Perception Of Pain In Others Research Articles

Neural time course of pain observation in infancy.

Perception of pain in others is of great evolutionary significance for the development of human empathy. However, infants' sensitivity to others' painful experiences has not been investigated so far. Here, we explored the neural time course of infants' processing of others' pain by measuring event-related brain potentials (ERPs) while 6-month-old infants observed a painful tactile stimulation directed towards the eye and a neutral tactile stimulation on the eyebrow. We analyzed both the Negative Central (Nc) and the later Late Positive Potential (LPP) ERP components, indexing respectively attention allocation and cognitive evaluation of perceptual stimuli. Results showed that observing painful touch elicits a mid-latency Nc (300-500ms) over the right fronto-central site, which is greater in amplitude as compared to neutral touch. A divergent activity was also visible in the centro-parietal early (550-750ms) and late (800-1000ms) LPP, showing increased amplitudes in response to neutral compared to painful touch. The cognitive evaluation of painful stimuli, reflected by the LPP, might thus not be fully developed at 6months of age, as adults typically show a larger LPP in response to painful as compared to neutral stimuli. Overall, infants show early attentional attuning to others' pain. This early sensitivity to others' painful tactile experiences might form a prerequisite for the development of human empathy.

Individual Differences and Similarities in the Judgement of Facial Pain: A Mixed Method Study.

Accurate assessment of pain by health-care professionals is essential to ensure optimal management of pain. An under-researched area is whether personality characteristics affect perception of pain in others. The aims were (a) to determine whether individual differences are associated with participants’ ability to assess pain, and (b) to determine facial cues used in the assessment of pain. One hundred and twenty-eight undergraduate students participated. They completed questionnaire assessments of empathy, pain catastrophizing, sensory sensitivity and emotional intelligence. They then viewed and rated four adult facial images (no, medium, and high pain—12 images total) using a 0–10 numerical rating scale, and noted the reasons for their ratings. (a) Empathy was the only characteristic associated with accuracy of pain assessment. (b) Descriptions of eyes and mouth, and eyes alone were most commonly associated with assessment accuracy. This was the case despite variations in the expression of pain in the four faces. Future studies could evaluate the effect on accuracy of pain assessment of (a) training empathic skills for pain assessment, and (b) emphasizing attention to the eyes, and eyes and mouth.

Probing the role of the right inferior frontal gyrus during Pain-Related empathy processing: Evidence from fMRI and TMS.

Recent studies have suggested that the right inferior frontal gyrus (rIFG) may be involved in pain‐related empathy. To verify the role of the rIFG, we performed a functional magnetic resonance imaging (fMRI) experiment to replicate previous research and further designed a noninvasive repetitive transcranial magnetic stimulation (rTMS) experiment to probe the causal role of the rIFG in pain‐related empathy processing. We assigned 74 volunteers (37 females) to three groups. Group 1 (n = 26) performed a task in which participants were required to perceive pain in others (task of pain: TP) and we used fMRI to observe the activity of the rIFG during pain‐related empathy processing. Then, we applied online rTMS to the rIFG and the vertex site (as reference site) to observe the performance of Group 2 (n = 24; performing TP) and Group 3 (n = 24; performing a control task of identifying body parts; task of body: TB). fMRI experiment demonstrated stronger activation in the rIFG than in the vertex during the perception of pain in others (p < .0001, Bonferroni‐corrected). rTMS experiment indicated that when the rIFG was temporarily disrupted, participants perceived pain in others significantly more slowly (p < .0001, Bonferroni‐corrected) than when the vertex was disrupted. Our results provide evidence that the rIFG is involved in pain‐related empathy processing, which yields insights into how the brain perceives pain in others.

"Do unto others"? Distinct psychopathy facets predict reduced perception and tolerance of pain.

