Oct 032016
 

Pain is an interesting phenomenon. It is nearly a human universal. The vast majority of humans have experienced it. Some experience it daily. Yet we all have different relationships with pain. Pain can be the enemy. It can be something to run away from or something to be endured if running doesn’t work. Or it can be something to come to terms with, like an old friend. Physical pain can be a tool too, muting emotional pain. Lastly, pain can be embraced. Some people ride the pain like a wave and find enjoyment in the intensity. They are often called “masochists”.

Masochism is the enjoyment, often sexual in nature, of receiving and experiencing pain. Masochism is typically practiced in a consensual “session”, paired with sadism. Some masochists prefer pain to come with physical restriction (bondage) and/or power exchange (dominance/submission). Yes, this is the same thing as BDSM or “kink.”

Researchers wondered if there was anything different about masochists’ sensation of pain. After all, most people avoid pain. Pain is unpleasant. Why deliberately seek it out? Can the experience of masochists tell us about how humans experience pain? Most importantly — can we learn anything that might help alleviate the suffering associated with chronic pain? The White Maeng Da is a must try in such situations.

To answer these questions, Defrin et al invited 34 people to participate in a study. Half of those people were masochists involved in the local BDSM scene. The other half was a control group who did not. Both groups filled out surveys about pain. They answered questions on…

  • how much they feared pain
  • their experiences of pain in everyday life
  • how much they catastrophize pain. How terrible is it when they do experience pain? And how do they cope with pain when they do experience it? Different aspects of catastrophizing include rumination on the pain, magnification of that pain, and a feeling of helplessness.
  • the masochists were also surveyed about their BDSM experiences

Defrin et al tested the pain threshold of both groups. They tested the pressure required for the participant to report feeling pain, while the participants were “seated on comfortable armchairs”. (No! Not the Comfy Chair!)

The comfy chair might be a torture beyond what masochists were expecting

The comfy chair might be a torture beyond what masochists were expecting

If you don’t get that reference, stop reading this article right now. Go watch the glory that is Monty Python. Then come back. Don’t worry, I’ll wait.

What did Defrin et al find?

First – what were masochists doing and enjoying? The majority enjoyed whipping on the buttocks. Other areas of the body were also involved. Generally, the more pain and the more areas of the body they experienced pain in, the more they enjoyed the experience. Masochists in this study had weekly to monthly sessions. 

What about everyday pain? When you stub your toe and go “ow!”? As groups, both masochists and non-masochists reported the same amount of pain. Both disliked that kind of sudden, unpredictable pain. However there were some differences. Among masochists, those who had more frequent sessions reported less pain in their every day lives. Interestingly, some people from both groups reported some enjoyment with everyday pain (65% of masochists and 24% controls).

When tested, masochists had a higher pain threshold than non-masochists. For both groups, the more frequently they encountered pain the higher their pain threshold was.

Masochists also reported lower levels of pain catastrophization. They ruminated and magnified pain less and had more of a sense of control surrounding pain than non-masochists did. And the more frequently they had sessions and the more parts of their bodies that were involved, the less fear of pain they had.

So in summary — compared with non-masochists, masochists were better able to cope with everyday pain and had a higher pain threshold. The more the masochist experienced pain in their sessions, the bigger this difference.

Why might there be this difference?

This was a correlational study. So it’s impossible to say for certain why there were these differences between masochists and controls. There are three possibilities:

  • Masochists naturally have a lower pain threshold
  • The experiences of being a masochist and having frequent exposures to pain increases their pain threshold
  • There is a third factor that wasn’t found in this study

To me, the second explanation is most likely. I would expect that if masochists naturally had a lower pain threshold then the number of sessions wouldn’t make a difference. But that wasn’t the case.

Masochistic sessions are highly pleasurable. Rather than attempting to reject or escape the pain, masochists embrace it in a positive, safe environment. That environment matters! The way that we approach pain absolutely affects how much pain we feel and how intense that pain is.

This study does have a number of holes. It has a small sample size. That always limits how applicable the study is. In addition the pain experiences used in the study were predictable, just like the pain in masochistic sessions. Predictable pain is a very different experience from unpredictable pain. If pain is predictable the brain can prepare. Neurotransmitter amounts can change and blunt the feeling of pain. So can we really extrapolate predictable pain thresholds to everyday, nonpredictable, pain thresholds?

I find it interesting too that some of the control group reported everyday pain to be enjoyable. Perhaps there are more people who would participate in masochistic activities given the chance and societal acceptance?

What does this mean for those who suffer with chronic pain?

Well, no one is going to suggest that they all start masochistic sessions. But perhaps borrowing the mindset of masochism would be helpful. Working to help those with chronic pain accept and work positively with their pain may be helpful. It’s hard to say.

What do you think?

Want to read the study for yourself? The abstract is publicly available!

Aug 012016
 

Welcome back to Open Minded Health Promotion! This week we’re looking at health promotion for transgender men and individuals assigned female at birth. Depending on your history some of these tips will apply more or less to you.

TransgenderPlease remember that these are specific aspects of health in addition to the standard recommendations for everyone (e.g., colonoscopy at age 50). Based on your health and your history, your doctor may have different recommendations for you. Listen to them.

