Mohsin Raza / Reuters

Residents, including shopkeepers and businessmen, hit the ground with their sandals to express their anger while shouting anti-American slogans during a demonstration in Lahore on Thursday.

American gunships launch a strike across the Afghan border into Pakistan, hitting a Pakistani check post and killing 11 soldiers. U.S. officials say the attack was in response to insurgent firing. Pakistan calls the attacks "unprovoked and cowardly."  That was in June of 2008.

Three Pakistani soldiers are killed at their border post as a result of an American helicopter strike. U.S. officials say they were targeting insurgents who were launching mortar rounds into Afghanistan. Pakistan protests by blocking the supply route for U.S. and NATO convoys. That was in September of 2010.

The details of exactly what happened during Saturday's early morning hours in Pakistan's Mohmand tribal agency, on the border with Afghanistan, are still unclear, but the story line is familiar.

This time, U.S. officials say they took fire from across the border in Pakistan and called in air support, reportedly checking with their Pakistani counterparts before authorizing a strike. Pakistani officials say they were never consulted, that their pleas to NATO to stop the attack once it had started were ignored, and responded by again shutting down the supply routes.

One thing that is certainly different this time is the death toll: 24 Pakistani soldiers were killed in this latest incident, including two officers, making it the deadliest incident of its kind since Pakistan and the U.S. declared an alliance in 2001. The higher death toll, according to analysts, means more pressure on Pakistan's military and civilian leaders to react strongly.

There is no debating that U.S.-Pakistan relations have taken a beating over the last year. But have they hit rock bottom? Or is this just the new "all-time low?"

Ispr / AFP - Getty Images

An image released by Pakistan's Inter Services Public Relations (ISPR) on Nov. 30, 2011 shows a Pakistani army post reportedly targeted by NATO helicopters resulting in the deaths of 24 Pakistani soldiers.

Last straw in a tough year
The condemnation from Pakistan over the latest attack has been swift and unrelenting.

Gen. Ashfaq Parvez Kayani, Pakistan's Army Chief, called the attack "unacceptable." Prime Minister Yousaf Raza Gilani said it was "an assault on the sovereignty of Pakistan," and pledged to conduct a complete review of all diplomatic, political, military and intelligence cooperation with the U.S. In addition Pakistan announced it would boycott next month's Bonn Conference on Afghanistan.

Amid the rising anger, Pakistan's military released a set of images Wednesday which it says shows the remote border posts attacked by NATO helicopters and fighter jets on Saturday.

"They're taking a tougher line than they have before," said Hasan Askari Rizvi, a Lahore-based defense analyst. "They're staking out a strong position to demonstrate within a domestic context that they can protect Pakistan's interests."

That, according to Rizvi, is even more important to the government and military establishments now, in a year when they've both lost credibility following a series of humiliating actions by the U.S.

Back in March, U.S. pressure to release CIA contractor Raymond Davis, who shot and killed two Pakistanis, forced Pakistan to take the domestically unpopular action of negotiating his exit in the face of intense public anger.

Then came the unilateral, American operation in May to capture and kill Osama Bin Laden within miles of Pakistan's premier military academy which forced Islamabad to choose between confessing involvement or admitting incompetence.

Former U.S. Joint Chiefs of Staff Admiral Mike Mullen's September accusation that Pakistan's largest intelligence agency uses the militant Haqqani network as a "veritable arm" to launch attacks on U.S. and NATO troops in Afghanistan left the relationship even further strained, and Pakistan's Army brass feeling "betrayed," according to military sources.

This latest incident, according to multiple Pakistani officials, has forced the country to rethink its engagement with the U.S. "We cannot be just a subject of abuse and attack," said one military official, speaking on condition of anonymity.

"Both of these entities – the government and military – have been discredited," said Rizvi. "Within Pakistan they are discredited because of U.S. actions across their borders. Outside, they are discredited because the U.S. is saying they are helping the Taliban."

Public relations problem
But according to some, the government and military's credibility problem may be partly their own making.

"The problem is that there's not really a source of information that's geared to inform," said Dr. Christine Fair, who focuses on South Asian political and military affairs at Georgetown University. "They're geared to massage perceptions of events, and the Pakistani government love taking their citizens for a ride on the victim bus."