Recent research has sought to understand how individuals high in psychopathic traits perceive pain in others (Decety, Skelly, & Kiehl, 2013; Marsh et al., 2013). Perception of pain in others is presumed to act as a prosocial signal, and underreactivity to others' pain may contribute to engagement in exploitative-aggressive behaviors among individuals high in psychopathic traits (Jackson, Meltzoff, & Decety, 2005). The current study tested for associations between facets of psychopathy as defined by the triarchic model (Patrick, Fowles, & Krueger, 2009) and decreased sensitivity to pain in 105 undergraduates tested in a laboratory pain assessment. A pressure algometer was used to index pain tolerance, and participants also rated their perceptions of and reactivity to the algometer-induced pain during the assessment and again 3 days later. A unique positive relationship was found between pain tolerance and the meanness facet of psychopathy, which also predicted reduced fear of painful algometer stimulation. Other psychopathy facets (boldness, disinhibition) showed negative relations with fear of pain stimulation during testing and at follow-up. Findings from this study extend the nomological network surrounding callousness (meanness) and suggest that increased pain tolerance may be a mechanism contributing to insensitivity to expressions of discomfort in others. (PsycINFO Database Record

Mirroring pain in the brain: emotional expression versus motor imitation.

Perception of pain in others via facial expressions has been shown to involve brain areas responsive to self-pain, biological motion, as well as both performed and observed motor actions. Here, we investigated the involvement of these different regions during emotional and motor mirroring of pain expressions using a two-task paradigm, and including both observation and execution of the expressions. BOLD responses were measured as subjects watched video clips showing different intensities of pain expression and, after a variable delay, either expressed the amount of pain they perceived in the clips (pain task), or imitated the facial movements (movement task). In the pain task condition, pain coding involved overlapping activation across observation and execution in the anterior cingulate cortex, supplementary motor area, inferior frontal gyrus/anterior insula, and the inferior parietal lobule, and a pain-related increase (pain vs. neutral) in the anterior cingulate cortex/supplementary motor area, the right inferior frontal gyrus, and the postcentral gyrus. The ‘mirroring’ response was stronger in the inferior frontal gyrus and middle temporal gyrus/superior temporal sulcus during the pain task, and stronger in the inferior parietal lobule in the movement task. These results strongly suggest that while motor mirroring may contribute to the perception of pain expressions in others, interpreting these expressions in terms of pain content draws more heavily on networks involved in the perception of affective meaning.

A social neuroscience perspective on clinical empathy.

Clinical empathy is an important element of quality health care. Empathic communication is associated with improved patient satisfaction, increased adherence to treatment, and fewer malpractice complaints (1). Patients' perceptions of their physicians' empathy are positively related to more favorable health outcomes (2–4). In addition to improving patient outcomes, clinical empathy is associated with increased overall well-being for the physician (5). High levels of practitioner empathy have been associated with decreased burnout, personal distress, depression and anxiety, along with increased life satisfaction and psychological well-being (6,7). Despite increasing appreciation of the value of empathy, medical educators continue to struggle with how best to educate students and residents on empathy maintenance. There have been several promising creative approaches that have shown demonstrable short-term success (8). However, there is a lack of evidence for enduring success, that is, for interventions during medical education that will enable physicians to sustain empathy throughout their careers. A more comprehensive and precise understanding of the subcomponents of empathy and how they are influenced by stress and anxiety is needed in order to design targeted interventions.

Effects of cause of pain on the processing of pain in others: an ERP study

Determining how the perceived cause of pain influences the perception of pain in others has implications for prosocial behavior and moral reasoning. In this research, behavior and event-related potential (ERP) responses were recorded as 28 participants (12 men, 16 women) viewed images of painful situations said to be self-inflicted by the protagonist or caused by another person on the protagonist. As predicted, participants provided significantly higher pain intensity ratings for depictions featuring pain caused by another person than depictions of self-inflicted pain. ERP analyses showed no significant differences between protagonist alone and protagonist with other images of pain in the early negative component (N1). However, contrary to initial hypotheses, more positive P3 amplitudes were induced by images of self-inflicted pain in protagonists than images of protagonist pain caused by another person. Salience was considered as a key influence that may help to account for this pattern of findings.

The modulation of somatosensory resonance by psychopathic traits and empathy.

