Is Empathy for Pain Unique in Its Neural Correlates? A Meta-Analysis of Neuroimaging Studies of Empathy
Open accessAbstract
Empathy is an essential component of our social lives, allowing us to understand and share other people's affective and sensory states, including pain. Evidence suggests a core neural network-including anterior insula (AI) and mid-cingulate cortex (MCC)-is involved in empathy for pain. However, a similar network is associated to empathy for non-pain affective states, raising the question whether empathy for pain is unique in its neural correlates. Furthermore, it is yet unclear whether neural correlates converge across different stimuli and paradigms that evoke pain-empathy. We performed a coordinate-based activation likelihood estimation (ALE) meta-analysis to identify neural correlates of empathy, assess commonalities and differences between empathy for pain and for non-pain negative affective states, and differences between pain-empathy evoking stimuli (i.e., facial pain expressions vs. acute pain inflictions) and paradigms (i.e., perceptual/affective vs. cognitive/evaluative paradigms). Following a systematic search, data from 128 functional brain imaging studies presenting whole-brain results of an empathy condition vs. baseline/neutral condition were extracted. Synthesizing neural correlates of empathy confirmed a core network comprising AI, MCC, postcentral gyrus, inferior parietal lobe, thalamus, amygdala, and brainstem. There was considerable overlap in networks for empathy for pain and empathy for non-pain negative affective states. Important differences also arose: empathy for pain uniquely activated bilateral mid-insula and more extensive MCC. Regarding stimuli, painful faces and acute pain inflictions both evoked the core empathy regions, although acute pain inflictions activated additional regions including medial frontal and parietal cortex. Regarding paradigms, both perceptual/affective and cognitive/evaluative paradigms recruited similar neural circuitry, although cognitive/evaluative paradigms activated more left MCC regions while perceptual/affective paradigms activated more right AI. Taken together, our findings reveal that empathy for pain and empathy for non-pain negative affective states share considerable neural correlates, particularly in core empathy regions AI and MCC. Beyond these regions, important differences emerged, limiting generalizability of findings across different affective/sensory states. Within pain-empathy studies, the core regions were recruited robustly irrespective of stimuli or instructions, allowing one to tailor designs according to specific needs to some extent, while ensuring activation of core regions.
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Bidirectional interactions between areas involved in PPS representation and the anterior cingulate cortex and anterior insular cortex could mediate the enhancing effect of physical and psychological closeness on empathic pain perception.
“Since ACC and AIC are also involved in affective pain-related processes such as empathic pain (Timmers et al. 2018), bidirectional interactions between areas involved in PPS representation and these regions could mediate the enhancing effect of physical and psychological closeness on empathic pain perception (Grynberg and Konrath 2020).”
From Neuroanatomical correlates of peripersonal space: bridging the gap between perception, action, emotion and social cognition (2024) · cites this paper as Timmers et al. 2018
Human brain imaging studies implicate the insula and anterior cingulate cortex as important regulators of empathic behaviors.
“Human brain imaging studies implicate the insula and anterior cingulate cortex (ACC) as important regulators of empathic behaviors [99,100].”
From Neural circuits regulating prosocial behaviors (2023) · cites this paper as [100]
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- Authors
- Timmers, I., Park, A. L., Fischer, M. D., Kronman, C. A., Heathcote, L. C., Hernandez, J. M., & Simons, L. E.
- Affiliations
- Stanford Medicine (US)
- Corresponding author
- Timmers, Inge
- ORCID
- Venue
- Frontiers in Behavioral Neuroscience
- Publisher
- Frontiers Media SA
- Published
- 2018-11-27
- Volume
- 12
- Pages
- 289-289
- ISSN
- 1662-5153 (ISSN-L)
- PMC
- PMC6277791
- OpenAlex
- W2903047954
- Cited by
- 154
- References
- 49
- Citations by year
- 2026: 13 · 2025: 25 · 2024: 24 · 2023: 17 · 2022: 20 · 2021: 24 · 2020: 22 · 2019: 9
- FWCI
- 2.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Frontiers in Behavioral Neuroscience (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- National Institutes of Health (R01‐grant)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD083270)
- Topics
- Social Sciences › Psychology › Social Psychology › Action Observation and Synchronization
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- empathy for pain, empathy, neural correlates, anterior insula, midcingulate cortex, facial expressions of pain, affective empathy, cognitive empathy, shared neural networks
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