Enhanced corticospinal response to observed pain in pain synesthetes

Beyond physical sensations: investigating empathy and prosocial behavior in vicarious pain responders

Empathy, the capacity to share others' emotional experiences, has been proposed as a key motivation for altruistic behavior in both humans and animals. Sharing another's emotional experience may generate a self-embodied simulation of their emotional state, fostering understanding and promoting prosocial behavior. Vicarious pain responders report sensing physical pain when observing others in pain. Whether this ability extends to emotional experiences remains unexplored. Using both questionnaires and ecologically valid behavioral tasks, we explored whether vicarious pain responders differ from nonresponders in empathic abilities and prosocial behavior. Participants watched video clips of people describing a negative emotional life event. We operationalized several empathic abilities and responses (empathic accuracy, affective synchrony, emotional reaction, and empathic motivation) based on participants' and targets' responses during and after watching the videos. Participants were also engaged in a donation task measuring tendency for prosocial behavior. Findings reveal that compared to nonresponders, vicarious pain responders exhibit enhanced empathic accuracy, intensified emotional reactions to others' emotional pain, and a greater motivation to communicate with the target. This study marks the first behavioral evidence showcasing vicarious pain responders' empathic abilities, reactions, and motivation in response to nonphysical pain of others, expanding our knowledge of this phenomenon and its association with broader empathic abilities.

Empathic pain observation does not influence automatic imitation in an online setting

Previous research has shown that empathic pain observation can lead to motor facilitation in the form of faster reaction times. However, it is unclear whether participants are focusing on the others' pain or simply focusing on their own discomfort/distress (from watching the videos) during the task. This is an important issue as self- vs other-oriented focusing plays a key role in empathic processing. To address this issue, we combined empathic pain observation with the automatic imitation task (AIT). Previous work has shown that AIT effects are smaller after experiencing pain, which has been interpreted as the result of the experience of pain leading to a self-oriented focus. If empathic pain observation similarly leads to a self-oriented focus, then we should expect similar AIT results after pain observation (smaller AIT effects); however, if it instead leads to an other-oriented focus, then we should see the opposite (larger AIT effects). Although we found initial evidence for the latter hypothesis (Experiment 1), subsequent failed replications suggests that we do not have sufficient evidence to claim that pain observation influences automatic imitation one way or the other (Experiment 2 and 3). We discuss some possible reasons for finding null results in these experiments and suggest future avenues of research to better elucidate this topic.

Increasing self-other bodily overlap increases sensorimotor resonance to others' pain

Empathy for another person’s pain and feeling pain oneself seem to be accompanied by similar or shared neural responses. Such shared responses could be achieved by mapping the bodily states of others onto our own bodily representations. We investigated whether sensorimotor neural responses to the pain of others are increased when experimentally reducing perceived bodily distinction between the self and the other. Healthy adult participants watched video clips of the hands of ethnic ingroup or outgroup members being painfully penetrated by a needle syringe or touched by a cotton swab. Manipulating the video presentation to create a visuospatial overlap between the observer’s and the target’s hand increased the perceived bodily self-attribution of the target’s hand. For both ingroup and outgroup targets, this resulted in increased neural responses to the painful injections (compared with nonpainful contacts), as indexed by desynchronizations of central mu and beta scalp rhythms recorded using electroencephalography. Furthermore, these empathy-related neural activations were stronger in participants who reported stronger bodily self-attribution of the other person’s hand. Our findings provide further evidence that empathy for pain engages sensorimotor resonance mechanisms. They also indicate that reducing bodily self-other distinction may increase such resonance for ingroup as well as outgroup targets.

To move or not to move: motor cortical output is enhanced during pain observation regardless of motor preparation state

Previous transcranial magnetic stimulation (TMS) studies have reported a decrease in motor cortical output during pain observation. In contrast, recent behavioral studies have shown that response times are faster after pain observation. This suggests that there is a mismatch between motor activity "during" versus "after" pain observation. We propose that these opposing effects of pain observation on motor activity may be explained by task constraints, as participants in TMS studies are instructed to keep still and relax their hands, whereas participants in behavioral studies maintain a state of readiness to respond. Task and methodological differences make it difficult to compare the results from TMS and behavioral paradigms examining the motor consequences of pain observation. As such, the aim of the current study is to directly test whether task instructions affect motor activity in TMS and behavioral measures of motor activity in the context of pain observation, within a single experiment. Participants watched videos of hands in painful versus nonpainful scenarios while TMS-induced motor evoked potentials were recorded. In the "active" block, participants responded to a cue that appeared immediately after each video; in the "passive" block, they relaxed their hand. Contrary to expectations, participants showed enhanced motor cortical output during pain observation (vs. no-pain) in "both" blocks. We discuss these results in relation to the wider literature on the social neuroscience of empathy.NEW & NOTEWORTHY The current study provides novel results showing an increase motor cortical output, measured via transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEPs), during empathic pain observation regardless of motor preparation state. Interestingly, this finding runs counter to the empathy for pain literature, which often finds a decrease in motor cortical output during empathic pain observation. We discuss potential explanations for this discrepancy and relate these results to the wider empathy for pain literature.

