The Social Side of Pain: What Does it Mean to Feel Another’s Pain?



This chapter gives an overview of the current state of the neuroscientific basis of empathy and the experience of vicarious pain; that is, an explicit sensory experience of pain when observing another in pain. We summarise the central and autonomic mechanisms that are associated with vicarious pain experience from studies using electrophysiology, electroencephalography, transcranial magnetic stimulation and functional Magnetic Resonance Imaging. While this research has given us fantastic insight into the neural mechanisms giving rise to vicarious pain experience, the mechanisms are not well contextualised in relation to the daily lived experience. We discuss the importance of social roles and context in vicarious experiences to provide insight into the aspects of life in which vicarious sensations may arise. For instance, when a parent vicariously reacts to a painful injury in their own child, this may motivate protection and nurturing. Healthcare providers who embody the pain or emotions of their client may report that this enhances intuitive and/or compassionate care. However, distressing vicarious reactivity towards the suffering of others may also ultimately disrupt the capacity to deliver compassionate care and/or lead to burnout. While several qualitative studies have characterised the experience of secondary trauma, and to a lesser degree emotion contagion in clinicians, there has been a lack of qualitative and mixed methods research in this field. In an attempt to emphasise the significance of the social context in empathic and vicarious responses, we give an overview of lived experience of vicarious pain from the perspective of a clinician who describes her experiences both with family members and patients in pain. In concluding, we draw parallels between the phenomenological lived account of vicarious pain experience and neurophysiological mechanisms, and discuss the implications of vicarious reactivity for interpersonal relationships, especially within a clinical context. Ultimately for our understanding of both the mechanisms and consequences of vicarious pains sensations future research should take advantage of mixed methods designs to triangulate the neuroscientific mechanisms with the lived experience.


Emotion Regulation Transcranial Magnetic Stimulation Empathic Concern Painful Procedure Corticospinal Excitability 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



MJG and BMF are supported by National Health and Medical Research Council (NHMRC) Early Career Fellowships (APP1036124; APP1070073).


The authors have no conflicts of interest to disclose. The qualitative insights and data reported in this chapter were collected from studies that had been approved by the university human research ethics committee, and all participants gave written informed consent.


  1. Appelhans BM, Luecken LJ (2006) Heart rate variability as an index of regulated emotional responding. Rev Gen Psychol 10(3):229–240CrossRefGoogle Scholar
  2. Avenanti A, Sirigu A, Aglioti SM (2010) Racial bias reduces empathic sensorimotor resonance with other-race pain. Curr Biol 20(11):1018–1022CrossRefPubMedGoogle Scholar
  3. Aydede M, Price D (2006) The experimental use of introspection in the scientific study of pain and its integration with third-person methodologies: the experiential-phenomenological approach. In: Aydede M (ed) Pain: new essays on its nature and the methodology of its study. MIT Press, Cambridge, pp 243–273Google Scholar
