flexibeast.space - quotes
Forer et al's “Pain for pain: the benefits and challenges of BDSM participation for people with chronic pain - An exploratory study” (2025)
Participation [in BDSM] can also benefit other aspects of one’s life, including trauma-processing, decreased psychological distress and rejection sensitivity (Hébert & Weaver, 2015; Sprott & Williams, 2019), and higher subjective wellbeing (Turley, 2024; Wismeijer & van Assen, 2013).
Pain is defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with, or resembling, actual or potential tissue damage (Raja et al., 2020). Meanwhile, CP [Chronic Pain] is defined as any pain that lasts for greater than three to six months, and may or may not have a clear aetiology, such as an injury or disease (Dydyk & Conermann, 2024).
CP is estimated to affect more than 30% of people worldwide (Cohen et al., 2021), with European residents reporting the highest prevalence (34%) and Western Pacific residents reporting the lowest at 21% (Zimmer et al., 2022). CP disproportionately affects women (Tsang et al., 2008), older adults (Tsang et al., 2008), certain racial/ethnic groups (e.g. Native Americans) (Overstreet et al., 2023; Zajacova et al., 2022), and people of lower socioeconomic status (Prego-Domínguez et al., 2021) and lower education level (Dahlhamer et al., 2018). Finally, experiencing CP increases the risk of developing symptoms associated with various psychiatric diagnoses, such as depression and anxietyspectrum disorders (Tsang et al., 2008; Vadivelu et al., 2017).
[T]he phenomenon of ‘pain offset relief’ ... [is] where removal of a painful stimulus that is causing an unpleasant physical sensation does not simply return individuals to their pre-stimulus or neutral state (e.g. in CP) but rather results in a short period of relief or euphoria (Franklin, 2014). This phenomenon has been linked to the activation of certain brain circuits and neurotransmitters, including dopamine and opioid transmission (Porreca & Navratilova, 2017). Another rationale for some of these treatments, namely those that involve peripheral nerve stimulation such as acupuncture and TENS (Johnson et al., 2022; Ong Sio et al., 2023) is the gate theory. This theory suggests that applying non-painful stimuli to non-nociceptive neurons causes activation of inhibitory interneurons and therefore inhibition of certain nociceptive neurons that would otherwise transmit pain signals to the central cortex (Melzack & Wall, 1965).
As PLWCP [People Living With Chronic Pain] cite reducing the intensity of pain as their priority for management (Goudman et al., 2021), these unanticipated benefits may serve as a motivating factor for continued participation in BDSM, and in specific activities that are more likely to facilitate an intense sensory experience and elicit a pleasurable sensation.
BDSM PRCP [People Reporting Chronic Pain] experienced multiple physical and mental benefits ‘often’ or ‘regularly’ ... The most common benefit was an endorphin rush (63.9%), while more than 30% reported empowerment (35.2%), reframing of limitations (34.9%), pain relief (34.7%), engaging emotionally with pain (33.0%), speaking about pain (31.1%), and strengthening pain tolerance (30.6%) as benefits. The least common benefit was masking nonconsensual pain (18.4%). In contrast, some PRCP did not appear to receive CP-related benefits from BDSM participation. More than 30% reported ‘not at all’ for managing pain through negotiation (41.1%), speaking about pain experienced (32.7%), empowerment (31.1%), and strengthening pain tolerance (30.1%).
Those assigned female at birth (67.2% PRCP versus 53.9% without CP), along with those who identified as women (56.2% vs 46.7%), were more likely to report experiencing CP. Effect sizes for both sex (0.13) and gender (0.14) were small.
Examining specific BDSM roles ..., PRCP were no more likely to occupy dominant (21.4% vs 21.8%) or submissive (48.3% vs 48.1%) roles than those without CP. Likewise, both were equally likely to identify with the role of a sadist (12.9% vs 15.9%). While there was no significant difference found between those who identified as masochists (22.6% vs 15.9%), this analysis approached significance (X2 (1, N = 519) = 3.715, p = 0.054); however, the effect size (0.09) was small to negligible.
Reporting CP did not appear to influence who someone co-participated with. This reinforces the above finding that many of those reporting CP did not have difficulties finding co-participants. However, PRCP were 168% more likely to cite mental health benefits as a driving purpose (OR = 2.68, 95% CI [1.31, 5.49], p = 0.007) for their continued participation in BDSM.
