Physical Pain As Pleasure: A Theoretical Perspective
The Journal of Sex ResearchISSN: 0022-4499 (Print) 1559-8519 (Online) Journal homepage: https://www.tandfonline.com/loi/hjsr20Physical Pain as Pleasure: A TheoreticalPerspectiveCara R. Dunkley, Craig D. Henshaw, Saira K. Henshaw & Lori A. BrottoTo cite this article: Cara R. Dunkley, Craig D. Henshaw, Saira K. Henshaw & Lori A. Brotto(2019): Physical Pain as Pleasure: A Theoretical Perspective, The Journal of Sex Research, DOI:10.1080/00224499.2019.1605328To link to this article: shed online: 02 May 2019.Submit your article to this journalView Crossmark dataFull Terms & Conditions of access and use can be found ation?journalCode hjsr20
THE JOURNAL OF SEX RESEARCH, 0(0), 1–17, 2019 2019 The Society for the Scientific Study of SexualityISSN: 0022-4499 print/1559-8519 onlineDOI: cal Pain as Pleasure: A Theoretical PerspectiveCara R. Dunkley, Craig D. Henshaw, Saira K. Henshaw, and Lori A. BrottoDepartment of Psychology, University of British Columbia and Department of Obstetrics andGynaecology, University of British ColumbiaPhysical pain represents a common feature of Bondage and Discipline/Dominance and Submission/Sadism and Machochism (BDSM) activity. This article explores the literature accountingfor how painful stimuli may be experienced as pleasurable among practitioners of BDSM, andcontrasting this with how it is experienced as painful among non-BDSM individuals. Wereviewed the available literature on pain and on BDSM, and used the findings to postulatea theory accounting for how painful stimuli are experienced as pleasurable. Our theory was thenchecked with BDSM practitioners. The emotional, physiological, and psychological elements ofpain interact to facilitate the experience of pain as pleasure in BDSM. A multitude ofinterconnected factors was theorized to alter the experience of BDSM pain, including: neuralnetworks, neurotransmitters, endogenous opioids and endocannabinoids, visual stimuli, environmental context, emotional state, volition and control, interpersonal connection, sexual arousal,and memories. The experience of pain in this context can bring about altered states ofconsciousness that may be similar to what occurs during mindfulness meditation. Throughunderstanding the mechanisms by which pain may be experienced as pleasure, the role of pain inBDSM is demystified and, it is hoped, destigmatized.In recent years, BDSM—an overlapping acronym referring to the practices of Bondage and Discipline (BD),Dominance and Submission (DS), and Sadism and Masochism (SM)—has garnered an increasing amount ofattention from researchers and laypeople alike. Bondageand discipline involves using psychological and/or physical restraints. Dominance and submission involves theexchange of power and control. Sadism and masochism,or sadomasochism, involves taking pleasure in one’s ownor another’s pain or humiliation (Hébert & Weaver,2014). Pain represents a characteristic commonlyinvolved in a sadomasochistic scene (Moser & Kleinplatz, 2007). In a broad sense, sadism and masochismrefer to the giving and receiving of physical or psychological pain or sensation for erotic pleasure. As BDSMmay or may not involve power exchange, the currentarticle generally uses the terms Top to denote the giver ofnoxious stimulation and Bottom (or masochist, dependingon the research being discussed) as the receiver ofstimulation. This article focuses on physical masochism,which can be defined as the consensual receiving andenjoyment of physical sensations that would characteristically be classified as painful. Pain represents an emotional sensory experience that is influenced byCorrespondence should be addressed to Cara R. Dunkley, 2136 WestMall, Vancouver, BC V6T 1Z4, Canada. E-mail: cdunkley@psych.ubc.capsychological, contextual, and social factors. The purpose of this article is to review the extant literature onthe processing of pain versus pleasure in relation toBDSM from a basic scientific perspective in hopes ofconsidering how a painful stimulus might be experiencedas pleasure by someone practicing BDSM, but experienced as suffering by someone who does not engage inBDSM play. Figure 1 depicts the interplay of factors thatcontribute to the processing of pain as pleasure. Table 1summarizes the findings and themes of the literaturereviewed.Consensual MasochismEvolutionary theory casts pain as a warning system,a sensory notification that protects the body against threat ordanger. Within this framework, pain functions as an alarm thatorients the recipient to potential environmental threat to prioritize escape and recovery (Williams, 2002). Pain automaticallyevokes a fight-or-flight response that allows the recipient tobriefly experience blunted pain sensations via neurophysiological responses that block pain signals to achieve safety andsubsequently heal (Wall, 1999). The pain that emerges afterinitial injury to bodily tissue serves to set limits on activities thatmay interfere with healing. From this perspective, pain has noreward in and of itself.
