Doubting your doctor increases the feeling of pain during a consultation

Distrusting the doctor treating you or the health care system in general could impact the reactions of your brain to the pain received. According a new study from the University of Miami, when doctors are perceived as less trustworthy by their patients, pain and pain-related brain activity can increase.

According to previous studies on the subject, a positive doctor-patient relationship has an effect on many patient health outcomes, including increasing the response to placebo and patient satisfaction, and affecting clinical parameters such as postoperative pain. It has been noted that it also reduces the patient’s physiological response when announcing their diagnostic of cancer.

Understand the neurobiological mechanisms behind the phenomenon

However, the neurobiological mechanisms underlying pain reductions related to patients’ trust in their doctor remained unclear. To understand them, the American researchers used functional neuroimaging (fMRI) to visualize brain responses of participants undergoing a painful medical procedure stimulation heat on the arms) and treated by virtual doctors appearing more or less trustworthy.

The “virtual” doctors corresponded to images of individuals dressed in white coats and whose faces were created by a computer algorithm to appear more or less trustworthy.

Not surprisingly, participants reported increased pain when they received painful thermal stimulation from physicians they perceived to be less trustworthy. Following the fMRI examination, the researchers also noted an increase inbrain activity in pain-related brain regions, as well as increased activity of a predictive neuromarker of pain — a signature of neurological pain — with “less reliable” physicians.

To go further in the explanation, the authors wanted to understand which factors could influence these results. It turns out that the more participants distrusted medical organizations, the higher their brain activity was in brain regions involved in pain, attention, and emotion when feeling and evaluating pain.

Pain: an essential aspect of medical care

In conclusion, the researchers do not recommend that doctors change facial expressions to appease the pain of their patients… Rather, they believe that even small (non-verbal) changes in the doctor-patient relationship can be enough to reduce patients’ pain. ” Pain is common to most medical conditions and is one of the main reasons patients seek medical treatmentadd the authors. Pain is also very costly to society in terms of financial burden and disability “.

It is interesting to point out that the study has limitations, particularly on the sample of participants. Only 42 people (between 18 and 35 years old) in good health participated in the study, which limits the generalizability of the results to populations with clinical pain. Moreover, only (virtual) stimuli of white and male faces were available for this study, not allowing to broaden the conclusions.