Brain’s Pain Responses Are Influenced By The Patient’s Trust In A Doctor

Summary: It appears that pain sensation during medical procedure or benefit from medical treatment for pain significantly depends on how much a patient trust a doctor. In a new study, researchers found that when patients did not trust a doctor much, they reported higher pain.

Doctors have long observed that emotional responses can also influence pain sensation. Researchers have long noted that placebos are especially good for managing pain including cluster headache relief and migraine headache relief. However, science still has to understand the underlying mechanism. A new study by the University of Miami suggests that how well one responds to the treatment for pain also depends on the doctor’s trustworthiness. Suppose a person does not trust a doctor, then a person is likely to report greater pain. It also means that in the absence of 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 in which pain sensation was induced in participants while they communicated with various virtual doctors. In the study, researchers made some doctors look more trustworthy than others. Furthermore, during the study, they measured pain sensation in patients and carried out brain scans using functional MRI (fMRI).

The study was pretty simple and effective. In the study, participants interacted with virtual doctors. However, these were not real doctors, and their faces were modified using a special computer algorithm. It meant that some doctors looked more trustworthy than others. Then patients were provided a medical procedure, which in fact, involved applying heat to cause some pain. The researchers found that patients reported greater pain due to heat application when they were interacting with less trustworthy doctors. Since researchers were also scanning the brains, they could also see more remarkable brain changes.

Researchers say that their findings have many implications. It is not just about pain management. It explains that treatment outcomes also depend on the doctor’s trustworthiness. Here it is worth understanding that trustworthiness is not just about doctors. Certain population groups tend to trust doctors less, like people of color or those with lower education. Hence, this lower trust in the health system may also explain poor outcomes in specific population groups. This is not the first investigation this particular group of researchers has done on the subject. They have done early studies using face-to-face meetings with doctors. In those experiments, they found that patients were more likely to trust a doctor that belonged to their cultural group. On the contrary, people are less likely to trust a doctor from another cultural group. 

Researchers say this is not the first study into the subject, but it is among the first to show how deep trust can influence pain sensation. It also demonstrated that trust could influence the working of the brain. It means that if patients did not trust a doctor, they would continue to report more significant pain. Such a kind of trust between the patient and doctor also affects diagnostic procedures. It also shows that patients are less likely to report pain if a highly reputed doctor does any diagnostic procedure. Thus, pain sensation depends on how much patients trust their doctor.

Researchers say that this study does not mean we should train doctors to use specific kinds of facial expressions. However, this study demonstrates that even a small change in doctor-patient relationships can influence health outcomes. Further, it also shows the importance of non-verbal communication between the doctor and the patient.

By Gurpreet Singh Padda, MD, MBA, MHP