalty rises to 2 to 4 years of prison, and a fine of 200 to 400 days at minimum wage, if the person intentionally causes the death of an animal. [103]

This law is considered to extend throughout the rest of the 31 constituent states of the country. In addition, The Law of Animal Protection of the Federal District is wide-ranging, based on banning "unnecessary suffering". Similar laws now exist in most states. [104]

United States Edit

The primary federal law relating to animal care and conditions in the US is the Animal Welfare Act of 1966, amended in 1970, 1976, 1985, 1990, 2002 and 2007. It is the only Federal law in the United States that regulates the treatment of animals in research, exhibition, transport, and by dealers. Other laws, policies, and guidelines may include additional species coverage or specifications for animal care and use, but all refer to the Animal Welfare Act as the minimum acceptable standard. [105]

The Animal Legal Defense Fund releases an annual report ranking the animal protection laws of every state based on their relative strength and general comprehensiveness. In 2013's report, the top five states for their strong anti-cruelty laws were Illinois, Maine, Michigan, Oregon, and California. The five states with the weakest animal cruelty laws in 2013 were Kentucky, Iowa, South Dakota, New Mexico, and Wyoming. [106]

In Massachusetts and New York, agents of humane societies and associations may be appointed as special officers to enforce statutes outlawing animal cruelty. [107]

In 2004, a Florida legislator proposed a ban on "cruelty to bovines," stating: "A person who, for the purpose of practice, entertainment, or sport, intentionally fells, trips, or otherwise causes a cow to fall or lose its balance by means of roping, lassoing, dragging, or otherwise touching the tail of the cow commits a misdemeanor of the first degree." [108] The proposal did not become law. [108]

In the United States, ear cropping, tail docking, rodeo sports, and other acts are legal and sometimes condoned. Penalties for cruelty can be minimal, if pursued. Currently, 46 of the 50 states have enacted felony penalties for certain forms of animal abuse. [109] However, in most jurisdictions, animal cruelty is most commonly charged as a misdemeanor offense. In one recent California case, a felony conviction for animal cruelty could theoretically net a 25-year to life sentence due to their three-strikes law, which increases sentences based on prior felony convictions. [110]

In 2003, West Hollywood, California passed an ordinance banning declawing of house cats. [111] In 2007, Norfolk, Virginia passed legislation only allowing the procedure for medical reasons. [112] However, most jurisdictions allow the procedure.

In April 2013, Texas Federal Court Judge Sim Lake ruled [113] that the Animal Crush Video Prohibition Act of 2010, which criminalized the recording, sale, and transport of videos depicting animal cruelty as obscenity, is in violation of the First Amendment. Judge Lake noted that obscenity tests require an explicitly sexual depiction, which the criminalized videos lack. This follows the precedent set by United States v. Stevens, which additionally held that restrictions on the possession of animal cruelty videos were unconstitutional.

In November 2019, President Trump signed the Preventing Animal Cruelty and Torture Act, making certain intentional acts of cruelty to animals federal crimes carrying penalties of up to seven years in prison. The Act expanded upon the 2010 Animal Crush Video Prohibition Act signed by President Barack Obama that banned the creation and distribution of videos that showed animals being crushed, burned, drowned, suffocated, impaled or subjected to other forms of torture. The underlying acts, which were not included in the 2010 bill, are part of the PACT Act and are now felony offenses. The bill was unanimously passed in both the House and Senate. [114] [115]

State welfare laws Edit

Several states have enacted or considered laws in support of humane farming.

