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. 2022 Nov;26(10):2227-2237.
doi: 10.1002/ejp.2037. Epub 2022 Sep 19.

Pain and masochistic behaviour: The role of descending modulation

Sophie Baudic  1 , Frédérique Poindessous-Jazat  1 , Didier Bouhassira  1
Affiliations

Pain and masochistic behaviour: The role of descending modulation

Sophie Baudic et al. Eur J Pain. 2022 Nov.

Abstract

Background: The mechanisms of pain perception in individuals with masochistic behaviour (MB) remain poorly documented. We hypothesized that MB is associated with context-specific changes in descending pain modulation.

Methods: We compared the effects of four standardized sets of images with positive (erotic), negative (mutilations), masochistic or neutral emotional valences on the RIII nociceptive reflex evoked by electrical stimulation of the sural nerve and recorded on the ipsilateral biceps femoris in 15 controls and 15 men routinely engaging in MB. We systematically assessed the RIII reflex threshold and recruitment curves (up to the tolerance threshold), thermal (heat and cold) pain thresholds measured on the upper and lower limbs and responses to the pain sensitivity questionnaire, to compare basal pain perception between our two groups of participants. We also assessed anxiety, depression, empathy, alexithymia, high sensation seeking and catastrophizing, to investigate their potential influence on the emotional modulation of pain.

Results: Thermal pain thresholds, RIII reflex recruitment curves, and responses to the psychological and pain sensitivity questionnaires were similar in the two groups. Neutral, positive and negative images modulated the RIII reflex similarly in the two groups. By contrast, masochistic images induced a significant (p < 0.01) decrease in RIII reflex responses in subjects with MB, whereas it tended to increase these responses in control subjects.

Conclusions: Our data suggest that psychological profile, basal pain sensitivity and the emotional modulation of pain are normal in individuals with MB but that these subjects selectively engage descending pain inhibition in the masochistic context.

Significance: Decrease pain perception related to masochistic behaviours is associated with specific activation of descending pain inhibition.

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Conflict of interest statement

The authors have no conflict of interest relating to this study to declare.

Figures

FIGURE 1
FIGURE 1
Comparisons of heat (a) and cold (b) detection thresholds, heat pain (c) and cold pain (d) thresholds (expressed in °C) measured on the lower (foot) and upper (hand) limbs in subjects with masochistic behaviour (MB) (blue columns) and controls (grey columns).
FIGURE 2
FIGURE 2
RIII reflex recruitment curves as a function of stimulus intensity, which was gradually increased to the tolerance threshold in subjects with masochistic behaviour (MB) (blue curve) and controls (grey curve). For the analysis of group data, each reflex response was expressed as a percentage of the maximal response observed on the recruitment curve.
FIGURE 3
FIGURE 3
Illustrative individual examples of the effects of neutral, positive (erotic), negative (mutilations) and masochistic images on the RIII reflex in a control subject (a–d) and in a subject with masochistic behaviour (e–h). For each of the four successive 5‐min experimental sequences (a–h), each bar of the histograms represents one single RIII reflex response expressed as a percentage of the mean value recorded during the 2‐min control period (i.e. before image‐viewing). The 1‐minute image‐viewing period (i.e. minute 3) is indicated by arrows.
FIGURE 4
FIGURE 4
Mean effects of neutral images (a), positive images (erotic) images (b), negative (mutilations) images (c) and masochistic images (d) on the RIII reflex in subjects with masochistic behaviour (MB) (blue columns) and controls (grey columns). Mean RIII reflex responses during each of the 5 min of the four successive experimental sequences are expressed as a percentage of the mean value recorded during the 2‐min control period. The 1‐min image‐viewing period (i.e. minute 3) is indicated by arrows. ***p < 0.001 for the comparison between subjects with MB and controls.
FIGURE 5
FIGURE 5
Effects of neutral, positive, negative and masochistic images (D) on the ratings (0–10 numerical rating scales) of the intensity (a) and unpleasantness (b) of the pain concomitantly elicited by electrical stimuli at the ankle during RIII reflex recordings in subjects with masochistic behaviour (MB) (blue columns) and controls (grey columns). **p < 0.01 for the comparison between subjects with MB and controls
FIGURE 6
FIGURE 6
Self‐Assessment Manikin ratings of valence/pleasure (a) and arousal (b) associated with emotionally neutral, positive, negative and masochistic images in subjects with masochistic behaviour (blue columns) and controls (grey columns). ***p < 0.001 for the comparison between subjects with MB and controls
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