Background & Aims

Chronic pain and major depressive disorder (MDD) are etiologically associated, frequently comorbid, and mutually increase patients’ severity and disability [1,2,3]. Despite this well-established association, to our knowledge, no studies have investigated psychological phenomena potentially differentiating both conditions. Our study addresses this gap by examining differences in empathy for pain, defined as the emotional response when imagining a loved one experiencing pain [4]. Fibromyalgia (FM), a paradigmatic nociplastic chronic pain condition, has vulnerability factors to experience heightened empathy for pain such as a history of chronic pain, hypervigilance for pain, and increased dispositional personal distress and empathic care [5,6]. In contrast, MDD, often associated with a blunted affect [7], may exhibit comparatively diminished empathy for pain.

Methods

Our sample comprised 37 women with FM (48.15±11.05 years), 18 women with MDD (48.37±10.96 years), and 39 healthy women (46.44±16.16 years). There were no significant differences in age, education level, or income among the groups (p’s>0.3). Participants engaged in an empathy for pain task, viewing images of hands and feet in painful situations [8]. During each image presentation, participants were instructed to imagine the injury happening to a loved one. They rated the unpleasantness of imagining their loved one experiencing the pain using a visual analog scale ranging from 0 to 10. We computed a repeated measures ANOVA model in R software to assess differences between groups across multiple trials. Subsequently, we employed post-hoc Tukey’s t-tests to identify specific group differences in cases where the ANOVA yielded significant results.

Results

The repeated measures ANOVA revealed a significant overall effect (F = 3.96, p = 0.022) among the three groups. Post-hoc t-tests showed that FM patients exhibited significantly higher pain empathy ratings compared to both MDD patients (mean (SD) FM = 7.49 (1.71), mean (SD) MDD = 6.08 (1.89); t = 6.8, p < 0.001) and healthy controls (mean (SD) FM = 7.49 (1.71), mean (SD) HC = 6.53 (2.37); t = 5.6, p < 0.001). Additionally, individuals with MDD had slightly lower pain empathy ratings compared to healthy controls (mean (SD) MDD = 6.08 (1.89), mean (SD) HC = 6.53 (2.37); t = -2.01, p = 0.045).

Conclusions

Our study shows that empathy for pain may serve as a key psychological differentiator between fibromyalgia and depression. In agreement with our hypotheses, empathy for pain was heightened in women with FM, whereas it was reduced in women with MDD. This finding underscores the need for a nuanced understanding of emotional experiences in these conditions beyond the primary affective symptoms and considering how they impact interpersonal dynamics and well-being.

References

1. Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011;12(9):964-973. doi:10.1016/j.jpain.2011.03.003

2. Baumeister H, Knecht A, Hutter N. Direct and indirect costs in persons with chronic back pain and comorbid mental disorders–a systematic review. J Psychosom Res. 2012;73(2):79-85. doi:10.1016/j.jpsychores.2012.05.008

3. Gracely RH, Ceko M, Bushnell MC. Fibromyalgia and depression. Pain Res Treat. 2012;2012:486590. doi:10.1155/2012/486590

4. Fallon N, Roberts C, Stancak A. Shared and distinct functional networks for empathy and pain processing: a systematic review and meta-analysis of fMRI studies. Soc Cogn Affect Neurosci. 2020;15(7):709-723. doi:10.1093/scan/nsaa090

5. Fitzgibbon BM, Giummarra MJ, Georgiou-Karistianis N, Enticott PG, Bradshaw JL. Shared pain: from empathy to synaesthesia. Neurosci Biobehav Rev. 2010;34(4):500-512. doi:10.1016/j.neubiorev.2009.10.007

6. Üçeyler N, Zeller J, Kewenig S, Kittel-Schneider S, Fallgatter AJ, Sommer C. Increased cortical activation upon painful stimulation in fibromyalgia syndrome. BMC Neurol. 2015 Oct 20;15:210. doi: 10.1186/s12883-015-0472-4.

7. Loas G, Salinas E, Pierson A, Guelfi JD, Samuel-Lajeunesse B. Anhedonia and blunted affect in major depressive disorder. Compr Psychiatry. 1994;35(5):366-372. doi:10.1016/0010-440x(94)90277-1

8. Jackson PL, Meltzoff AN, Decety J. How do we perceive the pain of others? A window into the neural processes involved in empathy. Neuroimage. 2005 Feb 1;24(3):771-9. doi: 10.1016/j.neuroimage.2004.09.006.

Presenting Author

Maria Suñol

Poster Authors

Maria Suñol, PhD

PhD

University of Barcelona

Lead Author

E-mail

Saül Pascual-Diaz

PhD

University of Barcelona

Lead Author

E-mail

Lucia Blanc

BSc

University of Barcelona

Lead Author

E-mail

Ana Arias

BSc

Hospital Clinic de Barcelona

Lead Author

E-mail

Tamara Rodríguez

MD

Hospital Clinic de Barcelona

Lead Author

E-mail

Xavier Torres

PhD

Hospital Clinic de Barcelona

Lead Author

E-mail

Myriam Cavero

MD

Hospital Clinic de Barcelona

Lead Author

E-mail

Marc Valentí

MD

Hospital Clinic de Barcelona

Lead Author

E-mail

Luciano Polino

MD

Hospital Clinic de Barcelona

Lead Author

E-mail

Marina López-Sola

Phd

University of Barcelona

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial