This approach, in conjunction with cumulative efforts testing the specificity and generalizability of brain measures across labs, can help us move beyond debates about which experiences are or are not pain, and towards a more comprehensive understanding of aversive experiences and their constituent representations.

Here, we advocate dispensing with binary definitions of pain versus nonpain, and instead considering the constellation of phenomena that comprise pain.

Neuroimaging evidence has suggested both overlapping and nonoverlapping representations across nociceptive and empathic pain, leading to debates as to whether empathic experience should be considered a type of pain or a distinct experience.

Pain features centrally in numerous illnesses and generates enormous public health costs. Despite its ubiquity, the psychological and neurophysiological nature of pain remains controversial. Here, we survey one controversy in particular: the relation between nociceptive pain, which is somatic in origin, and empathic pain, which arises from observing others in pain. First, we review evidence for neural overlap between nociceptive and empathic pain and what this overlap implies about underlying mental representations. Then, we propose a framework for understanding the nature of the psychological and neurophysiological correspondence across these types of ‘pain’. This framework suggests new directions for research that can better identify shared and dissociable representations underlying different types of distress, and can inform theories about the nature of pain.

Purchase access to all full-text HTML articles for 6 or 36 hr at a low cost. Click here to explore this opportunity.

To read this article in full you will need to make a payment

Inferring mental states from neuroimaging data: from reverse inference to large-scale decoding.

Neural pathways of embarrassment and their modulation by social anxiety.

Mentalizing and the role of the posterior superior temporal sulcus in sharing others’ embarrassment.

The pain of social disconnection: examining the shared neural underpinnings of physical and social pain.

Executed and observed movements have different distributed representations in human aIPS.

Premotor cortex and the recognition of motor actions.

I am touched by your pain: limb-specific modulation of the cortical response to a tactile stimulation during pain observation.

Differential pattern of functional brain plasticity after compassion and empathy training.

Empathic brain responses in insula are modulated by levels of alexithymia but not autism.

Racial differences in pain treatment and empathy in a Canadian sample.

Attention and reality constraints on the neural processes of empathy for pain.

Do you feel my pain? Racial group membership modulates empathic neural responses.

Dissociating the ability and propensity for empathy.

I feel how you feel but not always: the empathic brain and its modulation.

Cognitive modulation of pain: how do attention and emotion influence pain processing?.

Frontoparietal mechanisms supporting attention to location and intensity of painful stimuli.

Imaging how attention modulates pain in humans using functional MRI.

Mind wandering away from pain dynamically engages antinociceptive and default mode brain networks.

Representation of aversive prediction errors in the human periaqueductal gray.

From brain maps to cognitive ontologies: informatics and the search for mental structure.

Separate modifiability, mental modules, and the use of pure and composite measures to reveal them.

Cross-modal representations of first-hand and vicarious pain, disgust and fairness in insular and cingulate cortex.

The neural basis of error detection: conflict monitoring and the error-related negativity.

Tuning curves for approximate numerosity in the human intraparietal sulcus.

The analysis of visual motion: a comparison of neuronal and psychophysical performance.

Control of goal-directed and stimulus-driven attention in the brain.

Constructing emotion: the experience of fear as a conceptual act.

Ventromedial prefrontal–subcortical systems and the generation of affective meaning.

Psychological construction: the Darwinian approach to the science of emotion.

More on the fragility of performance: choking under pressure in mathematical problem solving.

Dissociable influences of opiates and expectations on pain.

The influence of negative emotions on pain: behavioral effects and neural mechanisms.

Pain affect encoded in human anterior cingulate but not somatosensory cortex.

Cognitive and emotional control of pain and its disruption in chronic pain.

Functional imaging of brain responses to pain. A review and meta-analysis (2000).

Beyond metaphor: contrasting mechanisms of social and physical pain.

Can cognitive processes be inferred from neuroimaging data?.

The relation of emotions to placebo responses.

A neural representation of categorization uncertainty in the human brain.

When math hurts: math anxiety predicts pain network activation in anticipation of doing math.

Overlapping activity in anterior insula during interoception and emotional experience.

A common role of insula in feelings, empathy and uncertainty.

The expected value of control: an integrative theory of anterior cingulate cortex function.

The integration of negative affect, pain and cognitive control in the cingulate cortex.

How do you feel--now? The anterior insula and human awareness.

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

Reduction of empathy for pain by placebo analgesia suggests functional equivalence of empathy and first-hand emotion experience.

Neural responses to ingroup and outgroup members’ suffering predict individual differences in costly helping.

Dissecting the social brain: introducing the EmpaToM to reveal distinct neural networks and brain–behavior relations for empathy and Theory of Mind.

The compassionate brain: humans detect intensity of pain from another's face.

Transcranial magnetic stimulation highlights the sensorimotor side of empathy for pain.

You, me, and my brain: self and other representations in social cognitive neuroscience.

Reduced spontaneous but relatively normal deliberate vicarious representations in psychopathy.

Responsibility modulates pain–matrix activation elicited by the expressions of others in pain.

Empathic neural responses are modulated by the perceived fairness of others.

Empathy for pain involves the affective but not sensory components of pain.

Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain.

Felt and seen pain evoke the same local patterns of cortical activity in insular and cingulate cortex.

Is pain the price of empathy? The perception of others’ pain in patients with congenital insensitivity to pain.

Social modulation of pain as evidence for empathy in mice.

Empathy hurts: compassion for another increases both sensory and affective components of pain perception.

The neuroscience of empathy: progress, pitfalls, and promise.

Relieving pain in America: a blueprint for transforming prevention, care, education, and research.

Glossary

a subset of a brain pattern inferred to track a specific dimension of psychological experience (e.g., attention shifts or location coding).

an approach to psychology and neuroscience positing that complex states (e.g., emotions) can be best understood not as irreducible entities, but rather as combinations of psychological ‘ingredients’.

pain that arises from observing actual or threatened tissue damage in another person.

a pattern or component that displays sensitivity and specificity to one psychological state, allowing for reverse inference about that state based on the activation of that pattern.

pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.

the set of voxels activated (and their accompanying intensity) by a stimulus or task.

the probability of engaging a neural marker given that a particular mental state is present.

a state under which activity in two patterns or components is modulated by differing tasks; for example, activity in pattern A tracks psychological variable X but not variable Y, and activity in pattern B tracks psychological variable Y but not variable X.

the probability of not engaging a neural marker when a particular mental state is not present.