  4. Azevedo RT, Macaluso E, Avenanti A, Santangelo V, Cazzato V, Aglioti SM (2012) Their pain is not our pain: Brain and autonomic correlates of empathic resonance with the pain of same and different race individuals. Hum Brain Mapp 34(12):3168–3181CrossRefPubMedGoogle Scholar
  5. Banissy MJ, Cohen Kadosh R, Maus GW, Walsh V, Ward J (2009) Prevalence, characteristics and a neurocognitive model of mirror-touch synaesthesia. Exp Brain Res 198(2–3):261–272CrossRefPubMedGoogle Scholar
  6. Bastian B, Jetten J, Ferris LJ (2014) Pain as social glue: shared pain increases cooperation. Psychol Sci 25(11):2079–2085CrossRefPubMedGoogle Scholar
  7. Bernhardt BC, Singer T (2012) The neural basis of empathy. Annu Rev Neurosci 35:1–23CrossRefPubMedGoogle Scholar
  8. Blakemore S-J, Bristow D, Bird G, Frith C, Ward J (2005) Somatosensory activations during the observation of touch and a case of vision-touch synaesthesia. Brain 128(7):1571–1583CrossRefPubMedGoogle Scholar
  9. Blatt B, LeLacheur SF, Galinsky AD, Simmens SJ, Greenberg L (2010) Does perspective-taking increase patient satisfaction in medical encounters? Acad Med 85(9):1445–1452CrossRefPubMedGoogle Scholar
  10. Bourke J (2014) The story of pain: from prayer to painkillers. Oxford University Press, New YorkGoogle Scholar
  11. Bufalari I, Aprile T, Avenanti A, Di Russo F, Aglioti SM (2007) Empathy for pain and touch in the human somatosensory cortex. Cereb Cortex 17:2553–2561CrossRefPubMedGoogle Scholar
  12. Cheng Y, Lin CP, Liu HL, Hsu YY, Lim KE, Hung D, Decety J (2007) Expertise modulates the perception of pain in others. Curr Biol 17(19):1708–1713Google Scholar
  13. Cheng Y, Yang C, Lin C, Lee P, Decety J (2008) The perception of pain in others suppresses somatosensory oscillations: a magnetoencephalography study. Neuroimage 40:1833–1840CrossRefPubMedGoogle Scholar
  14. Cheon BK, Im DM, Harada T, Kim JS, Mathur VA, Scimeca JM, Parrish TB, Park H, Chiao JY (2013) Cultural modulation of the neural correlates of emotional pain perception: the role of other-focusedness. Neuropsychologia 51(7):1177–1186Google Scholar
  15. Cisler JM, Olatunji BO, Feldner MT, Forsyth JP (2010) Emotion regulation and the anxiety disorders: an integrative review. J Psychopathol Behav Assess 32(1):68–82CrossRefPubMedPubMedCentralGoogle Scholar
  16. Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, Salazar WH (2001) “Let me see if I have this right…”: words that help build empathy. Ann Intern Med 135(3):221–227CrossRefPubMedGoogle Scholar
  17. Craig KD (1968) Physiological arousal as a function of imagined vicarious and direct stress experiences. J Abnorm Psychol 73(6):513–520CrossRefPubMedGoogle Scholar
  18. Cui F, Abdelgabar AR, Keysers C, Gazzola V (2015) Responsibility modulates pain-matrix activation elicited by the expressions of others in pain. Neuroimage 114:371–378Google Scholar
  19. Davidov M, Zahn-Waxler C, Roth-Hanania R, Knafo A (2013) Concern for others in the first year of life: theory, evidence, and avenues for research. Child Dev Perspect 7(2):126–131CrossRefGoogle Scholar
  20. Daykin AR, Richardson D (2004) Physiotherapists’ pain beliefs and their influence on the management of patients with chronic low back pain. Spine 29(7):783–795CrossRefPubMedGoogle Scholar
  21. de Waal F (2010) The age of empathy: nature’s lessons for a kinder society. Broadway Books, New YorkGoogle Scholar
