Summary: It appears that pain sensation during a medical procedure, or benefit from medical treatment for pain, significantly depends on how much a patient trusts 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. If a person does not trust a doctor, that 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. 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.
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 who dealt with doctors who looked less trustworthy reported more pain from the same heat, and 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, which is one reason placebos work so well for pain, including cluster and migraine headaches. This study adds trust to that list. Researchers altered virtual doctors’ faces so some looked more trustworthy than others, and 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 assume.
Why do some patients trust their doctor less?
Some groups tend to trust doctors less, including people of color and people with less formal education, and 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, and 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 influence health outcomes, and that trust shapes how the brain processes 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, and a patient who trusts the doctor is more likely to feel the benefit.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