  • On 5 November 2002, Florida voters passed Amendment 10 by a margin of 55% for, amending the Florida Constitution to ban the confinement of pregnant pigs in gestation crates. [116]
  • On 14 January 2004, the bill AB-732 died in the California Assembly's Agriculture Committee. [117] The bill would have banned gestation and veal crates, eventually being amended to include only veal crates. [118] On 9 May 2007, the bill AB-594 was withdrawn from the California State Assembly. The bill had been effectively killed in the Assembly Agriculture Committee, by replacing the contents of the bill with language concerning tobacco cessation coverage under Medi-Cal. [119] AB-594 was very similar to the current language of Proposition 2. [120]
  • On 7 November 2006, Arizona voters passed Proposition 204 with 62% support. The measure prohibits the confinement of calves in veal crates and breeding sows in gestation crates. [121]
  • On 28 June 2007, Oregon Governor Ted Kulongoski signed a measure into law prohibiting the confinement of pigs in gestation crates (SB 694, 74th Leg. Assembly, Regular Session). [122]
  • In January 2008, Nebraska State Senate bill LB 1148, to ban the use of gestation crates for pig farmers, was withdrawn within 5 days amidst controversy. [123]
  • On 14 May 2008, Colorado Governor Bill Ritter signed into law a bill, SB 201, that phases out gestation crates and veal crates. [124][125]

Venezuela Edit

Venezuela published a "Law for Protection of Domestic Fauna free and in captivity" in 2010, defining responsibilities and sanctions about animal care and ownership. Animal cruelty acts are fined, but are not a cause for imprisonment. [126] The law also forbids the possession, breeding and reproduction of pit bull dogs, among similar breeds that are alleged to be aggressive and dangerous. It elicited reactions from dog owners, who said that aggressiveness in dogs is determined more by treatment by the owner than by the breed itself. [127]

Asia Edit

Israel Edit

Israel Banned the sale of fur to fashion industry in June 2021, being the first country in the world to do so [128]

China Edit

As of 2006 there were no laws in China governing acts of cruelty to animals. [129] There are no government supported charitable organizations like the RSPCA, which monitors the cases on animal cruelty. All kinds of animal abuses, such as to fish, tigers, and bears, are to be reported for law enforcement and animal welfare. [130] [131] [132] [133] [134] [135]

In the absence of a unified law against animal mistreatment, the World Animal Protection notes that some legislation protecting the welfare of animals exists in certain contexts, especially ones used in research and in zoos. [136]

In September 2009, legislation was drafted to address deliberate cruelty to animals in China. If passed, the legislation would offer some protection to pets, captive wildlife and animals used in laboratories, as well as regulating how farm animals are raised, transported and slaughtered. [137]

In 2008, the People's Republic of China was in the process of making changes to its stray-dog population laws in the capital city, Beijing. Mr. Zheng Gang who is the director of the Internal and Judicial Committee which comes under the Beijing Municipal People's Congress (BMPC), supported the draft of the Beijing Municipal Regulation on Dogs from the local government. The law would replace the Beijing Municipal Regulation on Dog Ownership, introduced in 1989. The extant regulation talked of "strictly" limiting dog ownership and controlling the number of dogs in the city. The proposed draft focused instead on "strict management and combining restrictions with management." [138]

Hong Kong Edit

As of 2010, Hong Kong has supplemented or replaced the laws against cruelty with a positive approach using laws that specify how animals should be treated. [139] The government department primarily responsible for animal welfare in Hong Kong is the Agriculture, Fisheries and Conservation Department (AFCD).

Laws enforced by the AFCD include these:

  • the Prevention of Cruelty to Animals Ordinance (also enforced by the police)
  • the Public Health (Animals and Birds) Ordinance (including regulations for licences imposed on livestock keepers and animal traders and a Code of Standards for Licensed Animal Traders)
  • the Dogs and Cats Ordinance
  • the Pounds Ordinance
  • the Rabies Ordinance
  • the Wild Animals Protection Ordinance

In addition, the Food and Environmental Hygiene Department (FEHD) does the following:

  • enforces the Public Health and Municipal Services Ordinance, which includes regulations for slaughterhouses and wet markets
  • publishes a Code of Practice for the Welfare of Food Animals (which describes their transport)
  • publishes Operational Guidelines for the Welfare of Food Animals at Slaughterhouses

The Department of Health does the following:

