Image-based responses to pain-related and neutral stimuli among women with and without chronic pain: pain appraisal, self-oriented discomfort, and willingness to help

Empathy is a multidimensional interpersonal process that cannot be inferred from a single rating. Estimating another person’s pain, experiencing discomfort while viewing a potentially painful event, and reporting willingness to help may be relevant to empathic responding, but they represent distinguishable processes. Evidence regarding responses to others’ pain among people with chronic pain remains mixed. This study compared image-based pain appraisal, self-oriented discomfort, and reported willingness to help among women with and without chronic pain. The study included 136 women, 76 with chronic pain and 60 control participants without chronic pain. Participants viewed six pain-related and two neutral bodily images and rated the inferred pain intensity of the depicted person, their own discomfort, and their willingness to help. Group differences were examined separately for each rating and stimulus type. All reported t tests were interpreted as two-sided. The groups did not differ significantly on any rating for pain-related stimuli. For neutral stimuli, women with chronic pain reported higher pain-appraisal ratings than controls (M = 1.30, SD = 1.71 vs. M = 0.73, SD = 0.96), t(134) = -2.27, p = .025, d = 0.39, and greater reported willingness to help (M = 1.66, SD = 1.93 vs. M = 0.81, SD = 1.19), t(134) = -2.89, p = .004, d = 0.50. The difference in self-oriented discomfort did not reach statistical significance, t(134) = -1.88, p = .062, d = 0.33. The findings suggest group differences in the appraisal of neutral or ambiguous bodily cues rather than evidence of globally heightened empathy. Interpretation is limited by the small, imbalanced, and unmatched stimulus set, the potentially first-person perspective, the absence of facial information, and the lack of criterion ratings from the depicted individuals.