Recent research has highlighted the indispensability of traditional molecular biology and imaging techniques in pain research. However, the mechanisms underlying pain empathy remain unclear. Consequently, a deeper understanding of these mechanisms would greatly enhance pain management. This article aimed to scrutinize previous research findings on pain empathy, with a particular emphasis on the correlation between empathy for pain and distinct anatomical structures, such as mirror neurons, the anterior cingulate cortex, insular cortex, prefrontal cortex, and amygdala. Additionally, this study explored the involvement of endogenous systems, including oxytocin and the locus coeruleus norepinephrine system, hypothalamic-pituitary-adrenal axis, opioid system, and 5-hydroxylamine signaling. In conclusion, the mechanisms of pain empathy are complex and diverse, and research on pain empathy and target treatment will contribute to pain treatment.