Can We Share a Pain We Never Felt? Neural Correlates of Empathy in Patients with Congenital Insensitivity to Pain

Danziger, Nicolas; Faillenot, Isabelle; Peyron, R.

doi:10.1016/j.neuron.2008.11.023

Cited by 180 publications

(110 citation statements)

References 60 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…Taken together, these and the present findings suggest that the first-hand experience of emotions is crucial and possibly even necessary for an accurate representation of other people's emotions (but see also ref. 33). However, the notion of functional equivalence and shared representations should not mistakenly imply that empathic and first-hand pain experiences rely on fully shared neural processes and psychological functions.…”

Section: Discussionmentioning

confidence: 99%

Placebo analgesia and its opioidergic regulation suggest that empathy for pain is grounded in self pain

Rütgen

Seidel

Silani

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

198

218

View full text Add to dashboard Cite

Empathy for pain activates brain areas partially overlapping with those underpinning the first-hand experience of pain. It remains unclear, however, whether such shared activations imply that pain empathy engages similar neural functions as first-hand pain experiences. To overcome the limitations of previous neuroimaging research, we pursued a conceptually novel approach: we used the phenomenon of placebo analgesia to experimentally reduce the first-hand experience of pain, and assessed whether this results in a concomitant reduction of empathy for pain. We first carried out a functional MRI experiment (n = 102) that yielded results in the expected direction: participants experiencing placebo analgesia also reported decreased empathy for pain, and this was associated with reduced engagement of anterior insular and midcingulate cortex: that is, areas previously associated with shared activations in pain and empathy for pain. In a second step, we used a psychopharmacological manipulation (n = 50) to determine whether these effects can be blocked via an opioid antagonist. The administration of the opioid antagonist naltrexone blocked placebo analgesia and also resulted in a corresponding "normalization" of empathy for pain. Taken together, these findings suggest that pain empathy may be associated with neural responses and neurotransmitter activity engaged during first-hand pain, and thus might indeed be grounded in our own pain experiences.T here is widespread consensus that empathy recruits brain structures that are also involved in the first-hand experience of the emotion for which one is showing empathy. For example, in the domain of pain, recent image-based and coordinate-based meta-analyses of functional MRI (fMRI) studies have shown that sharing the pain of others consistently activates the bilateral anterior insular (AI) and anterior midcingulate cortex (aMCC) (1). The AI and aMCC are key areas of the network of areas activated by pain, and their activity has been directly related to the affective-motivational component of pain (2). The observation of such shared neural activations has therefore motivated simulationist models, such as the shared representations account of empathy (see refs. 3-5 for review), which propose that we come to understand the feelings of others by engaging the same mental representations as when directly experiencing the emotion with which we are empathizing.However, neuroimaging alone cannot provide sufficient empirical support for such claims because fMRI activation of the same brain area does not necessarily imply equivalence of mental representations and neural functions (see ref. 6 for review). Areas such as the aMCC and AI, for example, are not only activated by pain, but also by phenomena as distinct as cognitive control and responding to salient events in general (see refs. 7-9 for review). This ambiguity is a result of inherent methodological limitations. First, fMRI has mostly been used as a correlational method that identifies neural responses co-occurring with certain c...

show abstract

Section: Discussionmentioning

confidence: 99%

Placebo analgesia and its opioidergic regulation suggest that empathy for pain is grounded in self pain

Rütgen

Seidel

Silani

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

198

218

View full text Add to dashboard Cite

show abstract

“…Thus, it appears that individuals high upon this trait are particularly well equipped to fully engage in therapeutic efforts, (Quilty et al, 2008) and in this sense, be a good responder to treatment, even if it is placebo (Mackenbach, 2005). Interestingly, research in the mechanisms of empathy in the context of pain have shown responses to observed pain in mid-ACC and anterior insula, two key regions of the so-called 'shared circuits' for pain in self and that observed in others (Danziger et al, 2009). Given the overlapping neurobiology of pain, reward and placebo analgesia circuitry (Leknes and Tracey, 2008), it would not be surprising that regions engaged in empathic responses to others would also be involved in placebo responses.…”