  • enforces the Animals (Control of Experiments) Ordinance.
  • publishes a Code of Practice for the Care and Use of Animals for Experimental Purposes

As of 2006, Hong Kong has a law titled "Prevention of Cruelty to Animals Ordinance", with a maximum 3 year imprisonment and fines of HKD$200,000. [140]

India Edit

The Prevention of Cruelty to Animals Act, 1960 was amended in the year 1982. [141] According to the newly amended Indian animal welfare act, 2011 cruelty to animals is an offence and is punishable with a fine which shall not be less than ten thousand Rupees, which may extend to twenty five thousand Rupees or with imprisonment up to two years or both in the case of a first offence. In the case of second or subsequent offence, with a fine which shall not be less than fifty thousand Rupees, but may extend to one lakh Rupees and with imprisonment with a term which shall not be less than one year but may extend to three years. [142] This amendment is currently awaiting ratification from the Government of India. The 1962 Act is the one that is practiced as of now. The maximum penalty under the 1962 Act is Rs. 50 (under $1). [143] Many organizations, including ones such as the local SPCA, PFA and Fosterdopt are actively involved in assisting the general population in reporting cruelty cases to the police and helping bring the perpetrator to justice. Due to this, much of change has been observed through the subcontinent.

Japan Edit

In Japan, the 1973 Welfare and Management of Animals Act (amended in 1999 and 2005) [144] stipulates that "no person shall kill, injure, or inflict cruelty to animals without due course", and in particular, criminalises cruelty to all mammals, birds, and reptiles possessed by persons as well as cattle, horses, goats, sheep, pigs, dogs, cats, pigeons, domestic rabbits, chickens, and domestic ducks regardless of whether they are in captivity.

  • Killing or injuring without due reason: up to one year's imprisonment with labor or a fine of up to one million yen
  • Cruelty such as causing debilitation by discontinuing feeding or watering without due reason: a fine of up to five hundred thousand yen
  • Abandonment: a fine of up to five hundred thousand yen

Separate national and local ordinances exist with regards to ensuring health and safety of animals handled by pet shops and other businesses.

Animal experiments are regulated by the 2000 Law for the Humane Treatment and Management of Animals, which was amended in 2006. [145] This law requires those using animals to follow the principles outlined in the 3Rs and use as few animals as possible, and cause minimal distress and suffering. Regulation is at a local level based on national guidelines, but there are no governmental inspections of institutions and no reporting requirement for the numbers of animals used. [146]

Malaysia Edit

Saudi Arabia Edit

Veterinarian Lana Dunn and several Saudi nationals report that there are no laws to protect animals from cruelty since the term is not well-defined within the Saudi legal system. They point to a lack of a governing body to supervise conditions for animals, particularly in pet stores and in the exotic animal trade with East Africa. [147]

South Korea Edit

South Korea's animal welfare laws are weak by international standards. [148]

Taiwan Edit

The Taiwanese Animal Protection Act was passed in 1998, imposing fines up to NT$250,000 for cruelty. Criminal penalties for animal cruelty were enacted in 2007, including a maximum of 1 year imprisonment. [149]

Thailand Edit

Thailand introduced its first animal welfare law in 2014. The Cruelty Prevention and Welfare of Animal Act, B.E. 2557 (2014) came into being on 27 December 2014. [150] [151]

Europe Edit

European Union Edit

The European Union Council Directive 1999/74/EC [152] is a directive passed by the European Union on the minimum standards for keeping egg laying hens which effectively bans conventional battery cages. The directive, passed in 1999, banned conventional battery cages in the EU from 1 January 2012 after a 13-year phase-out.

