The Contribution of New Technological Breakthroughs to the Neuroscientific Research of Pain Communication

  • Aurore Meugnot
  • Philip L. JacksonEmail author


Pain is a universal experience of human distress but paradoxically eminently private. One can infer the level of pain in others based on varying sources of information making it difficult to accurately and systematically evaluate the actual experience of a person in pain. Yet, this is one of many difficult tasks healthcare professionals face every day. Assessing pain in others is further hindered by the fact that caregivers are humans, and humans cannot easily remain indifferent to other people’s distress, and tend to avoid it. From the patient’s point of view, available means of pain expression can be reduced, but they can also be voluntarily restricted when facing for instance distrustful professionals. From the healthcare professional’s point of view, facing pain on a continual basis and communicating one’s understanding and empathy can be difficult. Ultimately, beyond the individual feeling pain and another individual decoding the pain message, the patient-caregiver interaction itself crystallizes the complex phenomenon of pain communication. In this chapter, we discuss the perception of pain and its communication from the perspective of neuroscience. Firstly, we briefly review recent imaging studies on the cerebral responses to pain and pain in others. We point out neuroimaging evidence showing the varying involvement of regions of the “pain matrix” in the process of other’s pain perception (also called pain empathy). Secondly, we discuss current neurocognitive models which provide a first step towards understanding pain communication at the level of the central nervous system, although they fall short at characterizing the interactive mechanisms underlying this complex process, as the traditional one-brain approach used to date has focused on either the observer or the person in pain. We also review more recent neuroimaging studies on the phenomena of interpersonal synchrony. We argue that examining both individuals of a dyad together, and their interactions, is becoming necessary to address pain communication fully. Finally, we present new perspectives in the study of pain communication through the field of affective computing, which is making steady progress towards designing machines capable of detecting and reacting to behavioural and physiological markers of human emotions, including pain. We propose that the use of avatars offers a highly controllable experimental set-up to explore the mechanism underlying pain empathy and pain communication from both the patient’s and the caregiver’s perspective, as well as their interactions. Beyond designing intelligent and empathic tools to detect patients’ experiences, these research initiatives may help promote empathic behaviour and thus meet the challenge of preserving our humanness in the contexts of pain and suffering.


Facial Expression Virtual Reality Social Exchange Anterior Insula Late Positive Potential 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Akitsuki Y, Decety J (2009). Social context and perceived agency affects empathy for pain: an event-related fMRI investigation. Neuroimage. doi: 10.1016/j.neuroimage.2009.04.091
  2. Apkarian AV, Bushnell MC, Treede RD, Zubieta JK (2005) Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain 9:463–484. doi: 10.1016/j.ejpain.2004.11.001
  3. Ashraf AB, Lucey S, Cohn JF, Chen T, Ambadar Z, Prkachin KM, Solomon PE (2009) The painful face—pain expression recognition using active appearance models. Image Vis Comput 27(12):1788–1796CrossRefPubMedPubMedCentralGoogle Scholar
  4. Avenanti A, Minio-Paluello I, Bufalari I, Aglioti SM (2009) The pain of a model in the personality of an onlooker: influence of state-reactivity and personality traits on embodied empathy for pain. Neuroimage. doi: 10.1016/j.neuroimage.2008.08.001
  5. Avenanti A, Sirigu A, Aglioti SM (2010) Racial bias reduces empathic sensorimotor resonance with other-race pain. Curr Biol 20(11):1018–1022CrossRefPubMedGoogle Scholar
  6. Bartlett MS, Littlewort GC, Frank MG, Lee K (2014) Automatic decoding of facial movements reveals deceptive pain expressions. Curr Biol 24(7):738–743CrossRefPubMedPubMedCentralGoogle Scholar
  7. Bernhardt BC, Singer T (2012) The neural basis of empathy. doi: 10.1146/annurev-neuro-062111-150536
  8. Botvinick M, Jha AP, Bylsma LM, Fabian SA, Solomon PE, Prkachin KM (2005) Viewing facial expressions of pain engages cortical areas involved in the direct experience of pain. Neuroimage. doi: 10.1016/j.neuroimage.2004.11.043 PubMedGoogle Scholar
  9. Bouchard S, Bernier F, Boivin É, Dumoulin S, Laforest M, Guitard T, Robillard G, Monthuy-Blanc J, Renaud P (2013) Empathy toward virtual humans depicting a known or unknown person expressing pain. Cyberpsychol Behav Soc Netw 16(1):61–71.