A large number of neuroimaging studies have shown neural overlaps between first-hand experiences of pain and the perception of pain in others. This shared neural representation of vicarious pain is thought to involve both affective and sensorimotor systems. A number of individual factors are thought to modulate the cerebral response to other's pain. The goal of this study was to investigate the impact of psychopathic traits on the relation between sensorimotor resonance to other's pain and self-reported empathy. Our group has previously shown that a steady-state response to non-painful stimulation is modulated by the observation of other people's bodily pain. This change in somatosensory response was interpreted as a form of somatosensory gating (SG). Here, using the same technique, SG was compared between two groups of 15 young adult males: one scoring very high on a self-reported measure of psychopathic traits [60.8 ± 4.98; Levenson's Self-Report Psychopathy Scale (LSRP)] and one scoring very low (42.7 ± 2.94). The results showed a significantly greater reduction of SG to pain observation for the high psychopathic traits group compared to the low psychopathic traits group. SG to pain observation was positively correlated with affective and interpersonal facet of psychopathy in the whole sample. The high psychopathic traits group also reported lower empathic concern (EC) scores than the low psychopathic traits group. Importantly, primary psychopathy, as assessed by the LSRP, mediated the relation between EC and SG to pain observation. Together, these results suggest that increase somatosensory resonance to other's pain is not exclusively explained by trait empathy and may be linked to other personality dimensions, such as psychopathic traits.

The Role of Gender in the Interaction Between Self-Pain and the Perception of Pain in Others

While self-pain motivates protective behaviors and self-oriented feelings, the perception of others' pain often motivates concern and prosocial behaviors toward the person suffering. The conflicting consequences of these 2 states raise the question of how pain is perceived in others when one is actually in pain. Two conflicting hypotheses could predict the interaction between these 2 signals: the threat value of pain hypothesis and the shared-representation model of pain empathy. Here, we asked 33 healthy volunteers exposed to acute experimental pain to judge the intensity of the pain felt by models expressing different levels of pain in video clips. Results showed that compared to a control warm stimulus, a stimulus causing self-pain increased the perception of others' pain for clips depicting male pain expressions but decreased the perceived intensity of female high pain expressions in both male and female participants. These results show that one's own pain state influences the perception of pain in others and that the gender of the person observed influences this interaction. PerspectiveBy documenting the effects of self-pain on pain perception in others, this study provides a better understanding of the shared mechanisms between self-pain and others' pain processing. It could ultimately provide clues as to how the health status of health care professionals could affect their ability to assess their patients' pain.

The Perception of Pain in Others: How Gender, Race, and Age Influence Pain Expectations

Sex, race/ethnic, and age differences in pain have been reported in clinical and experimental research. Gender role expectations have partly explained the variability in sex differences in pain, and the Gender Role Expectations of Pain questionnaire (GREP) was developed to measure sex-related stereotypic attributions about pain. It is hypothesized that similar expectations exist for age- and race-related pain decisions. This study investigated new measures of race/ethnic- and age-related stereotypic attributions of pain sensitivity and willingness to report pain, and examined the psychometric properties of a modified GREP. Participants completed the Race/Ethnicity Expectations of Pain questionnaire, Age Expectations of Pain questionnaire, and modified GREP. Results revealed a 3-factor solution to the race/ethnicity questionnaire and a 2-factor solution to the age questionnaire, consistent with theoretical construction of the items. Results revealed a 4-factor solution to the modified GREP that differed from the original GREP and theoretical construction of the items. Participants’ pain-related stereotypic attributions differed across racial/ethnic, age, and gender groups. These findings provide psychometric support for the measures examined herein and suggest that stereotypic attributions of pain in others differ across demographic categories. Future work can refine the measures and examine whether select demographic variables influence pain perception, assessment, and/or treatment. PerspectiveThe findings suggest that one’s expectations of the pain experience of another person are influenced by the stereotypes one has about different genders, races, and ages. The 3 pain expectation measures investigated in the current study could be used in future work examining biases in pain assessment and treatment.

