Pain features centrally in numerous illnesses and generates enormous public health costs. Despite its ubiquity, the psychological and neurophysiological nature of pain remains controversial. Here, we survey one controversy in particular: the relation between nociceptive pain, which is somatic in origin, and empathic pain, which arises from observing others in pain. First, we review evidence for neural overlap between nociceptive and empathic pain and what this overlap implies about underlying mental representations. Then, we propose a framework for understanding the nature of the psychological and neurophysiological correspondence across these types of ‘pain’. This framework suggests new directions for research that can better identify shared and dissociable representations underlying different types of distress, and can inform theories about the nature of pain.