The Role of Sensorimotor Processes in Pain Empathy

Pain is a salient, aversive sensation which motivates avoidance, but also has a strong social signaling function. Numerous studies have shown that regions of the nervous system active in association with first-hand pain are also active in response to the pain of others. When witnessing somatic pain, such as seeing bodies in painful situations, significant activations occur not only in areas related to the processing of negative emotions, but also in neuronal structures engaged in somatosensation and the control of skeletal muscles. These empathy-related sensorimotor activations are selectively reviewed in this article, with a focus on studies using electrophysiological methods and paradigms investigating responses to somatic pain. Convergent evidence from these studies shows that these activations (1) occur at multiple levels of the nervous system, from the spinal cord up to the cerebral cortex, (2) are best conceptualized as activations of a defensive system, in line with the role of pain to protect body from injury, and (3) contribute to establishing a matching of psychological states between the sufferer and the observer, which ultimately supports empathic understanding and motivate prosocial action. Future research should thus focus on how these sensorimotor responses are related to higher-order empathic responses, including affective sharing and emotion regulation, and how this motivates approach-related prosocial behaviors aimed at alleviating the pain and suffering of others.

Enhanced self-reported affect and prosocial behaviour without differential physiological responses in mirror-sensory synaesthesia

Mirror-sensory synaesthetes mirror the pain or touch that they observe in other people on their own bodies. This type of synaesthesia has been associated with enhanced empathy. We investigated whether the enhanced empathy of people with mirror-sensory synesthesia influences the experience of situations involving touch or pain and whether it affects their prosocial decision making. Mirror-sensory synaesthetes (N = 18, all female), verified with a touch-interference paradigm, were compared with a similar number of age-matched control individuals (all female). Participants viewed arousing images depicting pain or touch; we recorded subjective valence and arousal ratings, and physiological responses, hypothesizing more extreme reactions in synaesthetes. The subjective impact of positive and negative images was stronger in synaesthetes than in control participants; the stronger the reported synaesthesia, the more extreme the picture ratings. However, there was no evidence for differential physiological or hormonal responses to arousing pictures. Prosocial decision making was assessed with an economic game assessing altruism, in which participants had to divide money between themselves and a second player. Mirror-sensory synaesthetes donated more money than non-synaesthetes, showing enhanced prosocial behaviour, and also scored higher on the Interpersonal Reactivity Index as a measure of empathy. Our study demonstrates the subjective impact of mirror-sensory synaesthesia and its stimulating influence on prosocial behaviour. This article is part of the discussion meeting issue 'Bridging senses: novel insights from synaesthesia'.

Differential Motor Facilitation During Action Observation in Followers and Leaders on Instagram

High power and high socioeconomic status individuals have been found to exhibit less motor system activity during observation of another individual’s behavior. In the modern world, the use of online social networks for social interaction is increasing, and these social networks afford new forms of social status hierarchy. An important question is whether social status in an online setting affects social information processing in a way that resembles the known effects of real-world status on such processing. Using transcranial magnetic stimulation (TMS), we examined differences in motor cortical output during action observation between Instagram “leaders” and “followers.” Instagram Leaders were defined as individuals who have more followers than they are following, while Instagram Followers were defined as individuals who have fewer followers than they follow. We found that Followers exhibited increased Motor-evoked Potential (MEP) facilitation during action observation compared to Leaders. Correlational analyses also revealed a positive association between an individual’s Instagram follower/following ratio and their perceived sense of online status. Overall, the findings of this study provide some evidence in favor of the idea that our online sense of status and offline sense of status might be concordant in terms of their effect on motor cortical output during action observation.

Statement of Significance: This study highlights the importance of examining the effects of online status on motor cortical output during action observation, and more generally alludes to the importance of understanding online and offline status effects on social information processing.

Emotion processing in persons who respond vicariously towards others in pain: Disinhibited left-lateralized neural activity for threatening expressions

We investigated emotional processing in vicarious pain (VP) responders. VP responders report an explicit sensory and emotional feeling of pain when they witness another in pain, which is greater in magnitude than the empathic processing of pain in the general population. In Study 1, 31 participants completed a chimeric faces task, judging whether emotional chimera in the left, or right, visual field was more intense. VP responders took longer to judge emotionality than non-responders, and fixated more on the angry hemiface in the right visual field, whereas non-responder controls had no lateralized fixation bias. In Study 2, blood-oxygen level-dependent signals were recorded during an emotional face matching task. VP intensity was correlated with increased insula activity and reduced middle frontal gyrus activity for angry faces, and with reduced activity in the inferior and middle frontal gyri for sad faces. Together, these findings suggest that VP responders are more reactive to negative emotional expressions. Specifically, emotional judgements involved altered left-hemisphere activity in VP responders, and reduced engagement of regions involved in emotion regulation.

