Empathy for Pain: Differential Brain Activation Patterns in Chronic Pain and Depression
Poster No:
1040
Submission Type:
Abstract Submission
Authors:
Maria Suñol1, Saül Pascual-Diaz1, Miguel Montero-Escobedo1, Lidia Izquierdo-Peralvarez1, Laura Martín-Herrero1, Anna Arias2, Xavier Torres2, Tamara Rodríguez2, Myriam Cavero2, Marc Valentí2, Luciano Polino2, Marina López-Solà1
Institutions:
1University of Barcelona, Barcelona, Barcelona, 2Hospital Clínic de Barcelona, Barcelona, Barcelona
First Author:
Co-Author(s):
Introduction:
Chronic pain and major depressive disorder (MDD) are etiologically linked, frequently comorbid, and mutually exacerbate symptom severity and disability (Kroenke et al., 2011; Baumeister et al., 2012). Despite this well-established association, to our knowledge, no studies have investigated psychological phenomena potentially differentiating both conditions and their neural substrates. Our study addresses this gap by examining behavioral and brain activation differences in empathy for pain, defined as the emotional response when observing or imagining a loved one experiencing pain (Fallon et al., 2020). Fibromyalgia, a paradigmatic nociplastic chronic pain condition, has vulnerability factors to experience heightened pain empathy such as a history of chronic pain, pain hypervigilance, and increased dispositional personal distress and empathic care (Fitzgibbon et al., 2010; Üçeyler e al., 2015). MDD, often associated with a blunted affect (Loas et al., 1994), may exhibit comparatively diminished empathy for pain.
Methods:
Our sample included 53 women with fibromyalgia (50.6±8.1 years), 27 women with MDD (48.7±11.2 years), and 50 healthy women (48.8±10 years). The groups did not differ in age, education level, or income (p's>0.3). Participants completed a Vicarious Pain fMRI Task inside a 3-Tesla scanner, during which they viewed validated images of hands and feet in painful situations (Jackson et al., 2005). Participants were instructed to imagine the injury happening to a loved one and rated the unpleasantness of the experience on a visual analog scale (0-10). Between-group differences in unpleasantness ratings, a proxy for empathy for pain, across multiple trials were evaluated using a repeated-measures ANOVA and post-hoc Tukey's t-tests in R. BOLD fMRI data were preprocessed using the CONN Toolbox v.22 in MATLAB-R2024b, including realignment, unwarping, outlier detection, normalization, and smoothing. First-level analyses computed general linear models in SPM12 to identify activation patterns during vicarious pain relative to baseline, regressing out average framewise displacement and outlier volumes. The resulting contrast images were used in second-level analyses to compare voxel-wise brain activation patterns across groups. We used a cluster-level FWE-correction (p<.05) and a voxel threshold of p<.001.
Results:
Women with fibromyalgia showed higher empathy for pain compared to both healthy women and women with MDD (F=5.7, p=.004; T's>6, p's<.001). Conversely, women with MDD showed lower empathy for pain than healthy women (T=-2.8, p=.013). Brain activation findings revealed distinct neural patterns. Compared to healthy women, women with fibromyalgia had activation reductions in the right dorsolateral prefrontal cortex (dlPFC) and the left fusiform gyrus (T's>4.6; pFWE's<.02), while women with MDD had reductions in the bilateral superior frontal gyri, premotor cortices, and right primary somatosensory cortex (T's>4.4; pFWE's<.005).
Conclusions:
Our behavioral results suggest heightened sensitivity to others' pain in fibromyalgia and reduced sensitivity in MDD. Reduced dlPFC activation in fibromyalgia may suggest difficulties in regulating emotional responses and cognitive control when empathizing with others' pain. Hypoactivation in the fusiform gyrus, involved in processing complex visual stimuli, may indicate challenges in interpreting pain-related visual cues. In MDD, reduced superior frontal gyri activation suggests difficulties in higher-order cognitive, emotional and social processing when empathizing with others' pain. Hypoactivation in sensorimotor regions may indicate challenges in processing sensory aspects of observed pain. These findings underscore the need for a nuanced understanding of emotional experiences in fibromyalgia and MDD beyond primary affective symptoms and considering how they impact interpersonal dynamics and well-being.
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 2
Emotion, Motivation and Social Neuroscience:
Social Cognition
Social Neuroscience Other
Modeling and Analysis Methods:
Activation (eg. BOLD task-fMRI) 1
Perception, Attention and Motor Behavior:
Perception: Pain and Visceral
Keywords:
Affective Disorders
FUNCTIONAL MRI
Pain
Psychiatric Disorders
Social Interactions
1|2Indicates the priority used for review
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Were any human subjects research approved by the relevant Institutional Review Board or ethics panel? NOTE: Any human subjects studies without IRB approval will be automatically rejected.
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Provide references using APA citation style.
Fallon, N., Roberts, C., & Stancak, A. (2020). Shared and distinct functional networks for empathy and pain processing: a systematic review and meta-analysis of fMRI studies. Social cognitive and affective neuroscience, 15(7), 709–723. https://doi.org/10.1093/scan/nsaa090
Fitzgibbon, B. M., Giummarra, M. J., Georgiou-Karistianis, N., Enticott, P. G., & Bradshaw, J. L. (2010). Shared pain: from empathy to synaesthesia. Neuroscience and biobehavioral reviews, 34(4), 500–512. https://doi.org/10.1016/j.neubiorev.2009.10.007
Jackson, P. L., Meltzoff, A. N., & Decety, J. (2005). How do we perceive the pain of others? A window into the neural processes involved in empathy. NeuroImage, 24(3), 771–779. https://doi.org/10.1016/j.neuroimage.2004.09.006
Kroenke, K., Wu, J., Bair, M. J., Krebs, E. E., Damush, T. M., & Tu, W. (2011). Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. The journal of pain, 12(9), 964–973. https://doi.org/10.1016/j.jpain.2011.03.003
Loas, G., Salinas, E., Pierson, A., Guelfi, J. D., & Samuel-Lajeunesse, B. (1994). Anhedonia and blunted affect in major depressive disorder. Comprehensive psychiatry, 35(5), 366–372. https://doi.org/10.1016/0010-440x(94)90277-1
Üçeyler, N., Zeller, J., Kewenig, S., Kittel-Schneider, S., Fallgatter, A. J., & Sommer, C. (2015). Increased cortical activation upon painful stimulation in fibromyalgia syndrome. BMC neurology, 15, 210. https://doi.org/10.1186/s12883-015-0472-4