  10. Cacioppo S, Zhou H, Monteleone G, Majka EA, Quinn KA, Ball AB, Norman GJ, Semin GR, Cacioppo JT (2014) You are in sync with me: neural correlates of interpersonal synchrony with a partner. Neuroscience. doi: 10.1016/j.neuroscience.2014.07.051
  11. Cheng Y, Lin CP, Liu HL, Hsu YY, Lim KE, Hung D, Decety J (2007) Expertise modulates the perception of pain in others. Curr Biol. doi: 10.1016/j.cub.2007.09.020
  12. Cheon BK, Im DM, Harada T, Kim JS, Mathur VA, Scimeca JM, Parrish TB, Park HW, Chiao JY (2011) Cultural influences on neural basis of intergroup empathy. NeuroImage. doi: 10.1016/j.neuroimage.2011.04.031
  13. Cheon BK, Im DM, Harada T, Kim JS, Mathur VA, Scimeca JM, Parrish TB, Park HW, Chiao JY (2013) Cultural modulation of the neural correlates of emotional pain perception: the role of other-focusedness. Neuropsychologia. doi: 10.1016/j.neuropsychologia.2013.03.018
  14. Coll MP, Budell L, Rainville P, Decety J, Jackson PL (2012) The role of gender in the interaction between self-pain and the perception of pain in others. J Pain. doi: 10.1016/j.jpain.2012.04.009
  15. Coll MP, Grégoire M, Prkachin KM, Jackson PL (2016) Repeated exposure to vicarious pain alters electrocortical processing of pain expressions. Exp Brain Res 234(9):2677–2686. doi:  10.1007/s00221-016-4671-z
  16. Consorti F, Mancuso R, Nocioni M, Piccolo A (2012) Efficacy of virtual patients in medical education: A meta-analysis of randomized studies. Comput Educ 59(3):1001–1008. doi: 10.1016/j.compedu.2012.04.017
  17. Contreras-Huerta LS, Baker KS, Reynolds KJ, Batalha L, Cunnington R (2013) Racial bias in neural empathic responses to pain. PLoS ONE 8(12):e84001CrossRefPubMedPubMedCentralGoogle Scholar
  18. Craig KD (2009) The social communication model of pain. Can Psychol. doi: 10.1037/a0014772 Google Scholar
  19. Decety J, Jackson PL (2004) The functional architecture of human empathy. doi: 10.1177/1534582304267187
  20. Decety J, Echols S, Correll J (2010) The blame game: the effect of responsibility and social stigma on empathy for pain. J Cogn Neurosci 22(5):985–997. doi:  10.1162/jocn.2009.21266
  21. Deladisma AM, Cohen M, Stevens A, Wagner P, Lok B, Bernard T et al (2007) Do medical students respond empathetically to a virtual patient? Am J Surg 193(6):756–760Google Scholar
  22. Drwecki BB, Moore CF, Ward SE, Prkachin KM (2011) Reducing racial disparities in pain treatment: the role of empathy and perspective-taking. Pain 152(5):1001–1006CrossRefPubMedGoogle Scholar
  23. Dumas G, Lachat F, Martinerie J, Nadel J, and George N (2011) From social behaviour to brain synchronization: review and perspectives in hyperscanning. IRBM. doi: 10.1016/j.irbm.2011.01.002
  24. Dyck M, Winbeck M, Leiberg S, Chen Y, Gur RC, Mathiak K (2008) Recognition profile of emotions in natural and virtual faces. PLoS ONE 3(11):e3628Google Scholar
  25. Eisenberger, NI (2015) Eisenberger social pain and the brain: controversies, questions, and where to go from here. Annu Rev Psychol 66:601–629. doi: 10.1146/annurev-psych-010213-115146
  26. Ekman P, Friesen WV, Hager JC (2002) Facial action coding system. The manual on CD ROM. Network Information Research Corporation, Salt Lake City, UTGoogle Scholar
