Emotional contagion and cognitive empathy regulate the effect of depressive symptoms on empathy-related brain functional connectivity in patients with chronic back pain.

ABSTRACT

BACKGROUND: Chronic pain and depression share common neural mechanisms, but their impacts on empathy are different. It is unclear how comorbid depressive symptoms affect empathy-related brain function in patients with chronic pain. METHODS: A total of 29 healthy participants and 107 patients with chronic back pain (CBP) were included in this study. All subjects underwent a functional MRI scan with concurrent empathic stimulation. Multiple linear regression, moderation analysis, and mediation analysis were used to explore the impacts of chronic pain and comorbid depression on empathy. RESULTS: The interaction between the pain intensity and the depressive symptoms affected the functional connectivity (FC) of the insula-middle frontal gyrus (MFG), and the severity of the self-rating depression scale (SDS) scores moderated the effect of the pain on the left insula-left MFG FC. Within the CBP group, the emotional contagion (EC) scores served as a mediator in the association between the SDS scores and the FC of the left middle cingulate cortex (MCC)-inferior temporal gyrus (ITG), and the level of cognitive empathy (CE) moderated the effect of the SDS scores on the left MCC-ITG FC. LIMITATIONS: There is a lack of research on the effects of depressive symptoms on empathy in individuals with different types of chronic pain. CONCLUSION: Depressive symptoms were strongly associated with the emotional contagion in patients with chronic back pain. Furthermore, the emotional contagion and the cognitive empathy regulated the effect of the comorbid depressive symptoms on the MCC-ITG connectivity in patients with chronic back pain.