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Mol Psychiatry. 2014 Mar;19(3):392-8. doi: 10.1038/mp.2012.195. Epub 2013 Jan 29.

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

Author information

1
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.
2
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
3
Department of Family Medicine, Brown University, Providence, RI, USA.
4
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.
5
Department of Psychiatry, Mass General Hospital/Harvard Medical School, Boston, MA, USA.
6
1] Department of Psychiatry, Mass General Hospital/Harvard Medical School, Boston, MA, USA [2] Athinoula A Martinos Center for Biomedical Imaging, Boston, MA, USA.
7
Athinoula A Martinos Center for Biomedical Imaging, Boston, MA, USA.

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.

PMID:
23358155
PMCID:
PMC3981541
DOI:
10.1038/mp.2012.195
[Indexed for MEDLINE]
Free PMC Article
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