  27. Fairhurst MT, Janata P, Keller PE (2013) Being and feeling in sync with an adaptive virtual partner: brain mechanisms underlying dynamic cooperativity. Cereb Cortex. doi: 10.1093/cercor/bhs243
  28. Feng C, Feng X, Wang L, Tian T, Li Z, Luo YJ (2015) Social hierarchy modulates neural responses of empathy for pain. Soc Cognit Affect Neurosci (201564). doi: 10.1093/scan/nsv135
  29. Gaffary Y, Eyharabide V, Martin JC, Ammi M (2014) The impact of combining kinesthetic and facial expression displays on emotion recognition by users. Int J Hum Comput Interact 30:904–920. doi: 10.1080/10447318.2014.941276
  30. Garcia-Larrea L, Peyron R (2013) Pain matrices and neuropathic pain matrices: a review. Pain. doi: 10.1016/j.pain.2013.09.001
  31. Garrett B, Taverner T, Masinde W, Gromala D, Shaw C, Negraeff M (2014) A rapid evidence assessment of immersive virtual reality as an adjunct therapy in acute pain management in clinical practice. Clin J Pain (Dec) 1–26. doi: 10.1097/AJP.0000000000000064
  32. Girard JM, Cohn JF, Jeni LA, Sayette MA, De la Torre F (2014) Spontaneous facial expression in unscripted social interactions can be measured automatically. Behav Res Methods 47(4):1136–1147. doi:  10.3758/s13428-014-0536-1
  33. Goubert L, Craig KD, Buysse A (2009) Perceiving others in pain: experimental and clinical evidence on the role of empathy. Soc Neurosci Empathy 153–165. doi: 10.7551/mitpress/9780262012973.003.0013
  34. Grégoire M, Coll MP, Eugène F, Jackson PL (2012) Revue des facteurs qui modulent les réponses cérébrale et comportementale à la douleur d’autrui. Douleurs 13(5):212–218Google Scholar
  35. Gu X, Han S (2007) Attention and reality constraints on the neural processes of empathy for pain. NeuroImage. doi: 10.1016/j.neuroimage.2007.02.025
  36. Guo X, Zheng L, Zhang W, Zhu L, Li J, Wang Q, Dienes Z, Yang Z (2012) Empathic neural responses to others’ pain depend on monetary reward. Soc Cognit Affect Neurosci. doi: 10.1093/scan/nsr034
  37. Guo X, Zheng L, Wang H, Zhu L, Li J, Wang, Q, Dienes Z, Yang, Z (2013) Exposure to violence reduces empathetic responses to other’s pain. Brain Cognit. doi: 10.1016/j.bandc.2013.04.005
  38. Hadjistavropoulos T, Craig KD (2002) A theoretical framework for understanding self-report and observational measures of pain: a communications model. Behav Res Ther 40(5):551–570Google Scholar
  39. Hadjistavropoulos T, Craig KD, Duck S, Cano A, Goubert L, Jackson PL, Mogil JS, Rainville P, Sullivan MJ, de C Williams AC, Vervoort T (2011) A biopsychosocial formulation of pain communication. doi: 10.1037/a0023876
  40. Hein G, Silani G, Preuschoff K, Batson CD, Singer T (2010) Neural responses to ingroup and outgroup members’ suffering predict individual differences in costly helping. Neuron. doi: 10.1016/j.neuron.2010.09.003
  41. Hirsh AT, Alqudah AF, Stutts LA, Robinson ME (2008) Virtual human technology: capturing sex, race, and age influences in individual pain decision policies. Pain. doi: 10.1016/j.pain.2008.09.010
  42. Hirsh AT, George SZ, Robinson ME (2009) Pain assessment and treatment disparities: a virtual human technology investigation. Pain. doi: 10.1016/j.pain.2009.02.005
  43. Hoffman HG, Richards TL, Van Oostrom T, Coda BA, Jensen MP, Blough DK, Sharar SR (2007) The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments. Anesth Analg 105(6):1776–1783Google Scholar