  22. Decety J (2010) The neurodevelopment of empathy in humans. Dev Neurosci 32(4):257–267CrossRefPubMedPubMedCentralGoogle Scholar
  23. Decety J, Chaminade T (2003) Neural correlates of feeling sympathy. Neuropsychologia 41(2):127–138CrossRefPubMedGoogle Scholar
  24. Decety J, Jackson PL (2006) A social-neuroscience perspective on empathy. Curr Dir Psychol Sci 15(2):54–58CrossRefGoogle Scholar
  25. Decety J, Meyer M (2008) From emotion resonance to empathic understanding: a social developmental neuroscience account. Dev Psychopathol 20(4):1053–1080CrossRefPubMedGoogle Scholar
  26. Decety J, Echols S, Correll J (2009) The blame game: the effect of responsibility and social stigma on empathy for pain. J Cogn Neurosci 22(5):985–997CrossRefGoogle Scholar
  27. Decety J, Smith K, Norman G, Halpern J (2014) A social neuroscience perspective on clinical empathy. World Psychiatry 13:233–237CrossRefPubMedPubMedCentralGoogle Scholar
  28. Derbyshire SWG, Osborn J, Brown S (2013) Feeling the pain of others is associated with self-other confusion and prior pain experience. Front Hum Neurosci 7:Article 470 Google Scholar
  29. Duprat R, Desmyter S, Rudi DR, van Heeringen K, Van den Abbeele D, Tandt H, Bakic J, Pourtois G, Dedoncker J, Vervaet M, Van Autreve S, Lemmens GMD, Baeken C (2016) Accelerated intermittent theta burst stimulation treatment in medication-resistant major depression: a fast road to remission? J Affect Disord 200:6–14CrossRefPubMedGoogle Scholar
  30. Eley D, Eley R, Bertello M, Rogers-Clark C (2012) Why did I become a nurse? Personality traits and reasons for entering nursing. J Adv Nurs 68(7):1546–1555CrossRefPubMedGoogle Scholar
  31. Fan Y, Duncan NW, de Greck M, Northoff G (2011) Is there a core neural network in empathy? An fMRI based quantitative meta-analysis. Neurosci Biobehav Rev 35(3):903–911CrossRefPubMedGoogle Scholar
  32. Fitzgibbon BM, Enticott PG, Bradshaw JL, Giummarra MJ, Chou M, Georgiou-Karistianis N, Fitzgerald PB (2012a) Enhanced corticospinal response to observed pain in pain synesthetes. Cogn Affect Behav Neurosci 12(2):406–418CrossRefPubMedGoogle Scholar
  33. Fitzgibbon BM, Enticott PG, Giummarra MJ, Thomson RH, Georgiou-Karistianis N, Bradshaw JL (2012b) Atypical electrophysiological activity during pain observation in amputees who experience synaesthetic pain. Soc Cogn Affect Neurosci 7(3):357–368CrossRefPubMedGoogle Scholar
  34. Fitzgibbon BM, Enticott PG, Rich AN, Giummarra MJ, Georgiou-Karistianis N, Bradshaw JL (2012c) Mirror-sensory synaesthesia: exploring ‘shared’ sensory experiences as synaesthesia. Neurosci Biobehav Rev 36(1):645–657CrossRefPubMedGoogle Scholar
  35. Forsythe LP, Romano JM, Jensen MP, Thorn BE (2012) Attachment style is associated with perceived spouse responses and pain-related outcomes. Rehabil Psychol 57:290–300CrossRefPubMedPubMedCentralGoogle Scholar
  36. Giummarra MJ, Fitzgibbon BM (2016) Vicarious experiences are associated with greater compassionate concern, but only via an indirect association with heightened anxious arousal traits (review) Google Scholar
  37. Giummarra MJ, Fitzgibbon BM, Georgiou-Karistianis N, Beukelman M, Verdejo-Garcia A, Blumberg Z, Chou M, Gibson SJ (2015a) Affective, sensory and empathic sharing of others’ pain: the Empathy for pain scale. Eur J Pain 19: 807–816 doi:  10.1002/ejp.607 Google Scholar