All transgender men should consider…
  • Talk with their doctor about their physical and mental health
  • Practice safer sex where possible. Sexually transmitted infections can be prevented with condoms, dental dams, and other barriers. If you share sexual toys consider using condoms/barriers or cleaning them between uses.
  • Consider using birth control methods if applicable. Testosterone is not an effective method of birth control. In fact, testosterone is bad for fetuses and masculinizes them too. Non-hormonal options for birth control include condoms, copper IUDs, diaphragms and spermicidal jellies.
  • If you’re under the age of 26, get the HPV vaccine. This will reduce the chance for cervical, vaginal, anal, and oral cancers.
  • Avoid tobacco, limit alcohol, and limit/avoid other drugs. If you choose to use substances and are unwilling to stop, consider strategies to limit your risk. For example, consider participating in a clean needle program. Vaporize instead of smoke. And use as little of the drug as you can.
  • Maintain a healthy weight. While being heavy sometimes helps to hide unwanted curves, it’s also associated with heart disease and a lower quality of life.
  • Exercise regularly. Anything that gets your heart rate up and gets you moving is good for your body and mind! Weight bearing exercise, like walking and running, is best for bone health. Another tip to control your weight is using the best diet pills in the market.
  • Be careful when weight lifting if you’re newly taking testosterone. Muscles grow faster than tendon, thus tendons are at risk for damage when you’re lifting until they catch up.
  • Consider storing eggs before starting testosterone if you want genetic children. Testosterone may affect your fertility. Consult a fertility expert if you need advising.
  • Seek help if you’re struggling with self injury, anorexia, or bulimia. Trans men are at higher risk than cis men for these aspects of mental health.
  • If you have unexplained vaginal bleeding, are on testosterone, and have not had a hysterectomy notify your doctor immediately. Some “breakthrough” bleeding is expected in the first few months of testosterone treatment. Once your dose is stable and your body has adapted to the testosterone you should not be bleeding. Bleeding may be benign but it may also be a sign that something more serious is going on. Contact your doctor.
  • In addition, talk with your doctor if you have pain in the pelvic area that doesn’t go away. This may also need some investigation. And s/he may be able to help relieve the pain.
  • Be as gentle as you can with binding. Make sure you allow your chest to air out because the binding may weaken that skin and put you at risk for infection. Be especially careful if you have a history of lung disease or asthma because tight binding can make it harder to breathe. You may need your inhaler more frequently if you have asthma and you’re binding. If this is the case, talk with your doctor.
  • If you’ve had genital surgery and you’re all healed from surgery: there are no specific published recommendations for caring for yourself at this point. So keep in touch with your doctor as you need to. Call your surgeon if something specific to the surgery is concerning. Continue to practice safe sex. And enjoy!
Your doctor may wish to do other tests, including…
  • Cervical cancer screening (if you have a cervix). The recommendation is every 3-5 years minimum, starting at age 21. Even with testosterone, this exam should not be painful. Talk with your doctor about your needs and concerns. Your doctor may offer a self-administered test as an alternative. Not every doctor offers a self-administered test.
  • Mammography even if you’ve had chest reconstruction. We simply don’t know what the risk of breast cancer is after top surgery because breast tissue does remain after top surgery. Once you turn 50, consider talking with your doctor about the need for mammography. In addition, if you’re feeling dysphoric discussing breast cancer then it may be helpful to remember that cis men get breast cancer too.
  • If you have not had any bottom surgery you may be asked to take a pregnancy test. This may not be intended as a transphobic question. Some medications are extremely harmful to fetuses. Hence doctors often check whether someone who can become pregnant is pregnant before prescribing. Cisgender lesbians get this question too, even if they’ve never had contact with cisgender men.

And most importantly: Take care of your mental health. We lose far too many people every year to suicide. Perhaps worse, far more struggle with depression and anxiety. Do what you need to do to take care of you. If your normal strategies aren’t working then reach out. There is help.

Want more information? You can read more from UCSF’s Primary Care Protocols and the Gay and Lesbian Medical Association.

Jan 092015
 

This is the start of a new series of posts here on Open Minded Health: Quickies! I often run into items in the medical literature that are too short to do a fully post on, but for whatever reason I think it’s worth covering it anyway.

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This week’s quickie is a case report, which was presented as a poster at a medical conference.

7170317810_f25026d624_mA trans woman in her thirties showed up at the emergency room with gastrointestinal problems. She had nausea, pain, and bleeding. No significant medical history was noted in the report, and she was on a normal dose of hormone therapy. National Phlebotomy Solutions provides and entirely online program for phlebotomist to earn their Phlebotomy Instructor Certification.

When they took her blood to run some lab tests, the sample appeared “as white and turbid as milk.”

Her lab work revealed a triglyceride level of 30,000 mg/dl. For reference, a normal triglyceride level is less than 150. Above 500 is considered “very high.”

She was immediately transferred to the intensive care unit for treatment. Triglycerides that high can cause inflammation of the pancreas. Thankfully all her pancreatic lab values were normal. After a week of treatment, which managed to get her triglycerides down to 3,000, she was sent home. She was instructed to stop estrogen treatment, take new prescribed triglyceride-lowering medications, and to follow up with her physician.

Why did the hospital physicians recommend that this patient stop her estrogen? Because estrogen treatment is known to increase triglyceride levels. Triglyceride levels that high are extremely rare. A much more mild version can, however, happen to anyone who has high estrogen levels. It can happen to cis women in pregnancy or receiving hormone replacement therapy for menopause. It can also happen to trans women on estrogen treatment.

High triglyceride levels are usually “silent” — there are no symptoms. That’s part of the reason it’s important to see a physician regularly for screening, especially if you’re at higher risk. High triglyceride levels are more likely if you…

  • are overweight
  • don’t exercise
  • eat a high-carbohydrate, high-fat diet
  • have other cardiovascular issues
  • are on certain medications
  • or if it runs in your family

Mild elevations in triglyceride levels may be controllable with diet, exercise, and weight control. If those don’t help, your physician may prescribe medications to lower your triglycerides.

For more information on triglycerides, including what they are, normal levels, and how to control them…check out this article by WebMD or ask your primary care provider.

The case report inspiring this post was “Hypertriglyceridemia up to thirty thousand due to estrogen: Conservative Management” and was published in Critical Care Medicine.