Symptoms of PTSD Associated With Painful and Nonpainful Vicarious Reactivity Following Amputation

Although the experience of vicarious sensations when observing another in pain have been described postamputation, the underlying mechanisms are unknown. We investigated whether vicarious sensations are related to posttraumatic stress disorder (PTSD) symptoms and chronic pain. In Study 1, 236 amputees completed questionnaires about phantom limb phenomena and vicarious sensations to both innocuous and painful sensory experiences of others. There was a 10.2% incidence of vicarious sensations, which was significantly more prevalent in amputees reporting PTSD-like experiences, particularly increased arousal and reexperiencing the event that led to amputation (φ = .16). In Study 2, 63 amputees completed the Empathy for Pain Scale and PTSD Checklist-Civilian Version. Cluster analyses revealed 3 groups: 1 group did not experience vicarious pain or PTSD symptoms, and 2 groups were vicarious pain responders, but only 1 had increased PTSD symptoms. Only the latter group showed increased chronic pain severity compared with the nonresponder group (p = .025) with a moderate effect size (r = .35). The findings from both studies implicated an overlap, but also divergence, between PTSD symptoms and vicarious pain reactivity postamputation. Maladaptive mechanisms implicated in severe chronic pain and physical reactivity posttrauma may increase the incidence of vicarious reactivity to the pain of others.

Effects of being imitated on motor responses evoked by pain observation: exerting control determines action tendencies when perceiving pain in others

Brain-imaging research has shown that experiencing pain oneself and perceiving pain in others lead to a similar pattern of activation, suggesting that the latter is based on internal simulation of the observed pain. Further evidence for this idea stems from transcranial magnetic stimulation measuring corticospinal excitability (CSE). It has been demonstrated that our motor cortex is involved whenever we observe another person receiving painful stimulation to the hand (Avenanti et al., 2005). However, both decreases and increases of CSE have been described during pain observation, so the exact nature of these CSE changes has remained unclear so far. In the present study, we hypothesized that CSE changes are determined by the control that the observer has over the hand that receives painful stimulation. To test this hypothesis, we manipulated the control over the observed hand using a paradigm in which participants' movements are being imitated by a hand on screen-giving them full control over the hand-or not. Consistent with previous results, we evidenced a decrease in CSE when participants experienced no control over the hand that received painful stimulation. In contrast, inducing control resulted in an increase in CSE. We conclude that exerting control over the observed hand leads to a completely altered action tendency. Whereas an anesthetic response is typically observed in the absence of control, increasing control induces motor facilitation reminiscent of preparation of an avoidance response.

Vicarious pain while observing another in pain: an experimental approach

Objective: This study aimed at developing an experimental paradigm to assess vicarious pain experiences. We further explored the putative moderating role of observer's characteristics such as hypervigilance for pain and dispositional empathy.

Methods: Two experiments are reported using a similar procedure. Undergraduate students were selected based upon whether they reported vicarious pain in daily life, and categorized into a pain responder group or a comparison group. Participants were presented a series of videos showing hands being pricked whilst receiving occasionally pricking (electrocutaneous) stimuli themselves. In congruent trials, pricking and visual stimuli were applied to the same spatial location. In incongruent trials, pricking and visual stimuli were in the opposite spatial location. Participants were required to report on which location they felt a pricking sensation. Of primary interest was the effect of viewing another in pain upon vicarious pain errors, i.e., the number of trials in which an illusionary sensation was reported. Furthermore, we explored the effect of individual differences in hypervigilance to pain, dispositional empathy and the rubber hand illusion (RHI) upon vicarious pain errors.

Results: Results of both experiments indicated that the number of vicarious pain errors was overall low. In line with expectations, the number of vicarious pain errors was higher in the pain responder group than in the comparison group. Self-reported hypervigilance for pain lowered the probability of reporting vicarious pain errors in the pain responder group, but dispositional empathy and the RHI did not.

Conclusion: Our paradigm allows measuring vicarious pain experiences in students. However, the prevalence of vicarious experiences of pain is low, and only a small percentage of participants display the phenomenon. It remains however unknown which variables affect its occurrence.

Motor cortical excitability and inhibition in acquired mirror pain

'Mirror pain' describes when the observation of another's pain experience induces a personal experience of pain. It has been suggested that mirror pain could result from changes in neural excitability or inhibition. In this study we used transcranial magnetic stimulation (TMS) to investigate motor cortical excitability in lower-limb amputees who experience mirror pain. Using paired-pulse TMS to assess motor cortical inhibition (CI) and cortical facilitation (CF), recordings were taken from the right first dorsal interosseus in lower-limb amputees who experience mirror pain (MP+), lower-limb amputees who do not experience mirror pain (MP-), and non-amputee controls. No differences in CI or CF were observed between the MP+ and both control groups. Thus, when not paired with a pain-related stimulus, changes in motor cortical excitability do not appear to contribute to the experience of mirror pain in lower-limb amputees.