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Physicians actually feel patients' pain, reports new study

Robin Wulffson MD's picture
pain, empathy, caring physician, placebo effect

When a patient is receiving treatment from a physician, particularly for a serious problem such as cancer, they have the expectation that the healthcare will be empathetic and actually care. However, not uncommonly, the patient comes away with the feeling that the physician does not feel his or her pain to any degree. A new study has found that when a physician treats a patient suffering from physical and/or emotional pain, the doctor actually feels the patient’s pain.

The findings were published online on January 29 by an international team of researchers in the journal Molecular Psychiatry.

The researchers noted that patient–physician interactions significantly contribute to placebo effects and clinical outcomes, meaning that if a patient feels that the physician is empathetic, it actually improves their chance of a good outcome. The placebo effect is the concept that if a patient has the expectation that a medication or treatment is beneficial, he or she will actually derive a benefit from it. For example, if a patient takes a pain pill that contains no active ingredients, pain relief can occur if he or she has confidence in the medication and/or the physician who prescribed it. The authors noted that neurological studies have been conducted on patients undergoing treatment; however, the neurobiology of the healthcare provider during treatment is unknown. Therefore, they conducted a study to investigate physicians’ brain activations during patient–physician interaction while the patient was experiencing pain, including a ‘treatment‘, ‘no-treatment’ and ‘control’ condition.

The investigators performed brain scans on physicians while they believed they were treating patients. Analysis of the scans revealed that doctors put themselves in their patients’ shoes––their brains actually felt the pain that their patients felt. Past research has found that certain areas of the brain are activated when an individual experiences the placebo effect. During this response, when a patient experiences pain relief, his or her right ventrolateral prefrontal cortex (VLPFC) is activated, and when he or she experiences reward, the rostral anterior cingulate cortex (rACC) activates. The researchers conducted an extensive social and medical experiment; they tested this effect on group of 18 physicians from different medical specialties who had all received their degrees within the past decade. They developed a unique setting in which the doctors would undergo functional magnetic resonance imaging (fMRI) on their brains as they interacted and observed patients.

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The first phase of the experiment involved conducting neuro-imaging of the doctors’ brains while they experienced pain first hand. The investigators introduced them to a pain-relieving electronic device, which was actually a “sham” machine, which simply administered “heat pain.” To make the physicians believe that the device truly worked, they used the machine to administer the heat pain and then “treated” them with the machine to simulate pain relief; in reality they simply reduced the heat stimulation. Once the physicians’ fMRI scans were finished, each was introduced to a patient and was asked to conduct a standardized clinical examination. This process essentially imitated a standard doctor’s appointment and helped the patient and physician to establish a relationship.

Subsequently, each physician-patient-patient pair was asked to enter a scanner room, where the patient was hooked up to the sham pain-relieving device from the earlier stage of the experiment. While connected to an fMRI, the doctors were given remote controls, which could either administer pain to their patient or relieve them of it. In reality, the patients, who were actually confederates of the research team, would grimace in order to pretend he or she was experiencing discomfort and then relax to simulate relief. Through the use of mirrors, the physicians were able to see their patients’ faces as they believed the device administered pain or relieved it. The investigators found that when the patient appeared to be in in pain, the doctor’s brain activated the regions that they had earlier imaged in the physician of their pain networks. This revealed that when the patient was in pain, the physician felt pain; thus, they shared the pain. As was noted in the first phase of the experiment, the physicians activated the right VLPFC region when they believed they were treating their patients.

The researchers note that this is the first experiment of its kind to show a physical foundation to the doctor-patient relationship. They hope that their findings can provide the medical community with clues as to how they can better match doctors and patients.

Reference: Molecular Psychiatry

See also: Does bedside manner make a difference in patient outcome?