  44. Hoffman HG, Chambers GT, Meyer WJ, Arceneaux LL, Russell WJ, Seibel EJ, Richards TL, Sharar SR, Patterson DR (2011) Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Ann Behav Med 41:183–191Google Scholar
  45. Hove MJ, Risen JL (2009) It’s all in the timing: interpersonal synchrony increases affiliation. Soc Cognit 27(6):949–960CrossRefGoogle Scholar
  46. Iannetti GD, Mouraux A (2010) From the neuromatrix to the pain matrix (and back). Exp Brain Res 205(1):1–12CrossRefPubMedGoogle Scholar
  47. Jackson PL, Rainville P, Decety J (2006) To what extent do we share the pain of others? Insight from the neural bases of pain empathy). Pain. doi: 10.1016/j.pain.2006.09.013
  48. Jackson PL, Eugène F, Tremblay MPB (2015a) Improving empathy in the care of pain patients. AJOB Neurosci. doi:  10.1080/21507740.20151047053
  49. Jackson PL, Michon, P-E, Geslin E, Carignan M, Beaudoin D, Korb S (2015b) EEVEE: the empathy-enhancing virtual evolving environment. doi: 10.3389/fnhum.2015.00112
  50. Jensen KB, Petrovic P, Kerr CE et al (2014) Sharing pain and relief: neural correlates of physicians during treatment of patients. Mol Psychiatry. doi: 10.1038/mp.2012.195 Google Scholar
  51. Jin W, Choo A, Gromala D, Shaw C, Squire P (2016) A virtual reality game for chronic pain management: a randomized, controlled clinical study. Stud Health Technol Inf 220:154–160.
  52. Kunz M, Lautenbacher S, Leblanc N, Rainville P (2012) Are both the sensory and the affective dimensions of pain encoded in the face? Pain. doi: 10.1016/j.pain.2011.10.027
  53. Lamm C, Batson CD, Decety J (2007) The neural substrate of human empathy: effects of perspective-taking and cognitive appraisal. J Cogn Neurosci 19(1):42–58. doi:  10.1162/jocn.2007.19.1.42
  54. Lamm C, Decety J, Singer T (2011) Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain. NeuroImage. doi: 10.1016/j.neuroimage.2010.10.014
  55. Latimer M, Jackson P, Johnston C, Vine J (2011) Examining nurse empathy for infant procedural pain: testing a new video measure. Pain Res Manag 16(4):228–233. PMCID: PMC3202373Google Scholar
  56. Lucey P, Cohn JF, Matthews I, Lucey S, Sridharan S, Howlett J, Prkachin KM (2011) Automatically detecting pain in video through facial action units. IEEE Trans Syst Man Cybern B Cybern 41(3):664–674CrossRefPubMedGoogle Scholar
  57. Macrae CN, Duffy OK, Miles LK, Lawrence J (2008) A case of hand waving: action synchrony and person perception. Cognition 109(1):152–156CrossRefPubMedGoogle Scholar
  58. Mailhot JP, Vachon-Presseau E, Jackson PL, Rainville P (2012) Dispositional empathy modulates vicarious effects of dynamic pain expressions on spinal nociception, facial responses and acute pain. Eur J Neurosci 35(2):271–278CrossRefPubMedGoogle Scholar
  59. Mantovani F, Castelnuovo G, Gaggioli A, Riva G (2003) Virtual reality training for health-care professionals. Cyber Psychol Behav 6(4):389–395. doi: 10.1089/109493103322278772
  60. Mathur VA, Harada T, Lipke T, Chiao JY (2010) Neural basis of extraordinary empathy and altruistic motivation. NeuroImage 51(4):1468–1475CrossRefPubMedGoogle Scholar
