Changes in Empathy in Patients With Chronic Low Back Pain: A Structural–Functional Magnetic Resonance Imaging Study

Abstract

Objective: Many pieces of research have focused on pain within individuals, but little attention has been paid to whether pain can change an individual's empathic ability and affect social relationships. The purpose of this study is to explore how chronic low back pain changes empathy. Methods: Twenty-four chronic low back pain patients and 22 healthy controls were recruited. We set up an experimental pain-exposed model for each healthy subject. All subjects received a painful-empathic magnetic resonance scan. After the scan, all subjects rated the pain intensity and multiple empathy-related indicators. The clinical assessment scale was the 20-item Basic Empathy Scale in Adults. Result: The chronic low back pain patients reported lower scores on the total scores of BES-A, the subscale scores of emotional disconnection and cognitive empathy, and the discomfort rating. The fMRI results in the chronic low back pain patients showed that there were multiple abnormal brain pathways centered on the anterior insula. The DTI results in the chronic low back pain patients showed that there were reduced fractional anisotropy values in the corpus callosum, bilateral anterior thalamic radiation (ATR), right posterior thalamic radiation (PTR), right superior longitudinal fasciculus (SLF), and left anterior corona radiate (ACR). Conclusion: Our study found that patients with chronic low back pain have impaired empathy ability. The abnormal functional connectivity of multiple brain networks, multiple damaged white matter tracts, and the lower behavioral scores in chronic low back pain patients supported our findings.

Impaired Cognitive Empathy in Outpatients with Chronic Musculoskeletal Pain: A Cross-Sectional Study

“…This study revealed the impaired cognitive empathy (i.e., lower squared cognitive empathy accuracy and longer task completion time based on the MET-C) in chronic MSK pain patients compared to HCs. This is consistent with previous research on chronic MSK pain, which found impaired empathy (as measured by the Basic Empathy Scale in Adults) in patients with chronic low back pain [ 17 ]. However, we found that the chronic MSK pain patients' emotional empathy was not impaired.…”

“…Empathy ability predicted self-perceived social support and positive life changes, which allows resilience in response to chronic pain [ 16 ]. Additionally, a study reported that patients with chronic low back pain had impaired empathy (as measured by the Basic Empathy Scale in Adults) [ 17 ], and improving empathy ability improves interpersonal relationships and quality of life [ 18 ].…”

Social Exclusion Down-Regulates Pain Empathy at the Late Stage of Empathic Responses: Electrophysiological Evidence

“…Past studies have shown that patients suffering from pain also have abnormal empathic responses to the pain of others. Ma et al ( 2020 ) investigated how chronic low back pain changes empathy and the results showed that patients with the chronic low back pain displayed lower scores on the subscale scores of emotional disconnection and cognitive empathy, and the discomfort rating of watching painful stimuli. Shin et al ( 2013 ) focused on the empathic abilities differences between patients with complex regional pain syndrome (CRPS) Type I and healthy control subjects and found that patients with CRPS showed poorer performance in accuracy of identifying emotional states of others and there was a significant association between the deficit in social-emotion recognition and the affective dimension of pain.…”

“…Another study has also shown that CRPS patients displayed impaired cognitive and emotional empathic abilities indexed by lower scores in perspective taking and empathic concern and higher scores in personal distress of the IRI (Sohn et al, 2016 ). Studies on the neural mechanism of clinical chronic pain showed that the chronic low back pain patients displayed multiple abnormal brain pathways centered on the anterior insula (AI) (Ma et al, 2020 ) and patients with chronic pain disorder displayed lower activation of the left perigenual ACC (Noll-Hussong et al, 2013 ). AI and ACC have been considered as key areas of pain empathy (Fan et al, 2011 ; Lamm et al, 2011 ).…”

Multi-feature data fusion based on common space model and recurrent convolutional neural networks for EEG tristimania recognition used in upper limb rehabilitation exercises

“…It is the overall reflection of the physiological activity of brain nerve cells on the surface of cerebral cortex or scalp. Compared with magnetoencephalogram (MEG) [4], functional magnetic resonance imaging (FMRI) [5], positron emission tomography (PET) [6] and other research tools, EEG is still an important tool for monitoring brain activity due to its relatively low cost, convenience of recording and not easily falsified [7]. EEG has gradually been applied in the auxiliary diagnosis of a number of diseases [8][9].…”