It is also illegal in many parts of Europe to declaw a cat. [153]

France Edit

In France, cruelty to animals is punishable by imprisonment of two years and a financial penalty (30,000 €). [154]

Germany Edit

In Germany, killing animals or causing significant pain (or prolonged or repeated pain) to them is punishable by imprisonment of up to three years or a financial penalty. [155] If the animal is of foreign origin, the act may also be punishable as criminal damage. [156]

Italy Edit

Acts of cruelty against animals can be punished with imprisonment, for a minimum of three months up to a maximum of three years, and with a fine ranging from a minimum of 3,000 Euros to a maximum of 160,000 Euros, as for the law n°189/2004. [157]

Ireland Edit

The Animal Health and Welfare Act 2013 [158] came into force in 2014, improving animal protection. [159] The maximum penalty is up to €250,000 and up to 5 years in prison. Sentences of up to 3 years have been imposed in several cases. [ citation needed ]

Portugal Edit

Since 1 October 2014, violence against animals has been a crime in Portugal. Legislation published in the Diário da República on 29 August criminalizes the mistreatment of animals, and indicates that "those who, without reasonable cause, inflict pain, suffering, or any other hardship to a companion animal abuse" are to be subject to imprisonment of up to one year. [160] If such acts result in the "death of the animal", the "deprivation of an important organ or member", or "serious and permanent impairment of its capacity of locomotion", those responsible will be punished by imprisonment up to two years. [160]

As for pets, the new law provides that "whoever, having the duty to store, monitor or pet watch, abandons them, thereby putting in danger their food and the provision of care owed" faces up to six months imprisonment. [160]

Sweden Edit

In Sweden cruelty to animals is punishable by financial penalty and prison for up to 2 years. The owner will lose the right to own animals and the animals will be removed from the owner. [161]

Switzerland Edit

The Swiss animal protection laws are among the strictest in the world, comprehensively regulating the treatment of animals including the size of rabbit cages, and the amount of exercise that must be provided to dogs. [162]

In the canton of Zurich an animal lawyer, Antoine Goetschel, is employed by the canton government to represent the interests of animals in animal cruelty cases. [163]

Turkey Edit

Under Turkey's Animal Protection Law No. 5199, cruelty to animals is considered a misdemeanor, punishable by a fine only, with no jail time or a black mark on one's criminal record. [164] [165] HAYTAP, the Animal Rights Federation in Turkey, believes that the present law does not contain a strong enough punishment for animal abusers. [166]

United Kingdom Edit

In the United Kingdom, cruelty to animals is a criminal offence for which one may be jailed for up to 6 months. [167]

On 18 August 1911, the House of Commons introduced the Protection of Animals Act 1911 (c.27) following lobbying by the Royal Society for the Prevention of Cruelty to Animals (RSPCA). The maximum punishment was 6 months of "hard labour" with a fine of 25 pounds. [168]

In the Metropolitan Police Act 1839 "fighting or baiting Lions, Bears, Badgers, Cocks, Dogs, or other Animals" was prohibited in London, with a penalty of up to one month imprisonment, with possible hard labour, or up to five pounds. The law laid numerous restrictions on how, when, and where animals could be driven, wagons unloaded, etc.. It also prohibited owners from letting mad dogs run loose and gave police the right to destroy any dog suspected of being rabid or any dog bitten by a suspected rabid dog. The same law prohibited the use of dogs for drawing carts. [169]

Up until then, dogs were used for delivering milk, bread, fish, meat, fruit, vegetables, animal food (the cat's-meat man), and other items for sale and for collecting refuse (the rag-and-bone man). [170] [171] As Nigel Rothfels notes, the prohibition against dogs pulling carts in or near London caused most of the dogs to be killed by their owners [172] as they went from being contributors to the family income to unaffordable expenses. Cart dogs were replaced by people with handcarts. [173] About 150,000 dogs were killed or abandoned. Erica Fudge quotes Hilda Kean: [172]

At the heart of nineteenth-century animal welfare campaigns is the middle-class desire not to be able to see cruelty.

The Protection of Animals Act 1911 [175] extended the ban on draft dogs to the rest of the kingdom. As many as 600,000 dogs were killed or abandoned.

