How Does Empathy Feel Like on Opioids?

When prescription opioids are used over a longer period for medical or non-medical purposes, it can have consequences on brain and behavior. Sara Kroll and Boris Quednow from the Psychiatric Hospital of the University of Zurich wanted to know what long-term opioid use does specifically to our empathy skills.

Observing others in pain elicits a strong autonomic arousal and even activates similar or even equivalent neural structures as those underpinning the observer’s own experience of pain. Affective neuroscience models suggest that this is the neural basis for empathy. A long-term use of opioids is commonly accompanied by deficits in social functioning but only little is known about the impact on specific social cognitive functions such as empathy. Given opioids’ high potential of pain relief, we expected decreased empathy for pain in individuals with chronic opioid use compared to healthy controls.
We tested this hypothesis by measuring subjective and psychophysiological response, e.g. heart rate variability and skin conductance responses, during an empathy-for-pain task in individuals with chronic non-medical prescription opioid use and compared them with opioid-naïve controls. Participants watched video clips of individuals showing a painful facial expression upon load noises. And indeed, we found significantly lower subjective levels of sharing the pain and even identifying the subjects’ pain as compared to healthy controls. Within the opioid users, difficulties in sharing the feeling of the others pain was associated with higher heart rate variability, which is a biomarker for emotion regulation. This indicates that stronger emotion regulation might have down-regulating effects on sharing others’ pain in chronic opioid users but not in healthy controls. Our findings strengthen the assumption that the experience of pain and empathy for pain might rely on similar opioidergic processes in the brain. Moreover, they also suggest empathy trainings including adequate self-regulation strategies as a promising therapeutic target for individuals with chronic opioid use such as chronic pain patients and opioid dependent individuals in order to prevent opioid dependence and relapse, respectively.

By: Sara Kroll & Boris Quednow, Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich.

Reference: Kroll, S. L., Thayer, J. F., Williams, D. P., Pfabigan, D. M., Baumgartner, M. R., Lamm, C. and Quednow, B. B., 2021. Chronic non-medical prescription opioid use and empathy for pain: Does pain make the difference? Psychophysiology 58, e13776. Article.