DUNKLEY, HENSHAW, HENSHAW, AND BROTTOFigure 1.Key points for an integrative model of processing pain as pleasure in the context of BDSM.1. Prior to the experience of pain, there is a preexisting emotional and interpersonal context based on presentcircumstances, memories of related past experiences, and the extent to which one feels in control. These situationalfactors may facilitate sexual arousal.2. The presence of sexual arousal prior to (and/or alongside) the infliction of pain stimuli serves as an analgesic, alteringlevels of dopamine and oxytocin.3. Contextual factors and sexual arousal lead to a positive anticipation of pain.4. Context, sexual arousal, and the positive anticipation of pain set the stage for receiving pain sensations and fosteringthe experience of pain as pleasure.5. Once pain is introduced, nociceptor stimulation engages bottom-up/top-down processing and produces changes inlevels of dopamine, cortisol, endogenous opioids, and endogenous endocannabinoids, further influencing the psychological and physiological response to pain sensations.6. These conditions may promote mindfulness and lead to an altered state of consciousness, colloquially called subspace,which contributes to the various mechanisms through which pain is experienced as pleasure in the context of BDSM.The pain or intensity that characterizes sadomasochisticexchanges is a specific type of pain that is experienced asrewarding or serving some benefit (Moser & Kleinplatz,2007). A distinction can also be made between hurt and harmin SM involving physical pain and emotional pain; the sensations of being hurt can be arousing and enjoyable, whereasharm is viewed as something negative that can cause damageand is to be avoided (Holt, 2016). Accidental pain or painexperienced outside the context of a sadomasochistic (SM)scene is typically not considered desirable (Nichols, 2006;Scott, 1983). Pain in the context of BDSM is qualitativelydifferent from the way pain is typically experienced or thoughtof (Nichols, 2006; Scott, 1983). For some Bottoms, the experience of pain might be analogous to the pain experienced byhigh-intensity athletes (Barker, Iantaffi, & Gupta, 2007). Forexample, one study evaluated the perception of experimentallyinduced pain among masochistic individuals compared to nonmasochistic controls, and examined whether the masochists’experiences and attitudes toward pain were related to emotionalcontext (Defrin, Arad, Ben-Sasson, & Ginzburg, 2015).Whether pain was reported as pleasurable and rewarding wascontext dependent among Bottoms; pain inflicted during intimate interpersonal SM sessions, which were typified as beingfrequent and voluntary, were reported to be experienced aspleasurable, compared to accidental environmental pain, whichwas reported to be negative and unpleasant.Thus, physical stimulation, and the threshold at whichsensations are experienced as painful or painful to the pointof unpleasantness, can be regarded as a continuum that2differs between individuals as well as within an individualacross situations and over time (Barker et al., 2007). Practitioners tend to differ not only in preferred types of stimulation, but also in terms of what areas of the body they preferto receive stimulation (Moser & Kleinplatz, 2007). BDSMpractitioners often have preferences for specific types ofsensations produced by different kinds of “play,” a termused to refer to BDSM activity. Further, those who enjoy theexperience of pain do not necessarily enjoy all types of painwith regard to the wide range of possible activities andassociated sensations BDSM has to offer.Motivation for MasochismWhat underlies the desire to experience pain with respect tomasochism? Based on extensive ethnographic research ina public BDSM community, Newmahr (2010) proposed fourdiscourses of pain within the context of BDSM, with transformed pain and autotelic pain being particularly relevant.Transformed pain centers on the reframing of pain, such thatpain is experienced as “not hurting” (p. 398) and instead istransformed almost instantly into pleasure. This discourseframes pain as an objective stimulus wherein pain is real butrendered as something other; it does not hurt and is thus not bad.In this sense, the Bottom actively modifies painful sensations insuch a way that it is processed as not pain and experienced aspleasure. Conversely, autotelic pain describes the enjoyment ofactual pain: The pain hurts, but the hurt feels good. The