The Protection of Animals Act 1911 has since been largely superseded by the Animal Welfare Act 2006, [176] which also superseded and consolidated more than 20 other pieces of legislation, including the Protection of Animals Act 1934 and the Abandonment of Animals Act 1960. The Act introduced the new welfare offence, which means that animal owners have a positive duty of care, and outlaws neglecting to provide for their animals' basic needs, such as access to adequate nutrition and veterinary care. [177]

Under the Criminal Damage Act 1971, domestic animals can be classed as property that is capable of being "damaged or destroyed". A charge of criminal damage may be appropriate for the injury or death of an animal owned by someone other than the defendant, and prosecution under the Animal Welfare Act 2006 may also be appropriate. [178] [179]

Oceania Edit

Australia Edit

In Australia, all states and territories have enacted legislation governing animal welfare. The legislation are: [180]

  • Animal Welfare Act 1992 (ACT) [181][182]
  • Prevention of Cruelty to Animals Act 1979 (NSW) [183][184]
  • Animal Welfare Act (NT) [185][186]
  • Animal Care and Protection Act 2001 (Qld) [187][188]
  • Animal Welfare Act 1985 (SA) [189][190]
  • Animal Welfare Act 1993 (Tas) [191][192]
  • Prevention of Cruelty to Animals Act 1986 (Vic) [193][194]
  • Animal Welfare Act 2002 (WA) [195][196]

Welfare laws have been criticized as not adequately protecting animals. [197] Whilst police maintain an overall jurisdiction in prosecution of criminal matters, in many states officers of the RSPCA and other animal welfare charities are accorded authority to investigate and prosecute animal cruelty offenses.


The Crucifixion was an ancient execution method, in which the criminal’s hands and feet were bound or nailed to a wooden, cross-like structure. It was a capital punishment reserved for slaves, traitors, ”heretics”, and usually the worst of criminals. It became widespread during the reign of Alexander the Great, but it still remains in occasional use in some countries.

Crucifixion of Jesus(Pietro Perugino,1487)

There were various methods of performing the crucifixion. Usually, the prisoner had to drag the crossbeam of his cross, weighing around 100 pounds, to the place of execution. Subsequently, his outstretched arms were bound to the crossbeam, or sometimes nailed through the wrists, and the crossbeam was raised and fixed to the already standing upright post.

Death was usually caused by overall exhaustion or by heart failure. Sometimes, to shorten the victim’s suffering, his legs were shattered using an iron club, so that subsequent asphyxiation soon ended his life.

A pain history should include:

Location, radiation, quality, severity, aggravating and relieving factors and timing, as well as the their understanding of the pain and impact on their everyday activities.

To get a better understanding of their condition, and a more accurate pain history, there are specific questions you can ask.


Note, this may be assisted by asking the resident to point to the pain. Use a body chart.



  • Would you describe the soreness or hurting as more like an ache, sharp or shooting?
  • Describe the pain – is it aching, sharp, deep, shooting?

How the person describes their pain helps to identify the type of pain being experienced and therefore how best to treat it.


  • Tell me about the worst pain or soreness, average pain/soreness, pain/soreness right now, pain/ soreness with movement.

Use pain scales to assist the resident rate pain severity and continue using the same scale in future assessments.

Aggravating and relieving factors

  • What makes it hurt more and what helps most?
  • When does it hurt most?
  • Is it worse when you sit or move?

This identifies activities, medications and therapies that have or have not helped relieve the pain as well as coping skills used by the person.


  • Is it worse in the morning or night?
  • How long does it last?
  • Does it come and go or is it there all the time?

The older person’s understanding of pain

Find out what the resident knows and feels about the pain, this will help you identify their understanding.

Impact of pain

  • Does the pain affect sleep, appetite, physical activity, relationships with others, emotions, concentration?

Disclaimer: Please be aware the above article is merely information – not advice. If you need medical advice, please consult a doctor or other healthcare professional.

Watch the video: Ασκήσεις με σκαμπό για πρόληψη u0026 αντιμετώπιση του πόνου της πλάτης (July 2022).


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