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Painstoppers would make them stronger but I can't imagine it really coming up in vanilla unless they run out of Go-Juice which doesn't happen too often for me. A funny thing you can do with vanilla hediffs is to give painstopper/ghoul pawns fiborous and sensory mechanites because they get the stat boosts but not the pain lol.
I kind of like the idea that Liches/Gaunts are doing it for the thrill and wouldn't use painstoppers while hunting terrestrials, though. Gorerunners were going to have them before I decided not to give them bionics.
Metabolism isn't really a problem anyway. Gaunts/gorerunners aren't supposed to be optimal.
Painstopper + extra pain gene. The extra pain gene gives metabolism that could be spent making these guys even more terrifying, but painstopper would prevent it from affecting combat cos anything multiplied by 0 is 0.
I have nothing else to report.
10/10