This is pretty deranged, even for you. I guess it would be weird for me to say that it expresses pain too much. You had other entries worse! I guess it's just because it's bad to see such a clear image of him screaming. The arrow hands contrast so much with his body. I've never seen that in a submission by you.
The fact that he had no genitalia didn't make it any scarier. The background contrasts so well with his body. I guess it's rare a picture from you does that. It's great to see how the shadings merge together. It works so well with the colors.