Can Doctors Feel Their Patients’ Pain?

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A study shows physicians may care more than you think about their patients’ pain.In spite of studies showing that the relationship between a doctor and patient can influence healing, the interaction isn’t known for its expressions of outward empathy. But a new study takes a closer look at the biology of the exchange and found some revealing surprises.

Using brain scans, researchers from Massachusetts General Hospital (MGH) and the Program in Placebo Studies and Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center/Harvard Medical School showed that that when doctors believe they are treating patients, they can feel their pain and also empathize with their patients’ relief after the treatment.

In the study, published in the journal Molecular Psychiatry, 18 doctors simulated treating a patient while in a functional MRI (fMRI) scan. They used what they believed to be an electric pain-relieving device on two female actors pretending to be patients.

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To convince the doctors that they were relieving the patients’ pain, the study authors gave each doctor a dose of “heat pain” to their forearms and then simply reduced the amount of heat when they touched them with the fake pain relieving device, therefore simulating treatment. While they were being tested, the researchers scanned the doctors’ brains to see which regions reacted to the heat pain stimulation.

Each doctor was then introduced to one of the patients, and performed a standard clinical examination. The doctor and patient then moved into a room with the scanner where the doctors were provided with a remote control that could activate the pain relief device. The room contained mirrors so the doctor could maintain eye contact with the patient, who was hooked up to both the heat pain stimulator and the pain relief device.

The doctors, who were in the fMRI machine, were then instructed to either treat the patient’s pain or press a control button that provided no relief. The doctors watched the facial reactions of their patients as they “felt” pain and when they felt relief. Throughout the experiment, the researchers image the brains of the physicians.

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The researchers focused on two parts of the brain connected to pain perception: the right ventrolateral prefrontal cortex (VLPFC) and the rostral anterior cingulate cortex (rACC). The VLPFC region is associated with pain relief and the rACC region is associated with reward. Both regions generally become more active when patients undergo placebo therapies, or think they are receiving benefit of some kind. The researchers found that these same areas were activated in the doctors’ brains when they thought they were providing effective treatment.

That’s in line with previous research on the placebo effect, which shows that belief in an effect can activate brain responses. The results are the first, however, to implicate the placebo effect in physicians who connect with their patients, and may provide new insight into the biology of caregiving. “This is a scientific-centric medical system. Unfortunately it is not as human-centered as we want it,” says senior author Ted Kaptchuk,  associate professor of medicine at Harvard Medical School and director of the PiPS at Beth Israel Deaconess Medical Center in Boston. “One of the things we are seeing is that these intangibles that we call ‘the art of medicine’ are just as tangible and important as the tricks in the black bag.”

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The study is reassuring in that way, since it potentially provides a foundation on which physicians can build a more understanding relationship with their patients, which will ultimately make them better physicians.

It may even be possible, says Kaptchuk, to find a biological model for high quality care. He hopes to repeat the study and take simultaneous brain scans of both patients and their doctors. “We are actually in a position that at some point, maybe we can measure the provision of care between a physician and patient,” he says. “That will allow us to actually model and develop and actually educate optimal provision of care. This is a study that has potential in those directions. We see this an a really interesting first step. It certainly doesn’t answer all the questions, but it’s a first step that no one has ever taken before.” And one for which patients are grateful.