PHYSICAL PAIN AS PLEASURETable 1.A Summary of the Literature ReviewedCategory of LiteratureSadomasochistic painThe purpose of painArticlesTheories and FindingsMoser & Kleinplatz, 2007; Holt, 2016; Nichols, 2006; Scott, 1983;Barker et al., 2007; Williams, 2002; Moser & Kleinplatz, 2007;Newmahr, 2010; Silva, 2015Williams, 2002; Wall, 1999SM pain is qualitatively different from other forms of pain.Preferences for SM pain are variable and subjective.SM pain serves many purposes and takes many forms.Pain is a warning system that protects the body againstthreat and physical damage.There is a neurological overlap between pain and pleasure.Top-down and bottom-up processing may alter theexperience of pain.Pain and physical exertion release endogenous opioids andcannabinoids, which alter the subjective experience ofpain.Nociceptors respond to physical stimulation and transmitsensory information to the brain; these could play a rolein individual preferences for certain kinds of SM pain.Pain is an emotional sensory experience.Negative emotions exacerbate pain, while positive emotionsmitigate pain.The emotion–pain relationship is supported byneuroimaging research and research on acute versuschronic pain.Emotions modify the experience of SM pain.There are romantic and sexual benefits of SM, such asenhanced relationship closeness.SM requires and fosters trust.The presence of loved ones can mitigate the experience ofpain or threat of pain.Pain can be rewarding in certain contexts, and reward canincrease pain tolerance.Emotional or psychological pain play may not involve anyphysical stimulation.Fear play or gratification from the threat of pain can servesimilar functions as physical SM pain.Attachment style research lends support to the importantrole of interpersonal connection and the modulation ofnoxious stimuli.SM pain can be used as a method to establish, maintain, orintensify power dynamics.Domination and submission represents a bidirectionalexchange of power and control.Domination and submission largely rests on the illusion ofpower exchange, as the Bottom has the control to end thescene at any time.Pain is experienced as less painful when the individualreceiving pain is in control of the pain stimulus.Sexual arousal is a common aspect of SM, with or withoutactual accompanying sexual activity.Considerable research supports the analgesic effect ofsexual arousal.Pain and pleasure are theorized to be mutually inhibitory.Pain releases dopamine and increases sexual activity inrodents.Sexual arousal and orgasm is associated with neural rewardsystem activity and dopamine release, which has ananalgesic effect.Due to the intimate nature of SM, oxytocin could bereleased during play, which may have an analgesic effecton pain.The array of factors that contribute to sexual response inconventional settings also play important roles in SM.Neurological andphysiologicalprocessing of pain aspleasureLeknes & Tracey, 2008; Silva, 2015; Wood, 2008; Dietrich &McDaniel, 2004; Hébert & Weaver, 2015; Holden et al., 2005;Rhudy & Meagher, 2000; Raichlen et al., 2012; Fuss et al., 2015;Calignano et al., 1998; Ogles & Masters, 2003; Sachs &Pargman, 1979; Fuss et al., 2015; French & Torkkeli, 2009;Richardson, 2000; Richardson et al., 1998; Calignano et al.,2000; Dietrich & McDaniel, 2004Emotions and painprocessingCraig, 2003; Merskey & Bogduk, 1994; Rhudy & Meagher, 2000;Franklin, 1998; Rhudy et al., 2010 ; Rainville et al., 2005;Ploghaus et al., 1999; Ploghaus et al., 2001; Apkarian, Bushnell,Treede, & Zubieta, 2005; Newmahr, 2010; Kamping et al., 2016Social connection andinterpersonalrelationshipsNichols, 2006; Ambler et al., 2016; Hébert & Weaver, 2015;Sagarin et al., 2009; Coan et al., 2006; Montoya et al., 2004;Benedetti et al., 2013Emotional pain playBarker et al., 2007; Moser & Kleinplatz, 2007; Hébert & Weaver,2015; Meredith, Strong, & Feeney, 2006; Sandnabba, Santtila,Alison, & Nordling, 2002Volition and controlCross & Matheson, 2006; Langdridge & Butt, 2005; Newmahr,2010.Moser & Kleinplatz, 2007; Sagarin et al., 2009; Easton & Hardy,2001; Weinberg & Kamel, 1983; Weisenberg, 1977Pain and sexual arousalAmbler et al., 2016; Leknes & Tracey, 2008; Paterson et al., 2013;Leknes & Tracey, 2008; Paterson et al., 2013; Komisaruk &Whipple, 1984; Whipple & Komisaruk, 1985, 1988; Budyginet al., 2012; Lepton & Stewart, 1996; Kender et al., 2008; Wood2008; Bianchi-Demicheli & Ortigue, 2007; Younger et al., 2010;Rhudy et al., 2008; Carmichael et al., 1987, 1994; Schneidermanet al., 2012; Eliava et al., 2016; Goodin et al., 2015; Tracy et al.,2015; Tracy et al., 2015; Tay & Yamamoto, 2016; Basson et al.,2008(Continued )3
