Pain Judgments Research Articles

Reduced Late Positive Potentials to distress in individuals with high psychopathic traits during pain judgment tasks

This study examined the empathic processing of individuals with psychopathic traits and healthy controls in response to pain, applying affective perspective-taking (Self vs. Other). Twenty subjects with high psychopathic traits and twenty control subjects performed pain judgment tasks in the study. During the tasks, late positive potentials (LPPs) of the participants were measured to assess emotional processing in reaction to visual stimuli depicting painful or non-painful situations. In early LPP time stage (500-700ms), the control group and the psychopathic trait group exhibited comparable levels of empathic processing regarding pain. However, in late LPP time window (700-1,100ms), the control group showed a greater LPP amplitude to Pain stimuli than No-pain stimuli, whereas the psychopathic trait group exhibited non-significant amplitude differences between Pain and No-pain stimuli. These findings imply that individuals with high psychopathic traits may swiftly terminate the processing and encounter difficulties in reappraising distress cues, especially in the late stage, providing psychophysiological support for distinctive empathic processing with temporal aspects.

The Influence of Sex and Gender, Gender Ontological Beliefs, and Sexism on Pain Sensitivity Judgments: Implications for Health Care Settings and Beyond

Chronic pain affects at least one in five individuals. Hence, adequate pain judgement is a vital interpersonal skill. Nonetheless, women often face treatment disparities due to biased assessments. Priorly, sex and gender (i.e., biological category vs. cultural representation) have not been investigated separately. Our study was thus designed to disentangle their distinct influence on pain judgments. In an online study, N = 679 participants (73.8% female) were presented with a novel vignettes paradigm including descriptions of fictional gender-stereotypical and counter-stereotypical women and men. Participants were instructed to rate the characters’ pain sensitivity before completing inventories measuring gender ontological beliefs and ambivalent sexism. We found significant interaction effects of observer and character sex, in that higher pain sensitivity was attributed to opposite-sex characters. Men showed a higher sex bias, which was partially mediated by lower social constructionism and higher hostile sexism. We further uncovered a gender bias across observers, in that feminine characters were assumed to be more pain sensitive, irrespective of their sex. Our research underscores the presence of sex and gender biases in pain judgments, even in scenarios with minimal contextual cues. Despite limitations, the findings offer insights for the development of intervention strategies, which might reduce treatment disparities.

Social cues influence perception of others' pain.

Accurately perceiving other people's pain is important in both daily life and healthcare settings. However, judging other's pain is inherently difficult and can be biased by various social and cultural factors. Here, we examined whether perception of others' pain and pain management recommendations are socially influenced by seeing the opinions of other raters. In Experiment 1 (N = 50), participants rated pictures depicting injured hands or feet of pre-selected high, medium and low intensities. Each picture was preceded by cues indicating ratings of 10 previous participants. Cues were randomized to indicate low (SocialLOW) or high (SocialHIGH) pain judgements and were not predictive of actual normative pain intensity. In Experiment 2 (N = 209), participants viewed facial video clips of patients with chronic shoulder pain making painful movements. They estimated patients' pain intensity and provided pain management recommendations. Experiment 1 revealed that perceivers' pain estimates were significantly and substantially higher for stimuli following SocialHIGH than SocialLOW cues (Cohen's d = 1.26, p < 0.001) and paralleled by increased skin conductance responses. Experiment 2 replicated the effect of social cues on pain judgements (d = 0.58, p < 0.001). However, social cues did not influence post-study pain management recommendations, potentially due to memory limitations. Together, these studies reveal that judgements of others' pain are robustly modulated by information about others' opinions. Future research could test the prevalence and strength of such effects in clinical settings. The present study shows that even arbitrary opinions of other raters influence the perception of others' pain. This finding adds new insight into the growing evidence of social and cultural biases in pain estimation.

The impact of sufferers' wealth status on pain perceptions: Its development and relation to allocation of healthcare resources.

