Emotional contagion of pain across different social cues shares common and process-specific neural representations

Insular and anterior cingulate cortex activation across vicarious pain induction procedures suggests that they are core pain empathy nodes. However, pain empathic responses encompass emotional contagion as well as unspecific arousal and overlapping functional activations are not sufficient to determine shared and process-specific neural representations. We employed multivariate pattern analyses to fMRI data acquired during physical and affective vicarious pain induction and found spatially and functionally similar cross-modality (physical versus affective) whole-brain vicarious pain-predictive patterns. Further analyses consistently identified shared neural representations in the bilateral mid-insula. Mid-insula vicarious pain patterns were not sensitive to capture non-painful arousing negative stimuli but predicted self-experienced pain during thermal stimulation, suggesting process-specific representation of emotional contagion for pain. Finally, a domain-general vicarious pain pattern which predicted vicarious as well as self-experienced pain was developed. Our findings demonstrate a generalizable neural expression of vicarious pain and suggest that the mid-insula encodes emotional contagion for pain.