  38. Giummarra MJ, Fitzgibbon BM, Tsao JW, Gibson S, Rich AN, Georgiou-Karistianis N, Chou M, Bradshaw JL, Alphonso AL, Tung ML, Drastal CA, Hanling S, Pasquina PF, Enticott PG (2015b) Symptoms of PTSD associated with painful and nonpainful vicarious reactivity following amputation. J Trauma Stress 28:1–9CrossRefGoogle Scholar
  39. Giummarra MJ, Poudel G, Pei-Tse AN, Nicholls MER, Fielding J, Verdejo-Garcia A, Labuschagne I (2016) Disinhibited left-lateralised neural mechanisms when processing threatening emotions in persons who respond vicariously towards others in pain (review)Google Scholar
  40. Godinho F, Faillenot I, Perchet C, Frot M, Magnin M, Garcia-Larrea L (2012) How the pain of others enhances our pain: searching the cerebral correlates of ‘compassional hyperalgesia’. Eur J Pain 16(5):748–759CrossRefPubMedGoogle Scholar
  41. Halifax J (2011) The precious necessity of compassion. J Pain Symptom Manage 41(1):146–153CrossRefPubMedGoogle Scholar
  42. Halpern J (2010) From detached concern to empathy: humanizing medical practice. Oxford University Press, OxfordGoogle Scholar
  43. Hein G, Silani G, Preuschoff K, Batson CD, Singer T (2010) Neural responses to ingroup and outgroup members’ suffering predict individual differences in costly helping. Neuron 68(1):149–160CrossRefPubMedGoogle Scholar
  44. Ho SS, Konrath S, Brown S, Swain JE (2014) Empathy and stress related neural responses in maternal decision making. Front Neurosci 8:152CrossRefPubMedPubMedCentralGoogle Scholar
  45. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS (2011) Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med 86(3):359–364CrossRefPubMedGoogle Scholar
  46. Huikuri HV, Stein PK (2013) Heart rate variability in risk stratification of cardiac patients. Prog Cardiovasc Dis 56(2):153–159CrossRefPubMedGoogle Scholar
  47. Jackson PL, Meltzoff AN, Decety J (2005) How do we perceive the pain of others? A window into the neural processes involved in empathy. Neuroimage 24:771–779CrossRefPubMedGoogle Scholar
  48. Kemp AH, Quintana DS, Felmingham KL, Matthews S, Jelinek HF (2012) Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: implications for cardiovascular risk. PLoS One 7(2), Article id: e30777Google Scholar
  49. Kim SS, Kaplowitz S, Johnston MV (2004) The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof 27(3):237–251CrossRefPubMedGoogle Scholar
  50. Kim JW, Kim SE, Kim JJ, Jeong B, Park CH, Son AR, Song JE, Ki SW (2009) Compassionate attitude towards others’ suffering activates the mesolimbic neural system. Neuropsychologia 47(10):2073–2081Google Scholar
  51. Lamm C, Decety J, Singer T (2011) Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain. Neuroimage 54(3):2492–2502CrossRefPubMedGoogle Scholar
  52. Lang PJ, Bradley MM, Cuthbert BN (1997) Motivated attention: affect, activation and action. In: Lang PJ, Simons RF, Balaban M (eds) Attention and orienting: sensory and motivational processes, vol 1. Lawrence Erlbaum Associates, Mahwah, pp 97–136Google Scholar
  53. Leiberg S, Eippert F, Veit R, Anders S (2012) Intentional social distance regulation alters affective responses towards victims of violence: an FMRI study. Hum Brain Mapp 33(10):2464–2476CrossRefPubMedGoogle Scholar
  54. Li Z, Yin M, Lyu XL, Zhang LL, Du XD, Hung GCL (2016) Delayed effect of repetitive transcranial magnetic stimulation (rTMS) on negative symptoms of schizophrenia: findings from a randomized controlled trial. Psychiatry Res 240:333–335Google Scholar