Wealth-based disparities in health care wherein the poor receive undertreatment in painful conditions are a prominent issue that requires immediate attention. Research with adults suggests that these disparities are partly rooted in stereotypes associating poor individuals with pain insensitivity. However, whether and how children consider a sufferer's wealth status in their pain perceptions remains unknown. The present work addressed this question by testing 4- to 9-year-olds from the US and China. In Study 1 (N=108, 56 girls, 79% White), US participants saw rich and poor White children experiencing identical injuries and indicated who they thought felt more pain. Although 4- to 6-year-olds responded at chance, children aged seven and above attributed more pain to the poor than to the rich. Study 2 with a new sample of US children (N=111, 56 girls, 69% White) extended this effect to judgments of White adults' pain. Pain judgments also informed children's prosocial behaviors, leading them to provide medical resources to the poor. Studies 3 (N=118, 59 girls, 100% Asian) and 4 (N=80, 40 girls, 100% Asian) found that, when evaluating White and Asian people's suffering, Chinese children began to attribute more pain to the poor than to the rich earlier than US children. Thus, unlike US adults, US children and Chinese children recognize the poor's pain from early on. These findings add to our knowledge of group-based beliefs about pain sensitivity and have broad implications on ways to promote equitable health care. RESEARCH HIGHLIGHTS: Four studies examined whether 4- to 9-year-old children's pain perceptions were influenced by sufferers' wealth status. US children attributed more pain to White individuals of low wealth status than those of high wealth status by age seven. Chinese children demonstrated an earlier tendency to attribute more pain to the poor (versus the rich) compared to US children. Children's wealth-based pain judgments underlied their tendency to provide healthcare resources to people of low wealth status.

The Evolution of Neuroimaging Technologies to Evaluate Neural Activity Related to Knee Pain and Injury Risk.

In this review, we present recent findings and advancements in the use of neuroimaging to evaluate neural activity relative to ACL injury risk and patellofemoral pain. In particular, we describe prior work using fMRI and EEG that demonstrate the value of these techniques as well as the necessity of continued development in this area. Our goal is to support future work by providing guidance for the successful application of neuroimaging techniques that most effectively expose pain and injury mechanisms. Recent studies that utilized both fMRI and EEG indicate that athletes who are at risk for future ACL injury exhibit divergent brain activity both during active lower extremity movement and at rest. Such activity patterns are likely due to alterations to cognitive, visual, and attentional processes that manifest as coordination deficits during naturalistic movement that may result in higher risk of injury. Similarly, in individuals with PFP altered brain activity in a number of key regions is related to subjective pain judgements as well as measures of fear of movement. Although these findings may begin to allow objective pain assessment and identification, continued refinement is needed. One key limitation across both ACL and PFP related work is the restriction of movement during fMRI and EEG data collection, which drastically limits ecological validity. Given the lack of sufficient research using EEG and fMRI within a naturalistic setting, our recommendation is that researchers target the use of mobile, source localized EEG as a primary methodology for exposing neural mechanisms of ACL injury risk and PFP. Our contention is that this method provides an optimal balance of spatial and temporal resolution with ecological validity via naturalistic movement.

Biased Beliefs About White Releasees' Sensitivity to Social Pain.

The accurate perception of others' pain is a prerequisite to provide needed support. However, social pain perception is prone to biases. Multiple characteristics of individuals bias both physical and social pain judgments (e.g., ethnicity and facial structure). The current work extends this research to a chronically stigmatized population: released prisoners (i.e., releasees). Recognizing the large United States releasee rates and the significant role support plays in successful re-integration, we conducted four studies testing whether people have biased judgments of White male releasees' sensitivity to social pain. Compared with the noncriminally involved, people judged releasees as less sensitive to social pain in otherwise identical situations (Studies 1a-3), an effect that was mediated by perceived life hardship (Study 2). Finally, judging releasees' as relatively insensitive to social pain undermined perceivers' social support judgments (Study 3). The downstream consequences of these findings on re-integration success are discussed.

