“No pain, no gain” is a rallying slogan employed at both the beauty parlor and at the gym. Sometimes after a workout, you might even get a massage, which is quite literally the act of inflicting pain to the point of relaxation.

It’s why those who go looking for pain are often labeled perverts. It’s why those who live with it near-constantly (chronic pain) are often considered abject. Oftentimes, the two are interlinked. Kink and BDSM scenes are no stranger to the disabled and those living with chronic pain (some living with chronic pain self-identify as disabled, others do not). Which might beg the question: why do those living in pain seek out more pain?

According to Emma Sheppard, perhaps the leading (and one of the only) academics whose research centers on kink and chronic pain, there isn’t a causal link between the two, so much as there is a common understanding. After interviewing several people who lived with chronic pain and engaged with kink play over the course of 18 months, Sheppard found that BDSM was a useful tool—and perhaps a more common one than previously thought—for the disabled to communicate and control their pain. While the participants were primarily sexually submissive, Sheppard also interviewed doms (someone who takes on the role of the sexually superior and controlling), as well as switches (someone who veers between the two). What seemed to draw each of these participants to kink was the element of control.

"Controlling pain is important. Whether that be resting to decrease some pain, using painkillers if they work, moving position at the simplest level. Kink is taking this to its natural conclusion by making pain to control,” one participant from Sheppard’s study explains. Other participants used kink as a distraction from their pain, while another viewed pain as merely a practical consideration, Sheppard tells me. “A couple of participants (who were switches) felt they were less able to do painful things to others during play, but that willingness and ability shifted as they became more accepting of their pain.”

Having lived with chronic pain for the better part of a decade herself, Sheppard’s research into the link between kink and her condition exposes uncomfortable truths in terms of society’s norms around sex and pain. “We don’t like acknowledging times when pain is the point,” she writes over email, “and there’s this expectation that we always want that pain to stop—that stopping pain is a big concern (or should be) for people in pain, especially chronic pain.” The focus on pain’s end and its cure is an “ableist norm” which shape the unpained person’s understanding of those living with chronic pain.

We believe that their pain can be ended, mostly because seeing someone you love in pain is, well, painful. It’s why we might be inclined to say things like ”have you tried CBD?” But this is unfortunately, quite a bit less productive than we’d hope—sort of like offering a glass of water to a stranger with acne.

“It’s really difficult to just live with pain, because in addition to managing pain—which takes up energy and mental space—and managing other aspects of disability, chronically pained people also have to manage everyone else’s response to their pain,” Sheppard writes. As a result, those living with chronic pain often lose friends and lovers, as they’re actively discouraged from expressing their pain. However, a kink environment has the potential to give pain a new vocabulary—which benefits both the chronically pained—and those trying to understand pain outside of its limited medical and socially constructed definition.

This has been the case for Kate Sloan, a writer who regularly blogs about her experiences with chronic pain and kink. “I’ve been living with chronic joint pain for about 4 years now—so, roughly as long as I’ve identified as kinky. I wonder often if there’s a correlation there,” she wrote on a blog post from April. When I ask her what that link could be, she tells me that since BDSM often gives its participants the skill to re-contextualize pain, so that it becomes pleasurable or even spiritually transcendent in some cases.