I can feel your pain so clearly that it makes me trigger my defence mechanisms!

We are very pleased to be hosting Prof Serge Marchand for PainAdelaide 2016. His team recently published an interesting paper and we thought it was a great opportunity for us, and for all those coming to PainAdelaide or subscribing to PainAdelaide at your place (click here to buy a pass), to get a quick window into his work.


The mere observation of someone getting hurt can make us grimace as if we were experiencing the painful situation ourselves. In fact, cortically we are! Brain imaging studies demonstrated that the empathetic observation of someone in pain, especially a loved-one, is triggering brain activity in pain-related structures in the observer [2].

We also know that a painful stimulus can trigger endogenous pain inhibition. If our empathic observation of a painful situation can activate the pain matrix in our brain, can it recruit endogenous pain inhibition as if it was a first person pain experience? That’s what we decided to test [1]. We found that endogenous pain analgesia can be activated by the mere observation of a video of ourselves or of our spouse in pain (immersion of the arm in cold water).

One can speculate that we have «empathetic endogenous pain modulation» as a defence mechanism from a potentially nociceptive environment. It could also prepare us to help the person in need without having to worry about nociceptive stimuli while helping.

Several questions remain. What about strangers’ pain, would we still trigger endogenous pain inhibition? We have some preliminary results supporting that observing strangers in pain can also indeed trigger endogenous pain inhibition. However, the magnitude of inhibition is not at all comparable to the one triggered by the observation of a loved-one in pain. It reinforces the implication of factors affecting empathetic pain observation such as proximity with the person in pain.

We just finished collecting the data doing the same task with women suffering from provoked vestibulodynia (PVD).  Interestingly, in these women, looking at videos of women in pain (cold pressor test) triggered hyperalgesia rather than analgesia, while the videos of men doing the same task had either no effect or an analgesic effect. As expected, adding a neutral video such as someone reading a book did not trigger pain inhibition.

We can speculate that, since PVD is specific to women, looking at another woman in pain triggers empathetic pain facilitation rather than an analgesic response, while this response was not triggered when observing men since it is implausible for men to suffer from PVD.  It would be interesting to see what would happen for pain conditions that are more prevalent in men or present in both men and women.


* at the time of publication, there was a 5 hour window to get PainAdelaide at your place! via Chuffed.org for $75. If you miss it, we will make it available for $90 right up until the meeting. Keep an eye on this page for the link.

About Serge Marchand

Serge Marchand Sherbrooke University hospital Dr Serge Marchand, is the Director of the centre de recherche clinique Étienne-Le Bel of the Sherbrooke University hospital (CRCELB-CHUS). He received his PhD in Neuroscience from Université de Montréal in 1992 and then completed his post-doctoral training in neuroanatomy at the University of California in 1994.  He is the author of several articles and book chapters in the field of pain mechanisms and treatment.  His research is characterized by a close link between fundamental and clinical projects on the neurophysiological mechanisms implicated in the development and persistency of chronic pain.

About Véronique Gougeon

Veronique GougeonVeronique completed her bachelor degree in psychology graduating with honors at the Université du Québec en Outaouais. After this she joined Dr Serge Marchand’s laboratory to do a Masters in Clinical Sciences studying the empathic observation of pain. She is continuing her research on empathy for her doctorate, focussing on exploring the characteristic of the observer.



[1] Gougeon V, et al. Triggering Descending Pain Inhibition by Observing Ourselves or a Loved-One in Pain. Clinical Journal of Pain 2016;32(3):238-245.

[2] 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;24(3):771-779.

Chief Editor: Lorimer Moseley.  Associate Editor: Hopin Lee


  1. Harvard Medical School’s PiPS has a new offshoot which will be of interest to many here. Called SIPS.


  2. John Quintner, Rheumatologist says

    At the risk of appearing to be pedantic (which I have indeed become in my dotage), surely “painful stimulus” is a misnomer and should be replaced by “nociceptive stimulus” and “pain matrix” by “pain-associated neural networks”.

  3. John Quintner, Rheumatologist says

    Hi EG, thanks for the clarification.

    “The very high empathy/sensitivity/mirroring that some people display is possibly due to damage to the developing sense of self.”

    To me, this statement seems to be more a speculation than an hypothesis.

  4. I’ve often thought that a poorly defined self correlates with a high empathic sensitivity/mirroring. The mirroring becomes a way for the child whose will has been broken (ill-defined self) to very accurately assess the mood of the parent. Knowing this, he can then perform only those behaviours which bring approval. The result is stress/confusion and perhaps pain. Happiness cannot come from others’ approval, after all.

    Many useful refs in this article too.


    John Quintner, Rheumatologist Reply:

    EG, can you please explain exactly what you mean by “a poorly defined self”? This may help me understand the remainder of your comment. Thanks, in anticipation.

    EG Reply:

    Hi John, I didn’t express that so well. I was meaning to describe a situation of reduced worthiness/value in the self-image. If such a situation develops in a child, he may develop a very keen awareness of what others are thinking/feeling about him. This awareness will then be used to mold his behaviour to do only that which pleases others. He becomes other-focussed, forever seeking approval and avoiding disapproval.

    So linking it back to this research…

    The very high empathy/sensitivity/mirroring that some people display is possibly due to damage to the developing sense of self. A hypothesis.

  5. There are a number of studies (some from Rainville’s group and some from Garcia-larrea’s) showing that observation of pain in others may increase pain perception and may facilitates the spinal processing of nociceptive stimuli. Vachon-Presseau et al., 2011 and Mailhot et al, 2012 suggested that attentional mechanisms may play a role (as they found negative correlation between pain facilitation and dispositional empathy). We tried to test that by using sub-optimal presentation of pain to minimize the effect of the attention and saw that sub-optimal processing of pain still improves pain perception. In this study videos of themselves or their partner may play a role as distracter (which also has suggested to recruit a similar mechanism to descending inhabitation observed in DNIC). It will be interesting to compare these effects together.

    Serge Marchand Reply:

    I agree that distraction is always an important aspect that we need to control when looking for any form of pain modulation mechanisms. In the second study that we just finished we used a «control video», watching the same people that have done the immersion task, but this time reading a book. It seems that this situation is not triggering inhibition. However, one could always argue that the task is less distracting!

  6. Thanks for this. Pain is not just an individual experience.

    Expertise in therapy amounts to opening oneself up to feel another’s pain but without becoming emotionally affected. The only possible way to do this is through Presence. In Presence, the self-referential neural circuitry goes quiet, allowing full mirroring without aversion.

    Serge Reply:

    I really like this difference between empathy and presence.
    If overtime we see someone in pain we are triggering our defence mechanisms (and DNIC), we could easily fatigue these mechanisms and be at risk in face of an injury.
    I’m sure we can test that in the lab 😉
    Let’s discuss that in Adelaide !