Exploring the Facets of Empathy and Pain in Clinical Practice: A Review

Roche, Jenny; Harmon, Dominic

doi:10.1111/papr.12563

“…Previous studies on empathy were mostly behavioral and neuroimaging studies on normal people (Lamm et al, 2011). A few studies have focused on changes in empathy (Roche and Harmon, 2017). Our knowledge is very limited about how empathy has changed in patients with chronic pain.…”

Section: Introductionmentioning

confidence: 99%

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

Ma

¹

,

Wang

²

,

Qiu

³

et al. 2020

Front. Hum. Neurosci.

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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.

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“…Such intuitive notions are in accordance with theoretical models on pain communication (Vangronsveld & Linton, ; Edmond & Keefe, ). This message is routinely delivered to caregivers during their professional education, with the aim not only to minimize pain sensations, anxiety and stress in patients (for instance in hospital ‘rounds’), but also to build an effective therapeutic relationship (Tait, ; Newton, ; Decety & Fotopoulou, ; Roche & Harmon, ). Divergent data have also been reported, however, and a recent experiment addressing this issue suggested that perceiving empathy from a partner might enhance pain, rather than decrease it (Hurter et al ., ).…”

Section: Introductionmentioning

confidence: 99%

Does an observer's empathy influence my pain? Effect of perceived empathetic or unempathetic support on a pain test

Fauchon

¹

,

Faillenot

²

,

Perrin

³

et al. 2017

Eur J of Neuroscience

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The physiological and behavioural effects of empathy for other's pain have been widely investigated, while the opposite situation, i.e. the influence on one's pain of empathetic feedback from others, remains largely unexplored. Here, we assessed whether and how empathetic and unempathetic comments from observers modulate pain and associated vegetative reactions. In Study 1, conversations between observers of a pain study were recorded by professional actors. Comments were prepared to be perceived as empathetic, unempathetic or neutral, and were validated in 40 subjects. In a subsequent pain experiment (Study 2), changes in subjective pain and heart rate were investigated in 30 naïve participants who could overhear the empathetic or unempathetic conversations pre-recorded in study 1. Subjective pain was significantly attenuated when hearing empathetic comments, as compared to both unempathetic and neutral conditions, while unempathetic comments failed to significantly modulate pain. Heart rate increased when hearing unempathetic remarks and when receiving pain stimuli, but heart acceleration to nociceptive stimulation was not correlated with pain ratings. These results suggest that empathetic feedback from observers has a positive influence on pain appraisal and that this effect may surpass the negative effect of unempathetic remarks. Negative remarks can either trigger feelings of guilt or induce irritation/anger, with antagonistic effects on pain that might explain inter-individual variation. As in basal conditions heart rate and pain perception are positively correlated, their dissociation here suggests that changes in subjective pain were linked to a cognitive bias rather than changes in sensory input.

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“…However, little empirical evidence demonstrates links between empathy ability and specific dimensions of chronic pain (such as pain intensity and duration) [ 19 ], especially for outpatients. In addition, these studies usually assessed empathy using single-dimension questionnaires, so they failed to accurately determine the level of empathy among chronic MSK pain patients [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

¹

,

Ou

²

,

Meng

³

et al. 2021

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Background. In recent years, a growing number of researchers showed significant interest in psychological and social interventions to manage chronic musculoskeletal (MSK) pain. Cognitive and emotional empathy is an attractive and valuable sociopsychological factor that may provide protection and resilience against chronic MSK pain. However, its effect on outpatients remains underexplored. Objective. To compare the empathy ability between chronic MSK pain outpatients and healthy controls and explore the relationship between cognitive/emotional empathy and chronic pain. Methods. Patients with chronic MSK pain ( n = 22 ) and healthy controls ( n = 26 ) completed the pain assessment and empathy ability task, utilizing a multidimensional empathy assessment tool with satisfactory reliability and validity (i.e., the Chinese version of the Multifaceted Empathy Test (MET-C)). Results. The data indicated that the chronic MSK pain outpatients had impaired cognitive empathy (i.e., lower squared cognitive empathy accuracy: Student’s t = − 2.119 , P = 0.040 , and longer task completion time: Student’s t = 3.382 , P = 0.002 ) compared to healthy controls, and cognitive empathy was negatively correlated with pain intensity ( r = − 0.614 , P = 0.002 ). Further, the impaired cognitive empathy was present in identifying positive, but not negative emotions. Conclusion. These results indicate that chronic MSK pain is associated with impaired empathy ability. Our studies contribute to offering a potential direction for developing psychosocial interventions to treat chronic MSK pain.

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Exploring the Facets of Empathy and Pain in Clinical Practice: A Review

Abstract: The review reveals that empathy deserves an unchallenged place in medical care, especially in pain medicine and medical education. It highlights the need to nurture empathy at all levels of professional expertise from medical student to senior doctors.

Cited by 22 publications

References 64 publications

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

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

Does an observer's empathy influence my pain? Effect of perceived empathetic or unempathetic support on a pain test

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

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