DUNKLEY, HENSHAW, HENSHAW, AND BROTTOTable 1.(Continued)Category of LiteratureAlteredstates of consciousnessPain and mindfulnessPsychological versusphysiological stressArticlesMasochism can be used to achieve altered states ofconsciousness, often called subspace.SM pain can allow individuals to escape from the burdensand responsibilities of day-to-day life.Altered states of consciousness elicited by SM pain may beakin to those elicited by intense physical activity orextreme rituals.Hypofrontality and flow contribute to altered states ofconsciousness in SM.Altered state of consciousness in SM have the potential toenhance connection and intimacy between partners.Kabat-Zinn, 1982; Kabat-Zinn et al., 1985; Brown & Jones, 2010; Mindfulness-based therapies are used to treat a variety ofpain conditions.Garland et al., 2012; Grant & Rainville, 2009; Oshiro et al.,2009; Zeidan et al., 2010; Kingston et al., 2007; Kingston et al., Mindfulness practice and training attenuates the experienceof pain and pain catastrophizing and increases pain2007; Perlman et al., 2010, Grant & Rainville, 2009; Zeidantolerance.et al., 2011; Grant et al., 2011; Zeidan et al., 2011Mindfulness practitioners experience less laboratoryinduced pain and greater pain tolerance thannonpractitioners.The association between mindfulness and pain hasa neurologically supported basis.Ambler et al., 2016; Klement et al., 2017; Sagarin et al., 2009Salivary cortisol levels increase from pre- to post-BDSMactivity.Despite heightened physiological stress, BDSM activity hasbeen found to relieve psychological distress.Hennen, 2008; Landridge, 2007; Sagarin et al., 2015; Hébert &Weaver, 2015; Taylor & Ussher, 2001; Pitagora, 2017;Baumeister, 1988, 1997; Newmahr, 2010; Sagarin et al., 2015;Klement et al., 2017; Westerfelhaus, 2007; Dietrich, 2003;Csikszentmihalyi, 1990; Ambler et al., 2016; Pitagora, 2017;Sagarin et al., 2015; Sagarin et al., 2015intersection of pain and pleasure with respect to autotelic pain isthe experience of pain hurting in a way that is enjoyable.Sacrificial pain, or pain for a greater good, frames pain asa steadily undesirable sensation that the Bottom suffers insacrifice (e.g., punishment and discipline). Investment pain isdescribed as an “unpleasant stimulus that promises futurerewards” (p. 402); reward is found as a result of the pain orfrom having withstood pain, instead of pleasure being takenfrom pain itself.Similarly, Silva (2015) examined reasons for desiring painin consensual BDSM, and found the top three reasons forreceiving SM pain to be (1) pain enhances feelings of helplessness and submission; (2) pain creates sensation contrast sothat it intensifies feelings of pleasure; and (3) pain is challenging, and the endurance of pain promotes feelings of achievement and pride. Other highly endorsed reasons reflected thefunctional utility of pain, including its ability to help participants forget the daily stresses of life and relieve emotional pain.An effect of gender also emerged, such that the most commonreason for receiving pain among women was its ability tofacilitate submission, versus its use to augment the experienceof pleasure among men. Taken together, there are numerousreasons for seeking out physical pain in the context of consensual masochism, with the pleasurable component of painoften, but not always, serving as a central motivation. Additional motivations underlying sadomasochism, which areexpanded on in the sections that follow, include its potentialto enhance intimacy and social connection, augment sexual4Theories and Findingsarousal, elicit an adrenaline rush, and produce altered states ofconsciousness.Neurological and Physiological Processing of Pain AsPleasureThe association between pleasure and pain likely existsin part due to the neurological overlap in the networks thatregulate pleasure and pain, which allow pleasure and pain tobe experienced concurrently (Leknes & Tracey, 2008; Silva,2015). In support of this, participants in a qualitative studydiscussed a neurophysiological component of SM, in whichpain and arousal become linked (Taylor & Ussher, 2001).Top-Down ProcessingWhat processes are at work when a painful sensory stimulusis experienced as pleasurable or rewarding? To the authors’knowledge, there is no scientific evidence to provide a concreteand comprehensive description of what mechanisms underliethe pain–pleasure connection or transformation with respect toSM. We theorize, however, that the transformation of pain intopleasure likely occurs in the brain in the form of top-downprocessing. The area of the body from which sensations arebeing elicited sends signals that convey the nature of thosesensations to the brain (bottom-up), and the brain, in turn, sendssignals down the spinal cord to the nerve cells (top-down). In
