Does BDSM challenge the theory of classical conditioning?
- paingeekscommunity
- Mar 12
- 6 min read
Classical conditioning has long been used to explain how pain becomes associated with certain stimuli, shaping both acute and chronic pain experiences. Yet, the phenomenon of BDSM—where individuals engage in consensual practices that involve pain—raises intriguing questions about the limits of this theory.
This month on Pain Geeks we have been reading the article:
We have been reading this article alongside our humanities piece by Robert Mapplethorpe from his series of polaroids in the late 1970s depicting images of bondage and BDSM which has got us thinking about pain, pleasure and the theory of classical conditioning.
Last month our humanities piece explored the experiences of ballerina's, you can read our blog "Pain, passion and learning" to find out more.
Pain is more than just a sensory experience—it is shaped by learning, expectation, and context. Classical conditioning, a foundational concept in behavioural psychology, has been proposed as a mechanism for how pain thresholds and sensitivity develop over time. But is this Classical Conditioning theory relevant in a modern understanding of learning and perception?
Does Pain Fit the Classical Conditioning Model?
Classical conditioning is a form of associative learning in which a previously neutral stimulus (conditioned stimulus, CS) is paired with an unconditioned stimulus (US) that elicits an automatic or reflexive response.
Over time, the neutral stimulus alone is thought to evoke the conditioned response. In the case of pain, this model is often used to explain how certain non-noxious cues become pain triggers—a process frequently seen in fear-avoidance models of chronic pain.
This places pain as the reflexive and automated response to stimuli - typically noxious stimuli - and non-noxious stimuli as neutral which can be conditioned to modulate an experience of pain or even evoke an experience of pain.
Indeed, Madden and Moseley (2016) demonstrated that clinicians often defer to classical conditioning as a way to explain this phenomena to patients when asked why everyday experience and actions had become painful in the absence of injury despite the lack of robust evidence to support this claim.
For example, if someone experiences severe back pain when bending forward, a clinician may explain that they have learned to associate the movement with pain, even after the original injury has healed.
Our reading from February 2025 by Traxler et al. (2019) sought to test whether such conditioning could be experimentally induced in a laboratory setting.
Conditioning Pain Sensitivity
The researchers designed a within-subject experiment to examine whether pain thresholds could be altered through classical conditioning. Participants were exposed to two types of vibrotactile stimuli—one designated as the conditioned stimulus (CS+) and the other as a control (CS-).
The CS+ was consistently paired with an electrocutaneous shock reported as painful, establishing an association between the tactile cue and pain.
The CS- was never paired with a shock, serving as a baseline comparison.
After repeated pairings, the researchers tested whether participants would perceive later vibrotactile stimuli as more painful when associated with the CS+.
Learning to Feel More Pain?
The results revealed that participants reported higher pain levels even when the CS+ was presented at pain-threshold intensity but without an actual shock. In other words, individuals were more likely to perceive a non-noxious stimulus as painful if they had previously learned to associate it with pain.
This can be seen to support the idea that pain perception is not purely driven by nociception (the detection of harmful stimuli) but is shaped by learned associations—a key tenet of classical conditioning. Much like Pavlovs' the dogs salivating at only a bell after being conditioned as associated with food.
Does This Study Truly Demonstrate Classical Conditioning?
While the findings align with classical conditioning principles, they also highlight limitations in the traditional stimulus-response model and how we understand pain.
With this model, pain necessarily must be a physiologically pre-programmed response to certain stimuli and consistently evoked through the nociceptive processing of noxious stimuli. However, pain research has revealed that nociception is neither necessary nor sufficient for the experience of pain, such as in the event of phantom limb pain. Therefore, whilst we may see data that fits with Classical Conditioning theory, Classical Conditioning is not enough to fully explain the phenomena.
In the context of pain and classical conditioning, this would mean that non-noxious cues (like a vibrotactile stimulus) should consistently trigger pain responses if they have been conditioned with painful stimuli.