Desensitized gamers? Violent video game exposure and empathy for pain in adolescents – an ERP study

ABSTRACTThis Event-Related Potential (ERP) study aimed to test how habitual and short-term violent video game exposure (VVGE) may affect empathy for pain responses in adolescents. In a within-subjects design, boys (N = 56; aged 12–16 years) performed a pain judgment task before and immediately after playing a violent video game. In this task, participants judged whether photos of hands depicted on their screen were in a painful situation or not. While both the P3 and the LPP components were not related to habitual violent video game exposure, general exposure to antisocial media content predicted lower P3 amplitudes to painful pictures. Further, 40 min of violent gameplay did not affect the P3 responses; however, it temporarily decreased LPP responses to painful pictures, suggesting a modest short-term desensitization effect. However, this latter interpretation is limited by a strong LPP pain effect – a significant amplitude difference between painful and non-painful pictures – that remained present in the post-game condition. Such persistent LPP effect may relate to the notion that adolescents are still learning how to properly regulate their emotional reactions. This study contributes to the limited literature on violent video games’ desensitization in adolescents’ brains, opening new avenues for media violence research.

Interaction between local blood flow and tolerance to prolonged pain in the elderly.

We aimed to explore the link between local vasodilation and pain perception in elderly subjects, testing the hypothesis that altered local cutaneous blood flow participates in the decrease in pain tolerance with age. Sixty-eight young and 83 older participants performed a pain tolerance test in which they hold their hand in an airtight box in which air temperature was regulated at 65°C until the pain became unbearable. Participants continuously estimated pain intensity. Skin temperature and local blood flow in the box-exposed hand were continuously monitored. In the young group, 97% of subjects resisted pain until the end of the test, whereas only 53% in the elderly group managed to do so, indicating that pain tolerance is impaired in the elderly. Among all participants, the skin temperature associated with the first pain sensation was below the threshold for nociceptor activation (43°C). Interestingly, blood flow in the elderly group was correlated with pain judgment, whereas no such correlation was observed in the young. Our results suggest that the local vasodilator response induced by local heating may be involved in pain perception and may influence thermal pain tolerance with aging. These results could contribute to a better understanding of vascular deficits and the development of chronic pain in vascular pathologies.

Social Class and Social Pain: Target SES Biases Judgments of Pain and Support for White Target Individuals.

Social pain, defined as distress caused by negative interpersonal experiences (e.g., ostracism, mistreatment), is detrimental to health. Yet, it is unclear how social class might shape judgments of the social pains of low-socioeconomic status (SES) and high-SES individuals. Five studies tested competing toughness and empathy predictions for SES's effect on social pain judgments. Consistent with an empathy account, in all studies (Ncumulative = 1,046), low-SES White targets were judged more sensitive to social pain than high-SES White targets. Further, empathy mediated these effects, such that participants felt greater empathy and expected more social pain for low-SES targets relative to high-SES targets. Social pain judgments also informed judgments of social support needs, as low-SES targets were presumed to need more coping resources to manage hurtful events than high-SES targets. The current findings provide initial evidence that empathic concern for low-SES White individuals sensitizes social pain judgments and increases expected support needs for lower class White individuals.

Investigating the relationship between pain indicators and observers' judgements of pain.

Due to the inherent subjectivity of pain, it is difficult to make accurate judgements of pain in others. Research has found discrepancies between the ways in which perceived "objective" (e.g., medical evidence of injury) and "subjective" information (e.g., self-report) influence judgements of pain. This study aims to explore which potential cues (depictions of sensory input, brain activation, self-reported pain and facial expressions) participants are most influenced by when evaluating pain in others. First, 60 participants (23 women, 36 ± 10 years old) judged who was in more pain between two different pain indicators representing two different patients. These trials revealed which congruent indicator (i.e., two high pain indicators) would most influence participant decisions. Second, participants prescribed quantities of analgesia for one patient's pain based on two different pain indicators. These trials revealed which incongruent indicators (i.e., one high and one low indicator) would most influence participant decisions. As predicted, facial expressions were perceived as subjective and were the least likely, among all pain indicators, to influence observer's judgements of pain. Participants relied upon indicators they perceived as objective. Self-report pain ratings had the greatest influence on participants judgements about how much analgesic cream to prescribe and was perceived as objective by half of the participants. We found that in situations where incongruent information was presented about an individual's pain, participants relied on pain indicators that they perceived to be objective. The current study provides important insights about biases that people hold when making judgements of pain in others. Interpretation and assessment of pain remains one of the largest barriers to pain management and involves complex, idiosyncratic processing. This study provides insights into what information participants view as critical in making attributions of pain when presented with multiple, seemingly incongruent sources of information.