A growing sense of anti-Americanism in Pakistan over the last decade has been fanned by a dominant, conservative Islamic, public discourse, said Rizvi – a sentiment the establishment has tapped into from time to time to pursue its own national interests. That's how a discussion about a potential U.S. aid package devolves into talk-show debates about America respecting Pakistan's sovereignty. Or the discovery of al Qaida's leader hiding in Pakistan turns into national outrage that the borders were breached by the U.S.

"In Pakistan, there are only two entities that publicly support good relations with the U.S.: One is the military, the second is the federal government," said Rizvi. "You don't find any other political party or major society group openly supporting the ‘War on Terror’ or relations with the U.S."

What about the billions in U.S. aid?
One question many Americans ask is: “Why do Pakistanis hate us so much if we give them so much money? “
Despite the fact that billions of dollars in U.S. aid and reimbursements have gone to Pakistan in the last decade, anti-U.S. feelings within the population are running higher than ever.

Opposition leader Imran Khan has capitalized on those frustrations, channeling them into a groundswell of political support in recent months and a 68 percent approval rating, according to one recent poll. Separately, a poll conducted exclusively in Pakistan's tribal regions last year found almost 80 percent opposed the “war on terror.” The Pew Research Center's 2010 Global Attitudes project showed a mere 17 percent of all Pakistanis polled held a favorable view of the U.S. and nearly 60 percent described the U.S. as an enemy.
 
American money has been used to fund everything from education projects to agricultural development, but money has been slow to hit the ground and has not been used in ways that directly affect most Pakistanis.

According to the Congressional Research Service, of the $20.7 billion allocated for Pakistan between FY2002 and FY2012, only $6.5 billion was "economic-related." The vast majority, $14.1 billion, was "security-related," and the lion's share of that, $8.8 billion, was military reimbursement for operations supporting the US/NATO mission across the border in Afghanistan, known as "Coalition Support Funds," or CSF.

Asif Hassan / AFP - Getty Images

Supporters of Pakistani cricketer turned politician Imran Khan's party, the Movement for Justice, shout slogans during a protest in Karachi on Thursday against the cross-border NATO air strike on Pakistani troops.

Rizvi said that most Pakistanis fail to benefit from U.S.-funded projects, and very little is known among the everyday citizenry about just how American money is being used on the ground – a problem, he says, that is one of "public relations."

"Over the last few years, a lot of funding has gone to state educational facilities, to improve facilities, enable professors to go to other countries for conferences, but very few people know that its American money," said Rizvi. "The [Pakistani] government doesn't tell them it’s American money, they create the impression that the government is making this possible for them."

That same "public relations" strategy has meant that the establishment has failed to mobilize domestic support for the war on terror, despite the fact that 30,000 Pakistanis have died in terror-related incidents since 2001. Losses in that war – accidental or deliberate – are therefore met with greater public anger, by a population that believes its military is fighting an American war.

Treading lightly
In the days since the latest tragic border clash, there has been a flurry of high-level efforts made by U.S. diplomatic, military, and intelligence officials to reach out to their Pakistani counterparts.

The U.S. and NATO are using careful language. NATO called the incident "tragic and unintended." A joint statement by the U.S. Departments of Defense and State expressed "deepest condolences" and "sympathies" from Secretaries Leon Panetta and Hillary Clinton. Officials have pledged to fully investigate what actually transpired on the ground. 

Following the incidents in 2008 and 2010, the U.S. and Pakistan found enough common ground to continue working together. The strong language being used and decisions being taken by Pakistani officials suggest it won’t be as easy this time around.

Prime Minister Gilani has already made clear that "business as usual will not be there." But U.S. officials and analysts express confidence that, with enough time and enough concessions, the two sides will ultimately be forced to find a way forward once again.

Pakistan relies on U.S. money and international support to bolster its economy, said Rizvi, and the U.S. relies on Pakistan's cooperation to stabilize Afghanistan.

"They will both realize that they need each other. They will have to tolerate each other," he said.

That may come at a price. Some believe the U.S. will have to take steps to pacify elements that have supported it in the past – issuing a public apology, or agreeing to not publicly rebuke Pakistan any longer, among other possibilities.

Despite ongoing investigations, Georgetown’s Fair believes both sides' dependence on one another means the focus will be on moving forward, not definitively determining the facts.

"There is no answer to this that's going to be helpful," says Fair. "I don't believe we're ever going to get to the bottom of what actually happened."

See a Photo Blog: Pakistan releases first images of border posts attacked by NATO