Self-flagellation, mutilation, bladder constriction are all part of a Paralympic cheats effort to boost performance.
A belt or a sharp object rather than a banned substance is used to gain an edge in elite competition.
The grisly practice of voluntary autonomic dysreflexia -- commonly known as boosting -- involves disabled athletes beating, stabbing and strapping parts of the body to provoke an adrenalin rush that can improve performance by up to 25 percent, or failing that, kill them.
Peter Van de Vliet, the medical and scientific director of the International Paralympic Committee says while it's not a widespread problem, it was a factor for athletes with spinal cord injuries.
In essence, they can harm parts of their bodies without feeling pain.
Recognised as an unfair advantage and a health threat, boosting entered the IPC's anti-doping code ahead of Athens in 2004,
High blood pressure readings taken before and after competitions can lead to an athlete's disqualification though no mandatory bans are meted out, unlike in conventional doping cases.
Van van Vliet says officials are still working out a suitable process for testing.
In addition to random checks to weed out boosters, officials will carry out some 1,100 urine and blood tests in Beijing, 70 percent more than at Athens.