The Role of Cingulate Cortex in Vicarious Pain

Table 1

Overview of studies.

(a) Affective Processing

Author and date	Stimuli	Task	Activation	Findings
Facial expressions
Botvinick et al. (2005) [29]	Videos of faces in pain or no pain and self-pain or no pain.	No rating.	ACC	ACC activation during self- and vicarious pain in facial expressions.
Budell et al. (2010) [21]	Videos of facial expressions of pain.	Rate pain experience on VAS.	sgACC; rACC; aMCC	ACC and aMCC activation during vicarious pain is more anterior than for previous findings in self-pain. Pain ratings correlated with sgACC activity.
Lamm et al. (2010) [39]	Images of hands deeply penetrated by needle or touched by Q-tip and facial expressions.	Rate pain intensity on VAS while sharing affect.	ACC; aMCC	Activation during vicarious painful stimulation with nonpainful object and nonpainful stimulation with painful object.; Empathic traits correlate with ACC.; Increased functional connectivity in MCC, aMCC, PAG, and aINS during vicarious pain.
Saarela et al. (2007) [28]	Images of faces of chronic pain patients at resting state of chronic pain or during provoked acute pain.	Rate pain intensity and unpleasantness on Likert scale.	ACC	ACC activation during vicarious pain.
Vachon-Presseau et al. (2012) [8]	Images of hands or feet subjected to pain or no pain and facial expressions of pain.	Rate pain experience on VAS.	aMCC	Activation during vicarious pain in limbs and facial expressions.; Empathic traits correlate with aMCC activation.; Affective-motivations response of vicarious pain is independent of channel of pain.
Limbs in pain
Corradi-Dell'acqua et al. (2011) [2]	Images of hands in pain or no pain.	Rate pain intensity on Likert scale.	MCC	Distinct neural populations involved in affective pain processing, attention, and motor preparation.; Overlapping neural populations for self- and vicarious pain.
Jackson et al. (2006) [10]	Images of hands or feet in pain or no pain.	Rate pain level on VAS from first- or third-person position.	ACC; aMCC	ACC associated with taking first-person position during vicarious pain.; Pain rating correlated with ACC.; aMCC associated with both self- perspective and the perspective of others during vicarious pain.
Jackson et al. (2005)	Images of hands or feet in pain or no pain.	Rate pain level on VAS.	ACC; aMCC	ACC activation during vicarious pain.; No correlation between empathic traits and ACC and self-reported pain sensitivity.
Lamm et al. (2007) [33]	Images of hands deeply penetrated by needles.	Rate sensory or affective qualities of pain on VASs.	sgACC; aMCC	sgACC associated with pain unpleasantness ratings.; aMCC activated during both sensory pain and affective pain focuses on pain.
Morrison and Downing (2007) [22]	Video of needle deeply penetrating hand or self-experienced needle penetrating hand.	Rate pain unpleasantness.	ACC	ACC activity adjacent and overlapping between self-pain and others pain.; ACC associated with pain unpleasantness ratings.
Morrison et al. (2004) [27]	Videos of hands experiencing pin prick or self-experienced pin prick.	Rate pain unpleasantness on Likert scale.	ACC	Activation during vicarious pain and self-pain.
Ochsner et al. (2008) [59]	Videos of individuals subjected to pain or self-experienced heat pain.	No rating.	aMCC	Activation during vicarious and self-pain.; Increased functional connectivity between aMCC, aINS, and mPFC during vicarious pain.
Ogino et al. (2007) [34]	Neutral, fear, and pain images.; Images of limbs in pain.	Imagine observed pain in own body.	aMCC	aMCC activation during vicarious pain and fear images.
Osborn and Derbyshire (2010) [51]	Images or short clips of limbs or full individuals subjected to pain.	Rate pain intensity on VAS.	rACC	rACC activation during vicarious pain in participants who could feel pain in their own body and those that could not.
Zaki et al. (2007) [54]	Videos of individuals subjected to pain or self-experienced heat pain.	No ratings.	ACC	Increased functional connectivity between ACC, aINS, and dmPFC during vicarious pain.; Increased functional connectivity between ACC, STS, PCC, and precuneus during vicarious pain.
Abstract cues
Singer et al. (2004) [30]	Abstract cue that loved one receives electric pain or self-experienced electric pain.	Rate pain unpleasantness.	rACC	rACC correlated with empathy scores.

(b) Attention

Author and date	Stimuli	Task	ACC activations	Findings
Gu and Han (2007) [38]	Images or cartoons of hands in pain or no pain.	Attend to pain cues or count hands in image.	aMCC	Greater functional connectivity to left inferior frontal cortex (top-down regulation) during vicarious pain.; Pain-related activation in aMCC eliminated when attention was withdrawn from pain.
Gu et al. (2010) [35]	Images of limbs in pain or no pain.	Judge if it is painful or not painful and laterality.	aMCC	No difference in activation between painful and nonpainful stimuli or judgment types.; Increased functional connectivity during vicarious pain with visual attention areas and anterior insula.
Fan and Han (2008) [49]	Images or cartoons of hands in pain or no pain.	Attend to pain cues or count hands in image.		Early differentiation between pain and no pain.

(c) Motor preparation

Author and date	Stimuli	Task	ACC activations	Findings
Morrison et al. (2006)	Short animations of a noxious or nonnoxious item, striking or not striking a hand.	Report whether hand in animation was struck or not struck by item via button press.	aMCC; MCC	Increased aMCC activation during vicarious pain and required motor responses.; Link between motor inhibition and MCC activity in caudal cingulate motor zone.