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Sharing pain and relief: neural correlates of physicians during treatment of patients

Abstract

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.

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Acknowledgements

We thank Dr Jonathan Berrebi and Dr Chantal Berna who provided technical and clinical expertise for this study. We also thank Professor Martin Ingvar for the valuable theoretical contributions to the study design and Magnus Gyllenswärd for help with graphic illustrations. The work was supported by the Swedish Society for Medical Research (SSMF, Osher Center for Integrative Medicine) and the Swedish Council for Working Life and Social Research to K. Jensen, Swedish Research Council to P Petrovic, K24 AT004095 (NCCAM) and R01 AT004662 (NCCAM) to T Kaptchuk, P01 AT006663 (NCCAM) to Bruce Rosen, KO1AT003883 (NCCAM), R21AT004497 (NCCAM), R03AT218317 (NIDA), R01AT006364 (NCCAM) to J Kong, R01AT005280 (NCCAM) to R Gollub, M01-RR-01066 and UL1 RR025758-01 for Clinical Research Center Biomedical Imaging Core from National Center for Research Resources (NCRR), and P41RR14075 for Center for Functional Neuroimaging Technologies from NCRR.

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Jensen, K., Petrovic, P., Kerr, C. et al. Sharing pain and relief: neural correlates of physicians during treatment of patients. Mol Psychiatry 19, 392–398 (2014). https://doi.org/10.1038/mp.2012.195

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