Docs can feel their patients’ pain

Washington, Jan ary 30: In a novel investigation in which physicians underwent brain scans while they believed they were actually treating patients, researchers have provided the first scientific evidence indicating that doctors truly can feel their patients’ pain – and can also experience their relief following treatment.

Led by researchers at Massachusetts General Hospital (MGH) and the Program in Placebo Studies and Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center/Harvard Medical School, the new findings help to illuminate one of the more intangible aspects of health care – the doctor/patient relationship.

“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,” explained first author Karin Jensen, PhD, an investigator in the Department of Psychiatry and Martinos Center for Biomedical Imaging at MGH and member of the PiPS.

Notably, she added, the findings also showed that the physicians who reported greater ability to take things from the patients’ perspective, that is, to empathize with patients’ feelings, experienced higher satisfaction during patients’ treatments, as reflected in the brain scans.

Previous investigations have demonstrated that a brain region associated with pain relief (right ventrolateral prefrontal cortex, VLPFC) and a region associated with reward (rostral anterior cingulate cortex, rACC) are activated when patients experience the placebo effect, which occurs when patients show improvement from treatments that contain no active ingredients. The placebo effect accounts for significant portions of clinical outcomes in many illnesses — including pain, depression and anxiety.

Jensen and her colleagues hypothesized that the same brain regions that are activated during patients’ placebo responses – the VLPFC and rACC — would similarly be activated in the brains of physicians as they treated patients. They also hypothesized that a physician’s perspective-taking skills would influence the outcomes.

To test these hypotheses, the scientists developed a unique equipment arrangement that would enable them to conduct functional magnetic resonance imaging (fMRI) of the physicians’ brains while the doctors had face-to-face interactions with patients, including observing patients as they underwent pain treatments.

As predicted, the researchers found that while treating patients, the physicians activated the right VLPFC region of the brain, a region previously implicated in the placebo response.

Furthermore, Jensen added, the physicians’ ability to take the patients’ viewpoints correlated to brain activations and subjective ratings; physicians who reported high perspective-taking skills were more likely to show activation in the rACC brain region, which is associated with reward.

The results will appear on-line in Molecular Psychiatry. (ANI)