  55. Maister L, Banissy MJ, Tsakiris M (2013) Mirror-touch synaesthesia changes representations of self-identity. Neuropsychologia 51(5):802–808CrossRefPubMedPubMedCentralGoogle Scholar
  56. Marshall AA, Smith RC (1995) Physicians’ emotional reactions to patients: recognizing and managing countertransference. Am J Gastroenterol 90(1):4–8PubMedGoogle Scholar
  57. McRae K, Gross JJ, Weber J, Robertson ER, Sokol-Hessner P, Ray RD, Gabrieli JDE, Ochsner KN (2012) The development of emotion regulation: an fMRI study of cognitive reappraisal in children, adolescents and young adults. Soc Cogn Affect Neurosci 7(1):11–22CrossRefPubMedPubMedCentralGoogle Scholar
  58. Melzack R, Casey KL (1968) Sensory, motivational, and central control determinants of pain: a new conceptual model. In: Kenshalo D (ed) The skin senses. Springfield, Charles ThomasGoogle Scholar
  59. Mercer SW, Reynolds WJ (2002) Empathy and quality of care. Br J Gen Pract 52(Suppl):S9–12PubMedPubMedCentralGoogle Scholar
  60. Molenberghs P (2013) The neuroscience of in-group bias. Neurosci Biobehav Rev 37:1530–1536CrossRefPubMedGoogle Scholar
  61. Mu Y, Fan Y, Mao L, Han S (2008) Event-related theta and alpha oscillations mediate empathy for pain. Brain Res 1234:128–136CrossRefPubMedGoogle Scholar
  62. Murray RJ, Debbane M, Fox PT, Bzdok D, Eickhoff SB (2015) Functional connectivity mapping of regions associated with self- and other-processing. Hum Brain Mapp 36(4):1304–1324CrossRefPubMedGoogle Scholar
  63. Nazarewicz J, Verdejo-Garcia A, Giummarra MJ (2015) Sympathetic pain? A role of poor parasympathetic nervous system engagement in vicarious pain states. Psychophysiology 52(11):1529–1537CrossRefPubMedGoogle Scholar
  64. Neumann M, Wirtz M, Bollschweiler E, Mercer SW, Warm M, Wolf J, Pfaff H (2007) Determinants and patient-reported long-term outcomes of physician empathy in oncology: a structural equation modelling approach. Patient Educ Couns 69(1–3):63–75CrossRefPubMedGoogle Scholar
  65. Ochsner KN, Bunge SA, Gross JJ, Gabrieli JDE (2002) Rethinking feelings: an fMRI study of the cognitive regulation of emotion. J Cogn Neurosci 14(8):1215–1229CrossRefPubMedGoogle Scholar
  66. Osborn J, Derbyshire SWG (2010) Pain sensation evoked by observing injury in others. Pain 148(2):268–274CrossRefPubMedGoogle Scholar
  67. Preston SD, de Waal FBM (2002) Empathy: Its ultimate and proximate bases. Behav Brain Sci 25:1–72PubMedGoogle Scholar
  68. Rajendra Acharya U, Paul Joseph K, Kannathal N, Lim CM, Suri JS (2006) Heart rate variability: a review. Med Biol Eng Comput 44(12):1031–1051CrossRefPubMedGoogle Scholar
  69. Rapinesi C, Del Casale A, Scatena P, Kotzalidis GD, Di Pietro S, Ferri VR, Bersani FS, Brugnoli R, Raccah RN, Zangen A, Ferracuti S, Orzi F, Girardi P, Sette G (2016) Add-on deep transcranial magnetic stimulation (dTMS) for the treatment of chronic migraine: a preliminary study. Neurosci Lett 623:7–12CrossRefPubMedGoogle Scholar
  70. Reniers RLEP, Corcoran R, Drake R, Shryane NM, Voellm BA (2011) The QCAE: a questionnaire of cognitive and affective empathy. J Pers Assess 93(1):84–95CrossRefPubMedGoogle Scholar
  71. Robins PM, Meltzer L, Zelikovsky N (2009) The experience of secondary traumatic stress upon care providers working within a children’s hospital. J Pediatr Nurs 24(4):270–279CrossRefPubMedGoogle Scholar
  72. Singer T, Seymour B, O’Doherty J, Kaube H, Dolan RJ, Frith C (2004) Empathy for pain involves the affective but not sensory components of pain. Science 303(5661):1157–1162CrossRefPubMedGoogle Scholar