Pain Empathy and Its Association with the Clinical Pain in Knee Osteoarthritis Patients.

Knee osteoarthritis (KOA) is a painful chronic disorder. Evidence has shown that a history of chronic pain plays an important role in shaping empathy. Empathy, a valuable indicator of social functioning that refers to an individual's ability to share the experiences of others, however, has been overlooked in KOA patients. This study aimed to investigate empathy and its association with clinical pain in KOA patients. KOA patients (n=47) and healthy controls (HCs, n=44) completed two empathy-for-pain tasks: a pain judgment task in which participants judged whether a person in an image felt pain or not, and a pain rating task in which they estimated pain intensity for themselves and others. The Interpersonal Reactivity Index was used to measure participants' trait empathy, and clinical severity and psychological factors were assessed using relevant instruments. Compared to HCs, KOA patients showed higher accuracy when judging pain and non-pain images and reported overall higher pain intensity when rating for themselves and others. KOA patients also showed greater personal distress than HCs in terms of their self-reported empathy. Moreover, pain catastrophizing particularly mediated the relationship between pain severity and pain ratings for others, and depression, anxiety, and pain catastrophizing all mediated the association between pain severity and empathy-induced personal distress. These findings suggest that patients with KOA have increased empathy, demonstrated by elevated sensitivity to pain-related scenes and intense emotional responses.

The Effect of Cognitive Strategies and Facial Attractiveness on Empathic Neural Responses.

Empathy is a phenomenon that brings together both emotions and an understanding of another person. Recent studies have disentangled the mechanisms of empathy into emotional and cognitive aspects. Event-related potential (ERP) studies suggest that emotional empathy is related to the modulation of the amplitude of early ERPs, and cognitive empathy is linked to later ERPs. In the current study, we examined the influences of facial attractiveness on empathic response and the effect of cognitive strategies with setting the participants' attention to attractiveness or pain. Participants (N= 19) viewed photos of physically attractive and unattractive men and women receiving painful stimulation. The amplitude of the N2 component measured at the frontal regions was more negative in painful stimulation compared to the non-painful, but only for attractive faces. There were no differences between painful and non-painful stimulation for unattractive faces. The amplitude of the P3 measured at the central-parietal region component was more positive in the painful condition compared to the non-painful one, but only when participants performed a pain judgment task. There were no differences in the attractiveness judgment task. This study showed that the attractiveness of a model and drawing the participants' attention to pain constitute an essential modulator of pain empathy.

Is it painful? Playing violent video games affects brain responses to painful pictures: An event-related potential study.

Previous research showed mixed evidence on how violent video game exposure (VVGE) may affect empathy for pain in the brain. This study applied an event-related potential (ERPs) approach to improve understanding of how habitual and short-term violent game play may affect top-down and bottom-up empathy for pain brain responses. A total of 58 male participants with different levels of habitual VVGE performed a pain judgment task before and after 40 min of violent game play while their brain responses were recorded. Results showed that only late cognitive-evaluative ERP responses (P3, P625) were sensitive to the pictures’ painfulness, which were also affected by both habitual VVGE and short- term violent game play. As expected, participants with no habitual VVGE showed an ERP pain effect before game play: higher P3 and P625 amplitudes for painful versus nonpainful pictures. In contrast, a similar ERP pain effect was not observed in participants with high VVGE before game play, suggesting habitual desensitization. Short-term violent game play resulted in lower P3 and P625 amplitudes for painful pictures in the no VVGE group, indicating short-term desensitization. We discuss the observed VVGE desensitization effects in terms of top-down regulation of an empathetic response induced by painful stimuli. Though such adaptation could be beneficial in a violent game environment, possible long-term consequences associated with reduced empathic responsiveness in a social context should be further studied. In all, our findings contribute to the debate on the effects of VVGE on the brain by pro- viding first ERP evidence suggesting empathy for pain desensitization.