Perception of Pain in Others: Implication for Caregivers

SUMMARYThe subjective nature of pain renders its perception in others a challenge for clinicians and informal caregivers responsible for its assessment and relief. Adequate perception of others' pain relies on different behavioral and neurophysiological mechanisms. Several individual, relational and contextual factors can influence the way the brain reacts to others' pain and the perception and assessment of this pain. This article focuses on recent neurophysiological and psychological evidence that characterizes these factors, and discusses their potential impact on the perception of others' pain in a caregiving context. Factors influencing the perception of pain in others are divided into factors related to the self (caregiver), factors related to the other (patient), and factors related to the relationship between those individuals and the context in which the pain is perceived. We propose that the perception of others' pain plays a crucial role in the treatment provided by clinicians and informal caregivers, and that further research could lead to improving decision-making regarding pain management.

The perception of pain in others: how gender, race, and age influence pain expectations

One obvious component of pain assessment is the provider's perception of pain in another. Age, race, and sex have been identified as cues that may influence the assessment of others' pain. The current study explored the effects of age, race, and sex related expectations on the perception of pain. 105 healthy volunteers completed questionnaires that compared their own pain sensitivity and willingness to report pain to how they expected “typical” persons of a different age, race, and sex would respond.

Physicians down-regulate their pain empathy response: An event-related brain potential study

Watching or imagining other people experiencing pain activates the central nervous system's pain matrix in the observer. Without emotion regulation skills, repeated exposure to the suffering of others in healthcare professionals may be associated with the adverse consequences of personal distress, burnout and compassion fatigue, which are detrimental to their wellbeing. Here, we recorded event-related potentials (ERP) from physicians and matched controls as they were presented with visual stimuli depicting body parts pricked by a needle (pain) or touched by a Q-tip (no-pain). The results showed early N110 differentiation between pain and no-pain over the frontal area as well as late P3 over the centro-parietal regions were observed in the control participants. In contrast, no such early and late ERP responses were detected in the physicians. Our results indicate that emotion regulation in physicians has very early effects, inhibiting the bottom-up processing of the perception of pain in others. It is suggested that physicians' down-regulation of the pain response dampens their negative arousal in response to the pain of others and thus may have many beneficial consequences including freeing up cognitive resources necessary for being of assistance.

Sensory-motor rhythms are modulated in response to perception of pain in others

Event Abstract Back to Event Sensory-motor rhythms are modulated in response to perception of pain in others Steven Whitmarsh1*, Ole Jensen1, Ingrid Niewenhuis1 and Henk Barendregt2 1 Donders Institute for Brain, Cognition and Behaviour, Netherlands 2 Radboud University, Netherlands Recent years have seen the emergence of a neuroscientific understanding of empathic responses as embodied sensory and motor processing. For instance remarkable overlap in first- and third-person perspectives has been demonstrated when processing tactile, nociceptive, emotional or behavioral information. In the current study we used MEG (VSM-CTF; 275 sensors) to measure neuromagnetic responses to the observation of static pictures depicting hand and feet in painful and non-painful situations. Our main objective was to investigate oscillatory responses reflecting the perception of pain in others. We found that observation of the hand and feet in non-painful situations resulted in significant suppression of mu and beta oscillations over sensorimotor and visual regions. Observing the limbs in painful situations significantly suppressed these sensorimotor rhythms further. The effect was most pronounced above left sensorimotor regions. In addition, the painful stimuli also induced significantly higher power in the gamma band (65-100Hz) over occipital areas. In future analysis we will localize the source using beamformer techniques. In addition, we intend to characterize the functional cross-frequency coupling between central alpha/beta oscillations and the induced posterior gamma oscillations. Our findings so far suggest that viewing painful compared to neutral stimuli engages both sensorimotor areas and visual areas. This supports the notion that embodied representations are involved in processing the valence of perceived third-person events. Conference: Biomag 2010 - 17th International Conference on Biomagnetism , Dubrovnik, Croatia, 28 Mar - 1 Apr, 2010. Presentation Type: Poster Presentation Topic: Sensory Processing and Functional Connectivity Citation: Whitmarsh S, Jensen O, Niewenhuis I and Barendregt H (2010). Sensory-motor rhythms are modulated in response to perception of pain in others. Front. Neurosci. Conference Abstract: Biomag 2010 - 17th International Conference on Biomagnetism . doi: 10.3389/conf.fnins.2010.06.00154 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 26 Mar 2010; Published Online: 26 Mar 2010. * Correspondence: Steven Whitmarsh, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands, s.whitmarsh@cs.ru.nl Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Steven Whitmarsh Ole Jensen Ingrid Niewenhuis Henk Barendregt Google Steven Whitmarsh Ole Jensen Ingrid Niewenhuis Henk Barendregt Google Scholar Steven Whitmarsh Ole Jensen Ingrid Niewenhuis Henk Barendregt PubMed Steven Whitmarsh Ole Jensen Ingrid Niewenhuis Henk Barendregt Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Social context and perceived agency affects empathy for pain: An event-related fMRI investigation