Rope was equally as ‘often’ or ‘regularly’ participated in for both groups (42.4% of PRCP vs 39.2% of participants not reporting CP). The same pattern emerged for impact (77.4% vs 69.5%) and cutting (3.7% vs 1.6%). However, PRCP more ‘often’ or ‘regularly’ participated in fire (3.7% vs 1.0%), water (14.9% vs 7.7%), and blood (6.9% vs 3.3%) play. The effect sizes for water (0.16), fire (0.13), and blood (0.11) were small
Building upon the concept of unanticipated benefits, this is the first large-scale study to explore whether PRCP perceive challenges and/or benefits to participating in BDSM related to their experience of CP. In exploring this topic, four key findings emerged. First, many PRCP endorsed physical and mental benefits resulting from engagement in BDSM, while some reported little to no benefits. Second, experiences of CP can lead to challenges in getting wants and needs met, but these do not appear to deter their long-term participation. Third, PRCP are slightly over-represented within BDSM communities compared to the general population. Fourth, PRCP do not appear to seek out BDSM specifically for pain management. However, they are more likely to cite mental health as a reason for continued participation in BDSM and more frequently engage in some intense sensation BDSM activities. BDSM appears to provide self-perceived benefits to many PRCP, including the experience of an endorphin rush. Within the kink community, the altered state of consciousness and euphoria resulting from an endorphin rush is known as ‘sub-space’ or ‘dom-space’, depending on a person’s role during the activity, and is generally considered a positive experience (Ambler et al., 2017). This finding suggests that there is potential for PRCP to be experiencing a form of pain offset relief from their participation in BDSM
Supporting findings from smaller studies, participants also cited benefits related to empowerment, reframing of limitations, and pain relief (K. Brown & Iverson, 2023; Sheppard, 2018). Building upon this prior work, participants were equally likely to cite additional mental benefits (i.e. engaging emotionally with pain and improving the ability to speak about pain) and physical benefits (i.e. strengthened pain tolerance). However, self-perceived benefits from participating in BDSM were not universal. Managing pain through negotiation, speaking about pain experienced, empowerment and strengthening pain tolerance were equally as likely to being reported as experienced ‘often’ or ‘regularly’ as ‘not at all’. This is unsurprising given the varying efficacy of treatment methods for those with CP (Urits et al., 2021).
Although CP did present certain challenges to getting one’s wants and needs met during BDSM activities, potentially the result of discomfort or additional pain, this did not appear to lead to community-level negative effects. PRCP did not feel excluded or have difficulties finding co-participants and appeared to participate with an equal variety of partners as those without CP. This may point to the generally welcoming and accepting nature of BDSM communities compared to other spaces (Graham et al., 2016). Likewise, any negative effects related to CP that arose from participating in BDSM did not seem to impact long-term participation as there was no difference in years of participation between those reporting and not reporting CP.
PRCP were more likely to cite ‘mental health’ as a reason for their continued engagement in BDSM. It is unclear whether this improved mental health is related to their CP, but there is a known negative relationship between mental health and CP (Tsang et al., 2008; Vadivelu et al., 2017). Therefore, it is possible that practitioners experienced improved mental health secondary to BDSM participation, in part due to an improved ability to manage their CP.
[A]dditional representative research is needed to examine whether the prevalence of CP is truly higher in BDSM communities. Despite common challenges in obtaining racially and ethnically diverse samples within BDSM studies (A. Brown et al., 2020; Martinez, 2021), it is important that these populations within BDSM communities are analysed, given their triple marginalisation (CP, BDSM, and race/ ethnicity) and their increased likelihood of experiencing CP (Overstreet et al., 2023; Zajacova et al., 2022).
While PRCP were no more likely to seek out intense sensation-receiving roles (e.g. submissive, masochist vs dominant, sadist), they were more likely to seek out engagement in ‘edge-play’ activities, namely water-, fire-, and blood-play. Although what constitutes edge-play is undefined, it is generally considered to include activities that are viewed as more intense or risky. Edge-play may include activities that involve higher risk of exposure to certain bodily fluids that can increase risk of infection (e.g. urine, blood). It may also include activities that have higher risk of harm to participants (e.g. accidental burns, unintentional wounds, unwanted permanent scars). It is unclear why these activities would be more common among BDSM PRCP, but one hypothesis is that those with CP seek out more intense sensory experiences because they are likely to provide a stronger euphoric rush, regardless of whether the experience is specifically pain-based or derived from increased risk.
[W]hile we can argue that PRCP endorse benefits to their CP from BDSM participation, we were unable to determine to what degree engagement in BDSM activities is dictated by CP. As the survey was cross-sectional, we were also unable to determine causality or true significant benefits of BDSM for CP management.
[R]eported euphoria may come from different aspects of BDSM practice there were not expounded upon in this study (e.g. the eroticisation of BDSM-related pain, overcoming said pain, ‘taking’ pain for a partner). Furthermore, once PRCP identify that some BDSM activities result in benefits to their CP, does this become a primary motivation for continued participation in BDSM or does it continue to be a secondary benefit? Finally, do PLWCP have higher pain thresholds and find that the benefits of BDSM participation diminish over time, necessitating more intense sensations more frequently (e.g. higher engagement in edge-play).
[W]e are unable to determine how pain during BDSM activities may be used to address CP. For example, whether the type of CP being experienced impacts the choice of BDSM activities (e.g. use of impact-play implements that provide sharp/sting versus dull/ thud pain). Do BDSM activities result in similar pain to practitioners’ CP or do activities oppose it? This includes whether the administration of pain is focused on or avoids the body areas where CP manifests. Finally, for PRCP that are dominant, does their application of pain or intense sensation to their co-participant(s) mirror or differ from their own pain?
[P]rior to drawing any firm conclusions on the use of BDSM activities as a complementary, non-pharmacological, CP treatment method, additional research is needed. This is of particular importance given various consent and safety risks inherent in BDSM activities, particularly those involving edge-play. That being said, BDSM communities may be interested to utilise this knowledge to better support community members living with CP by hosting workshops that address specific challenges and/or developing educational resources to promote safer and more supportive practices for practitioners living with CP.
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