However, the study's results indicate a significant variability in conditioned pain responses, suggesting that classical conditioning alone is insufficient to explain pain modulation.
Several key points highlight the misalignment between the study's findings and classical conditioning theory:
Pain Perception is Not a Fixed Conditioned Response
In classical conditioning, once a CS-US association is formed, the CR should be predictable and stable.
However, in this study, the effect of conditioning on pain thresholds was not uniform across participants, suggesting individual differences, contextual factors, and cognitive modulation of pain perception.
Context and Expectation Play a Larger Role than Conditioning Alone
The study demonstrates that pain modulation is influenced by expectation and cognitive processing, which aligns more with predictive coding models rather than classical conditioning.
Predictive processing suggests that the brain actively interprets sensory input based on prior knowledge and expectations, rather than passively forming stimulus-response associations.
Pain is Multi-Dimensional, Not a Simple Learned Association
Classical conditioning assumes a relatively straightforward transfer of responses from US to CS.
Yet, pain is influenced by affective, cognitive, and social factors, meaning a purely associative learning model is insufficient to explain its complexities.
BDSM as an Example of Pain Reinterpretation
On the surface, BDSM might seem to contradict classical conditioning principles. Activities like impact play, restraint, or flogging involve stimuli that would typically be associated with pain and avoidance and it is likely that through a lifetime this has been in-forced culturally or actually. However, for practitioners, these same stimuli are often experienced as pleasurable or empowering. How does this fit within a conditioning framework?*
Surprisingly, within the BDSM community, classical conditioning is accepted as the dominant principle and is used to 'train' a person to experience increased and heightened pleasure alongside pain. Through repeated exposure, individuals may develop positive experiences to stimuli typically linked with pain or avoidance. Practitioners in a BDSM context consistently pair arousal, excitement, or emotional connection with activities that evoke pain based upon theory that the brain may begin to interpret these stimuli differently to the point where the painful activity may begin to evoke the pleasure of previously conditioned activities. This aligns with the findings of Traxler et al. (2019), where conditioning altered pain thresholds—suggesting that in BDSM, learned associations can shift pain perception toward pleasure rather than distress.
Despite this alignment, BDSM also highlights key limitations in classical conditioning’s ability to fully explain pain perception. If pain responses were purely conditioned, we would expect BDSM practitioners to react to noxious stimuli in a fixed way. However, context, consent, and psychological framing play critical roles. Pain in a BDSM setting is fundamentally different from pain in an injury or trauma context because, when it is part of the BDSM play, it is framed as safe, controlled and desired. Suggesting that our perceptions, including pain, are flexible and unique.
A More Complex View of Pain
Understanding pain as a learned experience has profound implications for both chronic pain management and rehabilitation, making this study a valuable contribution to the evolving science of pain perception.
Rather than supporting a strict classical conditioning model, the findings in this month's paper suggest that pain is context-dependent and shaped by higher-order cognitive processes. This aligns with more modern frameworks, such as:
Predictive processing theory, which argues that pain perception is produced between a priori knowledge and expectations paired with stimuli/error information being sampled locally. It. is an active process being produced within this dynamic coupling of information.
The biopsychosocial model, which considers the interplay between biological, psychological, and social influences on pain perception.
Therefore, while the study does show that pain processing is is updated by repeated coupling of noxious and non-noxious stimuli, it does not provide strong evidence that pain is governed purely by classical conditioning principles. Instead, it highlights the need for more nuanced and dynamic models of pain perception.
References:
Madden, V.J. and Moseley, G.L., 2016. Do clinicians think that pain can be a classically conditioned response to a non-noxious stimulus?. Manual therapy, 22, pp.165-173.
Traxler, J., Madden, V.J., Moseley, G.L. and Vlaeyen, J.W., 2019. Modulating pain thresholds through classical conditioning. PeerJ, 7, p.e6486.
* Various Reddit's and sub-reddits were used as background information for this blog.
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