Historically, physical pain has often been used as a form of punishment for misdeeds as well as self-atonement for guilty feelings and other forms of emotional and psychological distress. Psychological and emotional relief is a particularly common side effect of physical and emotional pain, especially when pain is controlled and manageable. In the practice of sadomasochism (SM), physical and emotional pain is often included in role play activities where guilt and punishment are dramatized for sexual pleasure. However, contrary to popular opinion, many SM practitioners argue that they do not actually like pain, but that pain within SM is used as a tool for psychological release. Neural and physiological mechanisms involved with contextual modulation of pain might render SM pain not as painful as it seems. Pain has also been associated with positive consequences which may be involved with the reasons why SM practitioners choose to engage in these activities. Could SM practitioners be using physical and/or emotional pain as a way to balance negative moods or other adverse psychological states? The current study explored the reported reasons why SM participants engage in painful activities and specifically whether mood altering or therapeutic benefits were amongst the perceived benefits. Participants (n = 510) completed an online questionnaire exploring reasons for engaging in SM pain, its potential benefits and whether therapeutic benefits were experienced. Data were analyzed using contingency tables, discriminant analysis, and factor analyses, and multiple linear regression analyses. Acknowledgment of psychological benefits from SM pain was expected and confirmed, with only 12% of the sample finding no therapeutic value in their SM pain interactions. Reports of reasons to engage in SM pain and therapeutic relief from SM pain varied according to a number of demographic and sexual/SM characteristics. In conclusion, SM pain was significantly associated with relief from emotional strain and overload, with women, experienced participants, strong masochists and strong sadists reporting relief most frequently.