Section: Discussionmentioning

confidence: 99%

Personality Trait Predictors of Placebo Analgesia and Neurobiological Correlates

Peciña

Azhar

Love

et al. 2012

Neuropsychopharmacol

166

107

View full text Add to dashboard Cite

Personality traits have been shown to interact with environmental cues to modulate biological responses including treatment responses, and potentially having a role in the formation of placebo effects. Here, we assessed psychological traits in 50 healthy controls as to their capacity to predict placebo analgesic effects, placebo-induced activation of m-opioid neurotransmission and changes in cortisol plasma levels during a sustained experimental pain challenge (hypertonic saline infused in the masseter muscle) with and without placebo administration. Statistical analyses showed that an aggregate of scores from Ego-Resiliency, NEO Altruism, NEO Straightforwardness (positive predictors) and NEO Angry Hostility (negative predictor) scales accounted for 25% of the variance in placebo analgesic responses. Molecular imaging showed that subjects scoring above the median in a composite of those trait measures also presented greater placebo-induced activation of m-opioid neurotransmission in the subgenual and dorsal anterior cingulate cortex (ACC), orbitofrontal cortex, insula, nucleus accumbens, amygdala and periaqueductal gray (PAG). Endogenous opioid release in the dorsal ACC and PAG was positively correlated with placebo-induced reductions in pain ratings. Significant reductions in cortisol levels were observed during placebo administration and were positively correlated with decreases in pain ratings, m-opioid system activation in the dorsal ACC and PAG, and as a trend, negatively with NEO Angry Hostility scores. Our results show that personality traits explain a substantial proportion of the variance in placebo analgesic responses and are further associated with activations in endogenous opioid neurotransmission, and as a trend cortisol plasma levels. This initial data, if replicated in larger sample, suggest that simple trait measures easily deployable in the field could be utilized to reduce variability in clinical trials, but may also point to measures of individual resiliency in the face of aversive stimuli such as persistent pain and potentially other stressors.

show abstract

“…Likewise, there was no difference between the two groups in inferring pain from facial expressions, suggesting that personal experience of pain is not necessarily required to perceive-and feel empathy for-pain in others [5]. Interestingly, a recent fMRI study, conducted by the same group and reported in the January 2009 issue of Neuron, demonstrated that patients with congenital insensitivity to pain showed normal fMRI responses to observed pain in the anterior midcingulate cortex and anterior insula-regions which are activated in normal subjects when they experience real pain, or when they observe pain being administered to others [4]. So, we do not need to have experienced physical pain to be able to empathise with others, but we do need to feel pain in order to ensure that our body looks after itself.…”

Section: Feel Your Painmentioning

confidence: 99%

Developments in autonomic research: a review of the latest literature

Macefield

2009

Clin Auton Res

View full text Add to dashboard Cite

Small-diameter afferents do not just subserve pain and temperature sensibilities, important for protection of the body though they are: there is a system of lowthreshold unmyelinated afferents that respond to light stroking (C-tactile afferents) and they are believed to subserve the affective components of touch. Patients with large-fibre sensory neuropathies exhibit skin sympathetic responses to stroking, and report the stimuli as feeling pleasant. Moreover, the posterior insula is activated. Patients with small-diameter sensory neuropathies, specifically those with congenital insensitivity to pain, suffer from cumulative injuries that can lead to joint degeneration. There is evidence that the nociceptive (and sympathetic) axons die because nerve growth factor is not being produced by the target tissues; patients with congenital insensitivity to pain have mutations in the NTRK1 gene, the gene responsible for producing the TrkA receptor, but there is also evidence for mutations in the SCN9A gene, which codes for a specific subunit of the voltage-gated sodium channel. Specific mutations, leading to clusters of cases of congenital insensitivity to pain, have been found in several geographical locations, with several genetic mutations having been documented. Interestingly, even patients with congenital insensitivity to pain, despite having never experienced pain, can still empathise with the pain in others-we do not need to feel pain in order to empathise, but we do need to feel pain in order to ensure that our body looks after itself.

show abstract

Can We Share a Pain We Never Felt? Neural Correlates of Empathy in Patients with Congenital Insensitivity to Pain

Cited by 180 publications

References 60 publications

Placebo analgesia and its opioidergic regulation suggest that empathy for pain is grounded in self pain

Placebo analgesia and its opioidergic regulation suggest that empathy for pain is grounded in self pain

Personality Trait Predictors of Placebo Analgesia and Neurobiological Correlates

Developments in autonomic research: a review of the latest literature

Contact Info

Product

Resources

About