The effect of sleep deprivation on empathy for pain: An ERP study

Empathy for pain has a strong adaptive function. It plays a protective role in survival and exerts a vital impact on successful social interaction. Sleep loss, however, is commonplace in current society, and people are increasingly plagued by it. Previous studies have investigated whether sleep loss affects empathy for pain, yet the results were undecided. We aimed to determine whether this effect is existed and further explore the temporal and frequency dynamics of neural activities involved in this effect by recording the electroencephalogram (EEG) signals. We recruited 25 healthy adults (11 females) who were required to perform a pain judgement and unpleasantness rating about the presented nociceptive and neutral pictures after nocturnal sleep (NS) and sleep deprivation (SD), and their neuronal activities were recorded by event-related potentials (ERPs). Results showed a significantly decreased amplitude in the early components (N2, N340) of vicarious pain processing after SD. In further time-frequency (TF) analysis, a reduced energy occurred in theta2 (5–7 Hz) band under SD condition. Moreover, the decreased theta2 was positively correlated with the subjective ratings of both other's pain and self-unpleasantness only under SD condition. Our results indicated that SD impairs affective sharing of empathy for pain.

Can neuroimaging prove pain and suffering?: The influence of pain assessment techniques on legal judgments of physical versus emotional pain.

It is difficult to "prove" pain and suffering-particularly emotional suffering. Neuroimaging technology might bolster pain claims in civil cases by making pain seem less subjective. We examined how neuroimaging of physical and emotional pain influences judgments of pain and suffering across nonlegal and legal contexts. We hypothesized that participants would rate pain assessed using neuroimaging as more severe and award higher compensation than pain assessed using self-report measures. We also hypothesized that participants would rate physical (vs. emotional) pain as more severe, except when the pain claim was bolstered by a neuroimaging assessment. In two experiments, we tested how pain assessment techniques influence perceptions of pain severity and monetary compensation differently for physical or emotional pain. Using a within-subjects design, participants (Experiment 1, N = 411, 59% male, 80% White) read 6 vignettes that described a person's chronic physical or emotional pain, evaluated using a clinical assessment, neuropsychological assessment, or neuroimaging assessment. We conceptually replicated Experiment 1 in a legal context (Experiment 2, N = 353, 42% male; 80% White) and tested whether the neuroimaging effect was due to knowing that the pain was assessed by neuroimaging or also required the inclusion of a neuroimage. When pain was assessed using neuroimaging (vs. non-neuroimaging assessments), participants rated the pain as more severe and gave larger monetary awards. When a person alleged physical (vs. emotional) pain, participants rated the pain as more severe and gave larger monetary awards. We conceptually replicated these findings in Experiment 2 and found that the neuroimaging effect was due to hearing about neuroimaging assessment and did not necessitate the inclusion of a neuroimage. Neuroimaging technology could be extremely useful for plaintiffs trying to overcome the difficult hurdle of proving their pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Race, social pain minimization, and mental health

People often believe Black individuals experience less social pain and require less social support to cope with distress than White individuals (e.g., Deska, Kunstman, Lloyd, et al., 2020). However, researchers have not tested whether biases in third-person pain judgments translate to first-person experiences with social pain minimization. For example, do Black individuals feel their social pain is underrecognized to a greater extent than White individuals? The current work tested whether Black individuals felt their social pain was minimized more than White individuals and if the experience of social pain minimization was related to worse mental health and greater life stress. Data from two cross-sectional, correlational studies provide initial support for these predictions ( Ntotal = 1,501). Black participants felt their social pain was minimized more than White participants and this race difference in social pain minimization was associated with worse mental health and greater life stress. These results suggest that Black individuals feel their pain is underrecognized and this experience of social pain minimization is related to worse mental health outcomes.

