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.
KeywordsEmotion Regulation Transcranial Magnetic Stimulation Empathic Concern Painful Procedure Corticospinal Excitability
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.
- 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
- Bourke J (2014) The story of pain: from prayer to painkillers. Oxford University Press, New YorkGoogle Scholar
- 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
- 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
- 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
- de Waal F (2010) The age of empathy: nature’s lessons for a kinder society. Broadway Books, New YorkGoogle Scholar
- 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
- 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
- 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
- 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
- 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
- Halpern J (2010) From detached concern to empathy: humanizing medical practice. Oxford University Press, OxfordGoogle Scholar
- 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
- 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
- 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
- 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
- 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
- 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
- Stephen L (1882) The science of ethics. Smith, Elder and Co, LondonGoogle Scholar
- Tracy LM, Giummarra MJ (2016) Clinician empathy towards patients with pain (under prep.)Google Scholar
- 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
- von Baeyer CL (2014) Sensitization and catastrophizing: introspection confirmed experimentally. Pain Research Forum. Retrieved 12/06/2016, from http://painresearchforum.org/forums/discussion/37588-sensitization-and-catastrophizing-introspection-confirmed-experimentally
- 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