Studying of the impact of social context on the perception of pain in others is important for understanding the role of intentionality in interpersonal sensitivity, empathy, and implicit moral reasoning. Here we used an event-related fMRI with pain and social context (i.e., the number of individuals in the stimuli) as the two factors to investigate how different social contexts and resulting perceived agency modulate the neural response to the perception of pain in others. Twenty-six healthy participants were scanned while presented with short dynamic visual stimuli depicting painful situations accidentally caused by or intentionally caused by another individual. The main effect of perception of pain was associated with signal increase in the aMCC, insula, somatosensory cortex, SMA and PAG. Importantly, perceiving the presence of another individual led to specific hemodynamic increase in regions involved in representing social interaction and emotion regulation including the temporoparietal junction, medial prefrontal cortex, inferior frontal gyrus, and orbitofrontal cortex. Furthermore, the functional connectivity pattern between the left amygdala and other brain areas was modulated by the perceived agency. Our study demonstrates that the social context in which pain occurs modulate the brain response to other's pain. This modulation may reflect successful adaptation to potential danger present in a social interaction. Our results contribute to a better understanding of the neural mechanisms underpinning implicit moral reasoning that concern actions that can harm other people.

Gender differences in the mu rhythm during empathy for pain: An electroencephalographic study

Our recent magnetoencephalography study demonstrated that the mu rhythm can reliably indicate sensorimotor resonance during the perception of pain in others (Cheng, Y., Yang, C.Y., Lin, C.P., Lee, P.L., Decety, J., 2008b. The perception of pain in others suppresses somatosensory oscillations: a magnetoencephalography study. NeuroImage 40, 1833–1840). The current study further investigated the neurophysiological mechanism underpinning empathy for pain in relation with gender through the measurements of the electroencephalographic mu suppression in healthy female ( N = 16) and male ( N = 16) adults during the observation of body parts in painful or no-painful situations. The results demonstrate that both genders exhibited sensorimotor activation related to pain empathy. However, females showed stronger mu suppressions than males when watching the painful as well as the non-painful situations. Further, the mu suppression for pain empathy was positively correlated with the scoring on the personal distress subscale of the interpersonal reactivity index only in the female participants. The present findings suggest the existence of a gender difference in pain empathy in relation with the sensorimotor cortex resonance. The mu rhythm can be a potential biomarker of empathic mimicry.

The perception of pain in others suppresses somatosensory oscillations: A magnetoencephalography study

