Neural mechanisms of physical and social pain empathy: an activation likelihood estimation meta-analysis of fMRI studies

Abstract This study employed a systematic meta-analysis to elucidate neural representation differences between empathy for physical and social pain. Addressing the critical unresolved question of neurofunctional similarities and distinctions between these two empathy types, we performed an activation likelihood estimation coordinate-based meta-analysis, quantitatively synthesizing 35 functional MRI studies. Key findings revealed the following: (i) Physical pain empathy demonstrated significant left-lateralized activation patterns involving core regions of the mirror neuron system—including emotional resonance (anterior cingulate cortex, prefrontal cortex), affective-cognitive integration (anterior insula), and action comprehension (inferior frontal gyrus, inferior parietal lobule); (ii) social pain empathy selectively activated the mentalizing network (dorsomedial prefrontal cortex/medial prefrontal cortex); (iii) differential analyses identified the inferior parietal lobule, anterior cingulate cortex, and superior frontal gyrus as core discriminative regions, with no shared activated brain areas detected. These findings provide large-scale evidence supporting functional segregation in neural substrates between empathy subtypes, offering critical neuroimaging evidence for multidimensional models of empathy.