**1.1 Empathy for pain**

Empathy is a crucial component of social interactions allowing not only understand and feel other's emotions but also promoting prosocial behaviour which is vital for our social life [1–3]. Most definitions of empathy based on empathy are about a capacity of sense of knowing another person's personal experience [4]. Empathy in the context of pain has been attracted since observing somebody in pain activates similar neurons as if the observer were feeling pain himself [5, 6]. The effect of experience and observing of pain bring an interpersonal interaction in observers.

Facing the pain of others might result from ignoring to comfort or help. Having personal pain experiences facilitate to reveal empathic responses when observing someone in pain [6]. Also, sharing emotional experiences with friends may promote empathy [7]. Personal beliefs about pain may affect the level of empathy in that person [8].

Additionally, personal identity was positively correlated with empathy in nurses, doctors, and teachers. Studies have shown successful teaching requires the link between cognitive and affective empathy [9]. Empathy promotes students' academic achievement and teachers' professional growth [10, 11]. Empathy was negatively correlated with a burnout in the nursing profession [12]. Furthermore, a 10-week empathy training experiment in nurses showed significantly improved professional identity [10].

As summed above pain empathy is influenced by several factors, such as personal identity [13, 14], gender [15], attention [15, 16], prosocial characteristics, and attitude [17]. Besides these, some neuropsychiatric disorders such as schizophrenia, psychopathy, and autism may lead to impaired empathic reactions. These individuals are less responsive to their pain and others [18, 19].

Sex differences are another affecting factor in empathy for pain. Women reported more significant empathic concern and affective distress via Empathy for Pain Scale in pain compared with men [20].

Regarding contextual influences in daily life, developing a sense of knowing another person's experience in pain has been affected by several factors, such as observer's learning experiences, shared knowledge, and observed person's pain expressions, etc. All elements contribute to more or less person's affective responses as well as behavioural responses. So, a person's reaction to what they see is not identical. Although there are different mentions on the core components of empathy, there is a consensus in the literature that empathy takes a multiple and interacting process between cognition, distinction and affective state of the person.

This pain empathy process occurs from observing the pain because of his/her sense of knowing of the other's personal experience and his/her affective response to this. In this context, empathy has divided into the three-part: firstly, cognitive/ evaluative part is similar to mentalising and theory of mind, ability to identify, and understand other people's emotion [21]. Second, the distinction is distinguishing of self pain from someone else's pain. The last part is pointing that sharing of the other person's affective state (which refers to the catching and automatic mimicking of other people's emotions) [22].

Successful internal balancing of empathy parts provides increased intimacy and closeness to other's emotions. So, a mother may sense a child's pain, understand the child's feelings and may kiss the wound. In an unsuccessful situation for differentiating cognitive and affective part in empathy may cause to observer's distress and burnout [8]. Finally, it would be sensible to assume that successful regulating our own emotions provide reliably use them to assess the content and sense of others' feelings correctly.

#### **2. Evaluation of empathy for pain**

Pain is a subjective term, and individuals mostly use this term through their previous experience related to the injury. When a person receives cues that another person is in pain, neural pain networks within the brain are activated, and one observing another's pain experience embodied empathic reactions such as distress. Several cues can communicate pain to another person: visualisation of the injury causing event, the injury itself, the injured's behavioral efforts to avoid further harm, and displays of pain and distress such as facial expressions, crying, and screaming [23]. To standardise and measure the empathic responses "*Empathy for Pain Scale (EPS)*" has been developed [24]. In this questionnaire, four painful scenarios are using 12 identical items rated on a scale ranging from 1 to 5 points (1 = strongly disagree; 5 = strongly agree. The scenarios are: (1) a person undergoing a surgical procedure (e.g., on the television hospital drama); (2) a person who

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**Figure 1.**

*studies.*

*Empathy for Pain*

*DOI: http://dx.doi.org/10.5772/intechopen.95276*

point of view of others.

for unfortunate others.

unease intense interpersonal settings.

**3. Neural network for pain empathy**

"Describes me very well" [25]. The four subscales are:

has a surgical procedure (e.g., with stitches or bandaged amputation stump); (3) a person who is accidentally injured (e.g., in a car accident); and (4) a person who is physically assaulted. The 12 response items are distress, discomfort, disgust, fear, restlessness, sense of compassion, sense of what it feels like, a need to get help, a desire to look away, non-painful sensations, painful sensations and visceral sensations (e.g., nausea). *Interpersonal Reaction Index (IRI)* is also used as a measurement tool for evaluating empathic reactions. The tool is self-report comprising 28-items answered on a 5-point Likert scale ranging from "Does not describe me well" to

1.*Perspective Taking* – the tendency to spontaneously adopt the psychological

2.*Fantasy* – taps respondents' tendencies to transpose themselves imaginatively into the feelings and actions of fictitious characters in books, movies, and plays.