Accumulating evidence demonstrates that similar neural circuits are activated during the first-hand experience of pain and the observation of pain in others. However, most functional MRI studies did not detect signal change in the primary somatosensory cortex during pain empathy. To test if the perception of pain in others involves the primary somatosensory cortex, neuromagnetic oscillatory activity was recorded from the primary somatosensory cortex in 16 participants while they observed static pictures depicting body parts in painful and non-painful situations. The left median nerve was stimulated at the wrist, and the poststimulus rebounds of the ~10-Hz somatosensory cortical oscillations were quantified. Compared to the baseline condition, the level of the ~10-Hz oscillations was suppressed during both of the observational situations, indicating the activation of the primary somatosensory cortex. Importantly, watching painful compared to non-painful situations suppressed somatosensory oscillations to a significant stronger degree. In addition, the suppression caused by perceiving others in the painful relative to the non-painful situations correlated with the perspective taking subscale of the interpersonal reaction index. These results, consistent with the mirror-neuron system, demonstrate that the perception of pain in others modulates neural activity in primary somatosensory cortex and supports the idea that the perception of pain in others elicits subtle somatosensory activity that may be difficult to detect by fMRI techniques.

Is the Extrastriate Body Area (EBA) Sensitive to the Perception of Pain in Others?

Recent neuroimaging findings suggest a role of the extrastriate body area (EBA) in self/other distinction and in the perception of pain and emotions in others. The present functional magnetic resonance imaging study investigated whether EBA is modulated by the perception of pain in others. Participants were scanned during 2 consecutive sessions: 1) a localizer task precisely identifying EBA in each individual and 2) event-related trials in which participants watched pictures of pain (needle injections into human hands) inflicted in others or control stimuli showing hands in no pain. The perception of pain recruited large parts of the so-called pain matrix, documenting shared neural representations between the perception of pain in self and other. Both the needle injections and the control stimuli consistently activated bilateral EBA, replicating involvement of this area in the perception of body parts. However, activation during the perception of painful stimuli was not different from signal changes during perception of the control stimuli. This suggests that EBA is not specifically involved in empathy for pain.

What Are You Feeling? Using Functional Magnetic Resonance Imaging to Assess the Modulation of Sensory and Affective Responses during Empathy for Pain

BackgroundRecent neuroscientific evidence suggests that empathy for pain activates similar neural representations as the first-hand experience of pain. However, empathy is not an all-or-none phenomenon but it is strongly malleable by interpersonal, intrapersonal and situational factors. This study investigated how two different top-down mechanisms – attention and cognitive appraisal - affect the perception of pain in others and its neural underpinnings.Methodology/Principal FindingsWe performed one behavioral (N = 23) and two functional magnetic resonance imaging (fMRI) experiments (N = 18). In the first fMRI experiment, participants watched photographs displaying painful needle injections, and were asked to evaluate either the sensory or the affective consequences of these injections. The role of cognitive appraisal was examined in a second fMRI experiment in which participants watched injections that only appeared to be painful as they were performed on an anesthetized hand. Perceiving pain in others activated the affective-motivational and sensory-discriminative aspects of the pain matrix. Activity in the somatosensory areas was specifically enhanced when participants evaluated the sensory consequences of pain. Perceiving non-painful injections into the anesthetized hand also led to signal increase in large parts of the pain matrix, suggesting an automatic affective response to the putatively harmful stimulus. This automatic response was modulated by areas involved in self/other distinction and valence attribution – including the temporo-parietal junction and medial orbitofrontal cortex.Conclusions/SignificanceOur findings elucidate how top-down control mechanisms and automatic bottom-up processes interact to generate and modulate other-oriented responses. They stress the role of cognitive processing in empathy, and shed light on how emotional and bodily awareness enable us to evaluate the sensory and affective states of others.

Expertise Modulates the Perception of Pain in Others

Perceiving the pain of others activates a large part of the pain matrix in the observer [1]. Because this shared neural representation can lead to empathy or personal distress [2, 3], regulatory mechanisms must operate in people who inflict painful procedures in their practice with patient populations in order to prevent their distress from impairing their ability to be of assistance. In this functional magnetic resonance imaging MRI study, physicians who practice acupuncture were compared to naive participants while observing animated visual stimuli depicting needles being inserted into different body parts, including the mouth region, hands, and feet. Results indicate that the anterior insula somatosensory cortex, periaqueducal gray, and anterior cingulate cortex were significantly activated in the control group, but not in the expert group, who instead showed activation of the medial and superior prefrontal cortices and the temporoparietal junction, involved in emotion regulation and theory of mind.