Summary: It appears that pain sensation during a medical procedure, or benefit from pain treatment, significantly depends on how much a patient trusts a doctor. In a new study, patients who did not trust a doctor much reported higher pain.
Doctors have long seen that emotions can shape pain. Researchers have long noted that placebos work especially well for pain, including cluster headache relief and migraine headache relief. But science still does not know how this works. A new study by the University of Miami suggests that how well you respond to pain treatment also depends on how trustworthy the doctor seems. A person who does not trust a doctor is likely to report more pain. It also means that without trust, a patient may not report benefits from drug therapy.
This new study regarding the association between pain sensation and doctor trustworthiness was published in the journal Cerebral Cortex. It was a simulation study. Researchers caused pain in people while they talked with different virtual doctors. They made some doctors look more trustworthy than others. During the study, they measured pain and scanned the brain with functional MRI (fMRI).
The study was simple and it worked. People talked with virtual doctors. These were not real doctors. A computer program changed their faces, so some looked more trustworthy than others. Then people got a medical procedure. In fact, it was heat applied to the skin to cause some pain. People reported more pain from the heat when they dealt with less trustworthy doctors. The brain scans also showed larger changes.
Researchers say the findings reach beyond pain care. They show that treatment results also depend on how much patients trust the doctor. And trust is not only about the doctor. Some groups tend to trust doctors less, like people of color or people with less schooling. So lower trust in the health system may also explain poor results in those groups. This team has studied the subject before. Earlier studies used face-to-face meetings with doctors. In those, patients were more likely to trust a doctor from their own cultural group. People were less likely to trust a doctor from another cultural group.
Researchers say this is not the first study on the subject. But it is among the first to show how deeply trust can shape pain. It also showed that trust could change how the brain works. If patients did not trust a doctor, they kept reporting more significant pain. Trust between patient and doctor also affects diagnostic procedures. Patients are less likely to report pain when a highly respected doctor does the test. So pain depends on how much patients trust their doctor.
Researchers say this does not mean doctors should be trained to make certain facial expressions. But the study shows that even a small change in the doctor-patient relationship can shape health outcomes. It also shows how much non-verbal communication (face, tone, body language) between doctor and patient matters.
Frequently asked questions
Does trusting your doctor affect how much pain you feel?
Yes. In a University of Miami study published in Cerebral Cortex, people dealt with doctors who looked more or less trustworthy. Those facing less trustworthy doctors reported more pain from the same heat. Their brain scans showed larger pain-related changes. When trust is low, patients report more pain and may also report less benefit from pain medicine. Trust is part of the treatment, not a courtesy around it.
What psychological factors affect pain perception?
Emotions shape pain. That is one reason placebos work so well for pain, including cluster and migraine headaches. This study adds trust to that list. Researchers changed virtual doctors’ faces so some looked more trustworthy than others. That shifted how much pain people reported and how strongly their brains responded. Non-verbal communication between doctor and patient matters more than most people think.
Why do some patients trust their doctor less?
Some groups tend to trust doctors less, including people of color and people with less formal schooling. That lower trust may help explain poorer outcomes in those groups. Earlier face-to-face studies by the same researchers found that patients trusted doctors from their own cultural group more. They trusted doctors from another cultural group less.
Can a better doctor-patient relationship improve pain treatment?
Yes. The researchers found that even a small change in the doctor-patient relationship can shape health outcomes. Trust also shapes how the brain handles pain. That does not mean doctors should be trained to put on certain facial expressions. It means the relationship itself is part of the care. A patient who trusts the doctor is more likely to feel the benefit.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