PHYSICAL PAIN AS PLEASUREtop-down processing (Figure 1), the brain regulates the degreeof pain it will experience through descending impulses that aremediated by endogenous endorphins (Ossipov, Dussor, &Porreca, 2010). The brain–spinal cord circuit is thus an opioidsensitive circuit that acts as a pain volume control, with somepainkilling circuits muting pain transmission through the activation of opioids and endorphins (Fields, Basbaum, & Heinricher, 2005). The descending pain modulatory circuitdiminishes pain through net inhibition, with inhibitory signals“calming” the nerve cells at the appropriate section of the spinalcord (Ossipov et al., 2010). Certain neurotransmitters, including serotonin, norepinephrine, and dopamine, have been foundto play a role in spinal descending inhibition of pain (Basbaum& Fields, 1978; Cui, Feng, McAdoo, & Willis, 1999; Wood,2008). This na
the experience of pain as pleasure. 5. Once pain is introduced, nociceptor stimulation engages bottom-up/top-down processing and produces changes in levels of dopamine, cortisol, endogenous opioids, and endogenous endocannabinoids, further influencing the psycho-logical and physiological response to pain sensations. 6.
of pain might even enhance the pleasure, as reflected perhaps by the common expression ‘no pain, no gain’ or the pleasure of eating hot curries. Pain–pleasure dilem-mas abound in social environments13, and culture-specific moral systems, such as religions, are often used to guide the balance between seeking pleasure and avoiding pain
pain”, “more pain” and “the most pain possible”. Slightly older children can also say how much they are hurting by rating their pain on a 0-10 (or 0-100) scale. Zero is no pain and 10 (or 100) is the worst possible pain. What a child is doing Often children show their pain by crying, making a “pain” face, or by holding or rubbing .
Short-term pain, such as when you suffer a sprained ankle, is called 'acute' pain. Long-term pain, such as back pain that persists for months or years, is called 'chronic' pain. Pain that comes and goes, like a headache, is called 'recurrent' pain. It is not unusual to have more than one sort of pain or to have pain in several places
General discussions of pain often refer simply to three types: 1) Acute (brief that subsides as healing takes place) 2) Cancer 3) Chronic non-malignant pain - "persistent pain" Classification of pain by inferred pathology: 1) Nociceptive Pain 2) Neuropathic Pain (McCaffery & Pasero, 1999) Nociceptive Pain A. Somatic Pain B. Visceral Pain
Knee Pain 1 Knee Pain 2 Knee Pain 3 Knee Pain 4 Knee Pain 5 Lateral Knee Pain Medial Knee Pain Patella Pain 1 Patella Pain 2 Shin Splint. 7 Section 6 Ankle/Foot Big Toe 89 . For additional support, wrap another tape around the last finger joint. Step 3. No stretch is applied during application. 30 Step 1 Step 2 Finger Pain. 31 Requires;
Pain Self-Management Strategies If you have chronic pain, this guide can help you manage your pain. Richard Wanlass, Ph.D. & Debra Fishman, Psy.D. UC Davis Medical Center, Department of Physical Medicine & Rehabilitation, 060411 . This project was partially funded by a grant . from the Robert Wood Johnson Foundation.File Size: 852KBPage Count: 16Explore furtherChronic Pain Self-Management - Veterans Affairswww.mentalhealth.va.govChronic Pain Self-Management Resourcesdepts.washington.eduPain Management - NHS Ayrshire and Arranwww.nhsaaa.netPAIN MANAGEMENT BEST PRACTICES - HHS.govwww.hhs.govSeven Practical Tips for Coping with Physical Pain .www.psychologytoday.comRecommended to you b
based recommendations for management of postopera-tive pain. The target audience is all clinicians who manage postoperative pain. Management of chronic pain, acute nonsurgical pain, dental pain, trauma pain, and periprocedural (nonsurgical) pain are outside the scope of this guideline. Evidence Rev
severe pain. Treatment of acute pain When assessing a patient with acute pain, the nurse should consider: The patient's report of pain or observation of pain (such as the number on a 1 to 10 scale). The patient's functional ability. The patient's level of consciousness. The site of pain and the cause.