  61. Meng J, Jackson T, Chen H, Hu L, Yang Z, Su Y, Huang X (2013) Pain perception in the self and observation of others: An ERP investigation. NeuroImage. doi: 10.1016/j.neuroimage.2013.01.024
  62. Miles LK, Nind LK, Henderson Z, Macrae CN (2010) Moving memories: behavioral synchrony and memory for self and others. J Exp Soc Psychol 46(2):457–460CrossRefGoogle Scholar
  63. Montague P, Berns GS, Cohen JD, McClure SM, Pagnoni G, Dhamala M, Wiest MC, Karpov I, King RD, Apple N, Fisher RE (2001) COMMENTARY Hyperscanning: simultaneous fMRI during linked social interactions. doi: 10.1006/nimg.2002.1150
  64. Mouraux A, Diukova A, Lee MC, Wise RG, Iannetti GD (2011) A multisensory investigation of the functional significance of the “pain matrix”. NeuroImage 54(3):2237–2249CrossRefPubMedGoogle Scholar
  65. Padfield D, Zakrzewska JM, De C Williams AC (2015) Do photographic images of pain improve communication during pain consultations? Pain Res Manag 20(3):123–128. PMCID: PMC4447153Google Scholar
  66. Picard RW (2003) Affective computing: challenges. Int J Hum Comput Stud 59(1–2):55–64CrossRefGoogle Scholar
  67. Preis MA, Kroener-Herwig B (2012) Empathy for pain: the effects of prior experience and sex. Eur J Pain (UK). doi: 10.1002/j.1532-2149.2012.00119.x
  68. Preis MA, Schmidt-Samoa C, Dechent P, Kroener-Herwig B (2013) The effects of prior pain experience on neural correlates of empathy for pain: An fMRI study. Pain. doi: 10.1016/j.pain.2012.11.014
  69. Preis MA, Kroener-Herwig B, Schmidt-Samoa C, Dechent P, Barke A (2015) Neural correlates of empathy with pain show habituation effects. An fMRI study. PLoS ONE. doi: 10.1371/journal.pone.0137056
  70. Price DD, Aydede M (2006) The experimental use of introspection in the scientific study of pain and its integration with third-person methodologies: the experiential-phenomenological approach. Pain 243–273.
  71. Prkachin KM, Rocha EM (2010) High levels of vicarious exposure bias pain judgments. J Pain. doi: 10.1016/j.jpain.2009.12.015
  72. Prkachin KM, Solomon PE (2008) The structure, reliability and validity of pain expression: evidence from patients with shoulder pain. Pain 139(2):267–274CrossRefPubMedGoogle Scholar
  73. Prkachin KM, Mass H, Mercer SR (2004) Effects of exposure on perception of pain expression. Pain. doi: 10.1016/j.pain.2004.03.027
  74. Prkachin KM, Solomon PE, Ross J (2007) Underestimation of pain by health-care providers: towards a model of the process of inferring pain in others. Can J Nurs Res 39(2):88–106Google Scholar
  75. Prkachin KM, Kaseweter KA, Browne ME (2015) Understanding the suffering of others: the sources and consequences of third-person pain. In: Pickering G, Gibson S (eds) Pain, emotion and cognition. Springer, Cambridge, pp 53–72Google Scholar
  76. Riečanský I, Paul N, Kölble S, Stieger S, Lamm C (2015) Beta oscillations reveal ethnicity ingroup bias in sensorimotor resonance to pain of others. Soc Cognit Affect Neurosci. doi: 10.1093/scan/nsu139
  77. Rizzolatti G, Craighero L (2004) The mirror-neuron system. doi: 10.1146/annurev.neuro.27.070203.144230
  78. Romano D, Llobera J, Blanke O (2016) Size and viewpoint of an embodied virtual body affect the processing of painful stimuli. J Pain. doi: 10.1016/j.jpain.2015.11.005 Google Scholar
  79. Schilbach L, Timmermans B, Reddy V, Costall A, Bente G, Schlicht T, Vogeley K (2013) Toward a second-person neuroscience. doi: 10.1017/S0140525X12000660
  80. Schmidt RC, O’Brien B (1997) Evaluating the dynamics of unintended interpersonal coordination. Ecol Psychol 9:189–206Google Scholar
  81. Shackman AJ, Salomons TV, Slagter HA, Fox AS, Winter JJ, Davidson RJ (2011) The integration of negative affect, pain and cognitive control in the cingulate cortex. Nat Rev Neurosci. doi: 10.1038/nrn2994
  82. Shenhav A, Botvinick M, Cohen JD (2013) The expected value of control: an integrative theory of anterior cingulate cortex function. Neuron Rev. doi: 10.1016/j.neuron.2013.07.007
  83. Sikka K, Ahmed AA, Diaz D, Goodwin MS, Craig KD, Bartlett MS, Huang JS (2015) Automated assessment of children’s postoperative pain using computer vision. Pediatrics 136(1):1–8. doi: 10.1542/peds.2015-0029
  84. Simon D, Craig KD, Miltner WHR, Rainville P (2006) Brain responses to dynamic facial expressions of pain. Pain 126(1–3):309–318CrossRefPubMedGoogle Scholar
  85. Singer T, Seymour B, O’doherty JP, Kaube H, Dolan RJ, Frith CD (2004) Empathy for pain involves the affective but not sensory components of pain. Science. doi: 10.1126/science.1093535
  86. Singer T, Seymour B, O’doherty JP, Stephan KE, Dolan RJ, Frith CD (2006) Empathic neural responses are modulated by the perceived fairness of others. doi: 10.1038/nature04271
  87. Stutts LA, Hirsh AT, George SZ, Robinson ME (2010) Investigating patient characteristics on pain assessment using virtual human technology. Eur J Pain. doi: 10.1016/j.ejpain.2010.04.003
  88. Tognoli E, Lagarde J, Deguzman GC, Kelso JAS (2007) The phi complex as a neuromarker of human social coordination Proc Natl Acad Sci USA 8;104(19):8190–8195. doi:  10.1073/pnas.0611453104
  89. Tognoli E, Kelso JAS, Gross J, Keitel A, Hauswald A (2015) The coordination dynamics of social neuromarkers. Citation: Tognoli E and Kelso JAS. doi: 10.3389/fnhum.2015.00563
  90. Valdesolo P, Desteno D (2011) Synchrony and the social tuning of compassion. Emotion (Washington, DC) 11(2):262–266Google Scholar
  91. Wittkopf PG, Johnson MI (2016) Managing pain by visually distorting the size of painful body parts: is there any therapeutic value? Pain Manag. doi: 10.2217/pmt.16.1 PubMedGoogle Scholar
  92. Xu X, Zuo X, Wang X, Han S (2009) Do you feel my pain? Racial group membership modulates empathic neural responses. doi: 10.1523/JNEUROSCI.2418-09.2009
  93. Yamada M, Decety J (2009) Unconscious affective processing and empathy: an investigation of subliminal priming on the detection of painful facial expressions. Pain 143(1–2):71–75CrossRefPubMedGoogle Scholar
  94. Yang CY, Decety J, Lee S, Chen C, Cheng Y (2009) Gender differences in the mu rhythm during empathy for pain: an electroencephalographic study. Brain Res. doi: 10.1016/j.brainres.2008.11.062
  95. Zaki J, Ochsner KN (2012) The neuroscience of empathy: progress, pitfalls and promise. Nat Neurosci. doi: 10.1038/nn.3085

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Ecole de psychologieUniversité LavalQuebecCanada
  2. 2.Centre interdisciplinaire de recherche en réadaptation et intégration socialeQuebecCanada
  3. 3.Centre de recherche de l’institut universitaire en santé mentale de québecQuebecCanada

Personalised recommendations