3.*Empathic concern* – assesses "other-oriented" feelings of sympathy and concern

4.*Personal distress* – measures "self-oriented" feelings of personal anxiety and

With the improvements in functional brain neuroimaging, most studies have focused on activity patterns and neural networks of empathy for pain [6, 26–28].

*(A) Mid-cingulate cortex (MMC) and (B) anterior insula (AI) are most impressed areas in empathy for pain* 

## *Empathy for Pain DOI: http://dx.doi.org/10.5772/intechopen.95276*

*Pain Management - Practices, Novel Therapies and Bioactives*

als are less responsive to their pain and others [18, 19].

Pain Scale in pain compared with men [20].

professional identity [10].

other people's emotions) [22].

**2. Evaluation of empathy for pain**

Additionally, personal identity was positively correlated with empathy in nurses, doctors, and teachers. Studies have shown successful teaching requires the link between cognitive and affective empathy [9]. Empathy promotes students' academic achievement and teachers' professional growth [10, 11]. Empathy was negatively correlated with a burnout in the nursing profession [12]. Furthermore, a 10-week empathy training experiment in nurses showed significantly improved

As summed above pain empathy is influenced by several factors, such as personal identity [13, 14], gender [15], attention [15, 16], prosocial characteristics, and attitude [17]. Besides these, some neuropsychiatric disorders such as schizophrenia, psychopathy, and autism may lead to impaired empathic reactions. These individu-

Sex differences are another affecting factor in empathy for pain. Women reported more significant empathic concern and affective distress via Empathy for

process between cognition, distinction and affective state of the person.

Regarding contextual influences in daily life, developing a sense of knowing another person's experience in pain has been affected by several factors, such as observer's learning experiences, shared knowledge, and observed person's pain expressions, etc. All elements contribute to more or less person's affective responses as well as behavioural responses. So, a person's reaction to what they see is not identical. Although there are different mentions on the core components of empathy, there is a consensus in the literature that empathy takes a multiple and interacting

This pain empathy process occurs from observing the pain because of his/her sense of knowing of the other's personal experience and his/her affective response to this. In this context, empathy has divided into the three-part: firstly, cognitive/ evaluative part is similar to mentalising and theory of mind, ability to identify, and understand other people's emotion [21]. Second, the distinction is distinguishing of self pain from someone else's pain. The last part is pointing that sharing of the other person's affective state (which refers to the catching and automatic mimicking of

Successful internal balancing of empathy parts provides increased intimacy and closeness to other's emotions. So, a mother may sense a child's pain, understand the child's feelings and may kiss the wound. In an unsuccessful situation for differentiating cognitive and affective part in empathy may cause to observer's distress and burnout [8]. Finally, it would be sensible to assume that successful regulating our own emotions provide reliably use them to assess the content and sense of others' feelings correctly.

Pain is a subjective term, and individuals mostly use this term through their previous experience related to the injury. When a person receives cues that another person is in pain, neural pain networks within the brain are activated, and one observing another's pain experience embodied empathic reactions such as distress. Several cues can communicate pain to another person: visualisation of the injury causing event, the injury itself, the injured's behavioral efforts to avoid further harm, and displays of pain and distress such as facial expressions, crying, and screaming [23]. To standardise and measure the empathic responses "*Empathy for Pain Scale (EPS)*" has been developed [24]. In this questionnaire, four painful scenarios are using 12 identical items rated on a scale ranging from 1 to 5 points (1 = strongly disagree; 5 = strongly agree. The scenarios are: (1) a person undergoing a surgical procedure (e.g., on the television hospital drama); (2) a person who

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has a surgical procedure (e.g., with stitches or bandaged amputation stump); (3) a person who is accidentally injured (e.g., in a car accident); and (4) a person who is physically assaulted. The 12 response items are distress, discomfort, disgust, fear, restlessness, sense of compassion, sense of what it feels like, a need to get help, a desire to look away, non-painful sensations, painful sensations and visceral sensations (e.g., nausea). *Interpersonal Reaction Index (IRI)* is also used as a measurement tool for evaluating empathic reactions. The tool is self-report comprising 28-items answered on a 5-point Likert scale ranging from "Does not describe me well" to "Describes me very well" [25]. The four subscales are:

