Physician empathy and patient pain

Physician empathy and patient pain

It turns out a doctor’s bedside manner really does matter. A new study reveals that empathy isn’t just a nice-to-have in healthcare, it’s a powerful pain reliever. Researchers using brain imaging technology have found that a caring and supportive clinician can actually reduce a patient’s experience of pain.

The study, published in Proceedings of the National Academy of Sciences of the United States of America, shed light on the power of empathy in pain management.1 Dr. Vitaly Napadow and others used brain imaging to observe the neural activity of chronic pain patients and clinicians during real-time interactions. The results demonstrated a tangible link between empathetic connection and pain reduction.

The study found that patients experienced less pain when interacting with a supportive clinician compared to being alone. Even more, a pre-existing therapeutic alliance, established through prior interaction, amplified this effect. This suggests that building strong patient-clinician relationships can significantly enhance pain management.

What is the healing power of connection? 

To study how empathy influences pain, researchers recruited 23 women with fibromyalgia and 22 acupuncturists. Each participant was paired with two different medical partners whom they interacted with during two separate MRI brain scans while experiencing controlled pain. 

In one scenario, the pair had a prior clinical interaction to establish a therapeutic relationship, while in the other, they had no prior contact. This allowed the researchers to compare brain activity and pain reports between the two scenarios, examining the impact of empathy and a pre-existing therapeutic alliance.

Before the MRI brain scans, the researchers established a personalized pain level for each patient using a cuff-like device on their leg. Then, patients and their clinician partners underwent two different MRI sessions. In the first, they had a typical clinical consultation beforehand to build rapport, simulating a real doctor-patient relationship. During the scan, they could see each other through video cameras, allowing for nonverbal communication. In the second session, there was no prior meeting, providing a control scenario. 

Throughout both sessions, the researchers carefully measured brain activity and used questionnaires to assess the quality of the patient-clinician connection. This allowed them to pinpoint how empathy and a strong therapeutic bond affect pain perception at a neurological level.

Why fibromyalgia? The study focused on women with fibromyalgia because the condition is more common in women and is strongly influenced by psychological and social factors. Acupuncturists were chosen as clinicians because acupuncture is a common treatment for fibromyalgia and allows for controlled stimulation during the brain scans. This unique design allowed for a close examination of the “two-brain” connection between patients and clinicians, shedding light on the neurological underpinnings of empathy and its role in pain management.

Empathy as a pain reliever

The study confirmed that interacting with a caring clinician can reduce pain, but it also revealed the brain mechanisms at play. When patients interacted with clinicians, they reported less pain and showed increased activity in brain areas associated with pain processing, especially when they had a prior relationship with the clinician.   

Interestingly, the researchers found that clinicians’ brain activity synchronized with patients’ brain activity in a specific brain region (the secondary somatosensory cortex) that’s key for processing pain sensations.2 

This “brain-to-brain” connection was stronger when the patient and clinician had a pre-existing relationship, suggesting that a strong therapeutic alliance literally aligns the clinician’s and patient’s brains, potentially facilitating more effective pain management. This finding supports the idea that empathy and social connection are crucial for pain relief, not just as psychological comforts but as factors that directly influence how the brain processes pain.

This research provides compelling evidence for the importance of empathy and social support in clinical settings. By understanding the neurological mechanisms behind these interactions, healthcare providers can develop more effective strategies for managing pain and improving patient care.

References

  1. Ellingsen DM, Isenburg K, Jung C, Lee J, Gerber J, Mawla I, Sclocco R, Grahl A, Anzolin A, Edwards RR, Kelley JM, Kirsch I, Kaptchuk TJ, Napadow V. Brain-to-brain mechanisms underlying pain empathy and social modulation of pain in the patient-clinician interaction. Proc Natl Acad Sci U S A. 2023 Jun 27;120(26):e2212910120. doi: 10.1073/pnas.2212910120. Epub 2023 Jun 20. PMID: 37339198; PMCID: PMC10293846.
  2. Raju H, Tadi P. Neuroanatomy, Somatosensory Cortex. [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

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