Distinct roles of the 'shared pain' and 'theory of mind' networks in processing others' emotional suffering

The brain mechanisms involved in processing another's physical pain have been extensively studied in recent years. The link between understanding others' physical pain and emotional suffering is less well understood. Using whole brain analysis and two separate functional localizers, we characterized the neural response profiles of narrative scenarios involving physical pain (PP), and scenarios involving emotional pain (EP) with functional magnetic resonance imaging (fMRI). Whole brain analyses revealed that PP narratives activated the Shared Pain network, and that the brain regions responsible for processing EP overlapped substantially with brain regions involved in Theory of Mind. Region of interest (ROI) analysis provided a finer-grained view. Some regions responded to stories involving physical states, regardless of painful content (secondary sensory regions), some selectively responded to both emotionally and physically painful events (bilateral anterior thalamus and anterior middle cingulate cortex), one brain region responded selectively to physical pain (left insula), and one brain region responded selectively to emotional pain (dorsomedial prefrontal cortex). These results replicated in two groups of participants given different explicit tasks. Together, these results clarify the distinct roles of multiple brain regions in responding to others who are in physical or emotional pain.