Alterations in event-related potential responses to empathy for pain in Parkinson’s disease on and off medication

ObjectiveHow Parkinson’s disease (PD) affects an individual’s empathic capacity remains poorly understood. By using the event-related potential (ERP) technique, we sought to: (1) study the temporal dynamics of empathic responses in patients with PD; (2) explore whether dopaminergic medication modulates empathic processing. MethodsTwenty-six patients with early-to-moderate PD (13 on– and 13 off-medication) and 14 healthy controls performed an empathy-for-pain paradigm test while we recorded their electroencephalography. The participants responded to neutral or painful pictures during an active empathic condition (pain judgment task) and a control condition that was manipulated by task demands (laterality judgment task). ResultsThe ERP results demonstrated an early automatic frontal response and a late controlled parietal response to pain in healthy elderly controls. The observed early and late ERP responses were detected in the on-medication patients but not in the off-medication patients. ConclusionsPD is associated with deficits in both affective and cognitive empathic responses, dopaminergic medication may have the potential to alleviate these deficits. SignificanceThis study helps to understand empathic deficits in patients with PD. Within-subject studies are required to reliably assess the effect of dopaminergic medication on empathic processing.

Supplemental Material for Can Neuroimaging Prove Pain and Suffering?: The Influence of Pain Assessment Techniques on Legal Judgments of Physical Versus Emotional Pain

Supplemental Material for Can Neuroimaging Prove Pain and Suffering?: The Influence of Pain Assessment Techniques on Legal Judgments of Physical Versus Emotional Pain

Confidence in subjective pain is predicted by reaction time during decision making

Self-report is the gold standard for measuring pain. However, decisions about pain can vary substantially within and between individuals. We measured whether self-reported pain is accompanied by metacognition and variations in confidence, similar to perceptual decision-making in other modalities. Eighty healthy volunteers underwent acute thermal pain and provided pain ratings followed by confidence judgments on continuous visual analogue scales. We investigated whether eye fixations and reaction time during pain rating might serve as implicit markers of confidence. Confidence varied across trials and increased confidence was associated with faster pain rating reaction times. The association between confidence and fixations varied across individuals as a function of the reliability of individuals’ association between temperature and pain. Taken together, this work indicates that individuals can provide metacognitive judgments of pain and extends research on confidence in perceptual decision-making to pain.

Dispositional Self-Construal Modulates the Empathy for Others' Pain: An ERP Study.

Previous studies have shown that temporal self-construal priming can modulate the empathic neural responses to others’ pain. However, little is known about the influences of the dispositional self-construal on empathic neural responses to others’ pain. The present study aimed to investigate neural correlates that underlie the modulation effect of dispositional self-construal on perception of others’ pain. Event-related potentials were recorded for pictures depicting the hands of strangers in painful or no-painful situations while subjects performed a pain judgment task. The regression analysis on behavioral data showed that the level of interdependent self-construal could positively predict behavioral ratings of perceived pain, but not the self-unpleasantness. The ERP results showed painful stimuli elicited decreased N2 amplitudes and larger P3 amplitudes than those by no-painful stimuli. Moreover, the level of interdependent self-construal (interdependence minus independence scores) could predict the amplitude differences on the P3 component (painful minus neutral stimulus conditions), but not the N2 component: the higher the level of the interdependent self-construal, the larger amplitude differences of P3 to painful stimuli (vs. no-painful stimuli). These findings extended previous studies by showing a clear modulation effect of the dispositional self-construal on empathic neural responses to others’ pain, and that this modulation effect occurred at the late cognitive evaluation stage indexed by the P3 component.