Brain Advance Access originally published online on June 24, 2006
Brain 2006 129(9):2494-2507; doi:10.1093/brain/awl155
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Is pain the price of empathy? The perception of others' pain in patients with congenital insensitivity to pain
1 Département de Neurophysiologie, Faculté de Médecine Pitié-Salpêtrière Paris, France 2 Consultation de la Douleur, Faculté de Médecine Pitié-Salpêtrière Paris, France 3 Institut National de la Santé et de la Recherche Médicale U713, Faculté de Médecine Pitié-Salpêtrière Paris, France 4 Department of Psychology, University of Northern British Columbia Prince George, Canada
Correspondence to: Nicolas Danziger, Département de Neurophysiologie, Faculté de Médecine Pitié-Salpêtrière, 91 Boulevard de l'Hôpital, 75634 Paris Cedex 13, France E-mail: ndanziger{at}hotmail.com
Empathy is a complex form of psychological inference that enables us to understand the personal experience of another person through cognitive/evaluative and affective processes. Recent findings suggest that empathy for pain may involve a ‘mirror-matching’ simulation of the affective and sensory features of others' pain. Despite such evidence for a shared representation of self and other pain at the neural level, the possible influence of the observer's own sensitivity to pain upon his perception of others' pain has not been investigated yet. The aim of this study was to explore how patients with congenital insensitivity to pain (CIP), who are largely deprived of common stimulus-induced pain experiences, perceive the pain of others. Ratings of verbally presented imaginary painful situations showed that CIP patients' semantic knowledge regarding the pain of others did not differ from control subjects. Moreover, the propensity to infer pain from facial expressions was very similar between CIP patients and control subjects. On the other hand, when asked to rate pain-inducing events seen in video clips in the absence of visible or audible pain-related behaviour, CIP patients showed more variable and significantly lower pain ratings, as well as a reduction in aversive emotional responses, compared with control subjects. Interestingly, pain judgements, inferred either from facial pain expressions or from pain-inducing events, were strongly related to inter-individual differences in emotional empathy among CIP patients, while such correlation between pain judgement and empathy was not found in control subjects. The results suggest that a normal personal experience of pain is not necessarily required for perceiving and feeling empathy for others' pain. In the absence of functional somatic resonance mechanisms shaped by previous pain experiences, others' pain might be greatly underestimated, however, especially when emotional cues are lacking, unless the observer is endowed with sufficient empathic abilities to fully acknowledge the suffering experience of others in spite of his own insensitivity.
Key Words: empathy for pain; pain judgement; facial expression of pain; congenital insensitivity to pain
Abbreviations: BEES, Balanced Emotional Empathy Scale; CIP, congenital insensitivity to pain; HSAN, hereditary sensory and autonomic neuropathy; SAM, self-assessment manikin; SPQ, Situational Pain Questionnaire; STEP, Sensitivity to Expressions of Pain
Received February 20, 2006. Revised April 13, 2006. Accepted May 10, 2006.
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