Pain modality shapes empathy: Amplified empathic responses for visceral compared to somatic pain

Visceral pain, an evolutionarily prepared signal of interoceptive threat, is highly prevalent in clinical populations yet remains underexplored in empathy research. While empathy for pain is central to social behavior, little is known about how different pain modalities, particularly visceral versus somatic pain, shape empathic responses. In this experimental study involving healthy adults, validated multiple-threat pain conditioning was combined with a novel, ecologically valid paradigm incorporating first-hand pain experience, perspective-taking (self, loved one, stranger), and memory assessments. Participants performed a trait empathy task (study day 1), received intensity-matched visceral and somatic stimuli (study day 2), accomplished an imagination-based empathy task (study day 3) and a delayed empathic recall session (study day 4). Visceral pain consistently elicited higher ratings of intensity, unpleasantness, empathic concern, and personal distress than somatic pain, during both direct experience and imagination. This effect was strongest when adopting the loved one's perspective and persisted in the absence of noxious stimulation. Empathic responses for the loved one exceeded those for both the self and the stranger, suggesting that relational closeness amplifies affective and evaluative dimensions of empathy. Moreover, individual differences in trait emotional empathy selectively predicted empathic concern and personal distress for visceral pain in the loved one's perspective, indicating a modality- and relationship-specific pattern. These findings show that empathy for pain is shaped by both pain modality and social context. The heightened salience of visceral pain may differentially influence empathic engagement, with implications for understanding interpersonal dynamics and improving care in patients with chronic visceral pain. PERSPECTIVE: This study explores how visceral and somatic pain influence empathic responses, both during first-hand experience and when imagining pain, revealing that visceral pain elicits stronger empathy, particularly for loved ones. These findings highlight the interplay between pain modality and social factors in shaping empathy, offering insights for chronic pain care.