  73. Squier RW (1990) A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships. Soc Sci Med 30(3):325–339CrossRefPubMedGoogle Scholar
  74. Stephen L (1882) The science of ethics. Smith, Elder and Co, LondonGoogle Scholar
  75. Taylor SE (2006) Tend and befriend: biobehavioral bases of affiliation under stress. Curr Dir Psychol Sci 15(6):273–277CrossRefGoogle Scholar
  76. Taylor SE, Cousino Klein L, Lewis BP, Gruenewald TL, Gurung RAR, Updegraff AJ (2000) Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychol Rev 107:411–429CrossRefPubMedGoogle Scholar
  77. Thayer JF, Ahs F, Fredrikson M, Sollers JJ III, Wager TD (2012) A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev 36(2):747–756CrossRefPubMedGoogle Scholar
  78. Tousignant-Laflamme Y, Rainville P, Marchand S (2005) Establishing a link between heart rate and pain in healthy subjects: a gender effect. J Pain 6(6):341–347CrossRefPubMedGoogle Scholar
  79. Tracy LM, Giummarra MJ (2016) Clinician empathy towards patients with pain (under prep.)Google Scholar
  80. Vachon-Presseau E, Martel MO, Roy M, Caron E, Jackson PL, Rainville P (2011) The multilevel organization of vicarious pain responses: effects of pain cues and empathy traits on spinal nociception and acute pain. Pain 152(7):1525–1531CrossRefPubMedGoogle Scholar
  81. Van Diest I, Bradley MM, Guerra P, Van den Bergh O, Lang PJ (2009) Fear-conditioned respiration and its association to cardiac reactivity. Biol Psychol 80(2):212–217CrossRefPubMedGoogle Scholar
  82. Vandenbroucke S, Crombez G, Van Ryckeghem DM, Brass M, Van Damme S, Goubert L (2013) Vicarious pain while observing another in pain: an experimental approach. Front Hum Neurosci 7:265CrossRefPubMedPubMedCentralGoogle Scholar
  83. Vandenbroucke S, Crombez G, Loeys T, Goubert L (2014) Observing another in pain facilitates vicarious experiences and modulates somatosensory experiences. Front Hum Neurosci 8:631CrossRefPubMedPubMedCentralGoogle Scholar
  84. Vandenbroucke S, Crombez G, Loeys T, Goubert L (2015) Vicarious experiences and detection accuracy while observing pain and touch: the effect of perspective taking. Attent Percept PsychophysGoogle Scholar
  85. von Baeyer CL (2014) Sensitization and catastrophizing: introspection confirmed experimentally. Pain Research Forum. Retrieved 12/06/2016, from
  86. Wager TD, Atlas LY, Lindquist MA, Roy M, Woo CW, Kross E (2013) An fMRI-based neurologic signature of physical pain. N Engl J Med 368(15):1388–1397Google Scholar
  87. Ward J, Banissy M (2015) Explaining mirror-touch synaesthesia. Cogn Neurosci 6(2–3):118–133CrossRefPubMedGoogle Scholar
  88. Williams F, Hasking P (2010) Emotion regulation, coping and alcohol use as moderators in the relationship between non-suicidal self-injury and psychological distress. Prev Sci 11(1):33–41CrossRefPubMedGoogle Scholar
  89. Williams A, O’Driscoll K, Moore C (2014) The influence of empathic concern on prosocial behavior in children. Front Psychol 5:425PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Faculty of Medicine, Nursing and Health Sciences, Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive MedicineMonash UniversityMelbourneAustralia
  2. 2.Faculty of Medicine, Nursing & Health Sciences, School of Psychological ScienceMonash UniversityClaytonAustralia
  3. 3.Faculty of Medicine Nursing and Health Sciences, Central Clinical SchoolMonash Alfred Psychiatry Research Centre, Monash UniversityMelbourneAustralia

Personalised recommendations