Sharing pain and relief: neural correlates of physicians during treatment of patients.
Patient-physician interactions significantly contribute to placebo effects and clinical outcomes. While the neural correlates of placebo responses have been studied in patients, the neurobiology of the clinician during treatment is unknown. This study investigated physicians' brain activations during patient-physician interaction while the patient was experiencing pain, including a 'treatment', 'no-treatment' and 'control' condition. Here, we demonstrate that physicians activated brain regions previously implicated in expectancy for pain-relief and increased attention during treatment of patients, including the right ventrolateral and dorsolateral prefrontal cortices. The physician's ability to take the patients' perspective correlated with increased brain activations in the rostral anterior cingulate cortex, a region that has been associated with processing of reward and subjective value. We suggest that physician treatment involves neural representations of treatment expectation, reward processing and empathy, paired with increased activation in attention-related structures. Our findings further the understanding of the neural representations associated with reciprocal interactions between clinicians and patients; a hallmark for successful treatment outcomes.
1] Department of Psychiatry, Mass General Hospital/Harvard Medical School, Boston, MA, USA [2] Athinoula A Martinos Center for Biomedical Imaging, Boston, MA, USA [3] Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
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KB
Jensen
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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P
Petrovic
Department of Family Medicine, Brown University, Providence, RI, USA.
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CE
Kerr
1] Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA [2] School of Psychology, Plymouth University, Plymouth, UK.
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Kirsch
Department of Psychiatry, Mass General Hospital/Harvard Medical School, Boston, MA, USA.
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Raicek
Department of Psychiatry, Mass General Hospital/Harvard Medical School, Boston, MA, USA.
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A
Cheetham
Department of Psychiatry, Mass General Hospital/Harvard Medical School, Boston, MA, USA.
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R
Spaeth
Department of Psychiatry, Mass General Hospital/Harvard Medical School, Boston, MA, USA.
A
A
Cook
1] Department of Psychiatry, Mass General Hospital/Harvard Medical School, Boston, MA, USA [2] Athinoula A Martinos Center for Biomedical Imaging, Boston, MA, USA [3] Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
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Gollub
1] Department of Psychiatry, Mass General Hospital/Harvard Medical School, Boston, MA, USA [2] Athinoula A Martinos Center for Biomedical Imaging, Boston, MA, USA.
J
J
Kong
Athinoula A Martinos Center for Biomedical Imaging, Boston, MA, USA.
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TJ
Kaptchuk
D000328:Adult; D001288:Attention / Q000502:physiology*; D001931:Brain Mapping; D004645:Empathy / Q000502:physiology*; D005260:Female; D006179:Gyrus Cinguli / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010146:Pain / Q000503:physiopathology / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D015990:Placebo Effect; D017397:Prefrontal Cortex / Q000502:physiology*; D012201:Reward