The next time a doctor says they feel your pain, it may be more than just a figure of speech.
In a novel investigation in which physicians were given brain scans as they thought they were treating patients, researchers at Massachusetts General Hospital and Harvard Medical School say they now have scientific evidence showing that doctors really do feel their patient’s pain – and can also feel their relief after treatment. The study was published in the journal Molecular Psychiatry.
“Our findings showed that the same brain regions that have previously been shown to be activated when patients receive placebo therapies are similarly activated in the brains of doctors when they administer what they think are effective treatments,” said lead author Karin Jensen, PhD, an investigator in the Department of Psychiatry at Massachusetts General Hospital.
She added that the brain scans showed that doctors who empathized with their patients’ feelings also experienced higher satisfaction during patients’ treatments.
While some behavioral research has suggested that physicians influence patient outcomes, Jensen said that there has been little effort directed at understanding the biology underlying the physician component of the clinical relationship.
Hoping to change that, Jensen and her colleagues developed unique equipment that would allow them to conduct magnetic resonance imaging (MRI) of the physicians’ brains while they had face-to-face interactions with patients, including observing patients as they underwent pain treatments.
The 18 doctors involved in the study were asked to administer pain relief with what they thought was a pain-relieving electronic device, which was actually a non-active “sham” device. Two 25-year-old females played the role of “patients” and followed a rehearsed script.
In order to convince the doctors that the device worked, investigators administered a dose of “heat pain” on the doctors’ arms to gauge pain threshold and then “treated” them with the fake machine, reducing the heat stimulation to show that the therapy worked.
The physicians underwent MRI scans during the heat stimulation so researchers could see exactly which brain regions were activated during first-person perception of pain.
During the next portion of the study, each doctor was introduced to a patient and asked to perform a standardized clinical exam in order to establish a rapport with the patient before MRI scanning. Doctors also answered a questionnaire to measure their self-reported perspective-taking skills.
After being led into a scanning room, the doctor was equipped with a remote control that could activate the fake analgesic device when prompted. Mirrors inside the scanner allowed doctors, who were seated on a chair next to the scanner’s bed, to maintain eye contact with the patient. They were then hooked up to both the thermal pain stimulator and the pain-relieving device.
The physicians were then instructed to either treat a patient’s pain or to press a control button that provided no relief.
When doctors were told not to activate pain relief, the patient exhibited a painful facial expression as the physicians watched. When instructed to treat the patients’ pain, doctors could see that the subjects’ faces were neutral and relaxed — the result of pain relief.
It was during these doctor-patient interactions that MRI scans measured the doctors’ brain activity. While treating patients, the physicians activated the region of the brain previously implicated in the placebo response.
Additionally, researchers found that a doctor’s ability to empathize with their patients’ corresponded to both brain activations and subjective ratings. Those who reported high perspective-taking skills were more likely to show activation in the region of the brain associated with reward.
“We already know that the physician-patient relationship provides solace and can even relieve many symptoms,” said senior author Ted Kaptchuk, director of the Program in Placebo Studies and Therapeutic Encounter, and Associate Professor of Medicine at Harvard Medical School.
“Now, for the first time, we’ve shown that caring for patients encompasses a unique neurobiology in physicians,” said Kaptchuk. “Our findings provide early evidence of the importance of interacting brain networks between patients and caregivers and acknowledge the doctor/patient relationship as a valued component of health care, alongside medications and procedures.”
“Our ultimate goal is to transform the ‘art of medicine’ into the ‘science of care,’ and this research is an important first step in this process as we continue investigations to find out how patient-clinician interactions can lead to measurable clinical outcomes in patients.”