Tuesday, December 4, 2012

Physician interaction may affect pain during medical procedures

"This won't hurt a bit"

It's the white lie that nobody believes. Pain is a universal concern, and before heading into a medical procedure we often ask "will this hurt"?

MSU Professor Issidoros Sarinopoulos (Photo by G.L. Kohuth)
recent study by Sarinopoulos el al. at Michigan State University looked at how a physician's interaction with his/her patients affected pain felt during a medical procedure. The study suggests that patients who feel a personal connection to their doctor feel less pain.

This study was done using fMRI, which measures activity in the brain. When we feel pain an fMRI sees activity in the part of our brain called the anterior insula. For this study patients were randomized1 into two groups. Both groups were interviewed by a physician about their medical history. When the test group was interviewed the physician would include probing "get to know you" type questions while the control group was asked only of their medical history. Then, while in the fMRI, patients were shown a picture of a physician. The test group was shown a picture of the interviewing physician with whom they now had a personal connection and the control group an unknown man in a white lab coat. Then they received a painful electrical shock.

The group that had a personal interview had less activity in pain centers of the brain and self-reported feeling less pain than the group with an impersonal medical interview. This may suggest that feeling personally connected to your doctor may reduce the pain you feel. I've written before about the ways that our brains can trick us, and this is just one more way.

A Warning
These results are very preliminary. Only 9 patients - all of them right-handed middle aged females - were studied. The principal investigator said:
“We need to do more research to understand this mechanism, but this is a good first step that puts some scientific weight behind the case for empathizing with patients, getting to know them and building trust.”  
The researchers are rightfully hesitant to make any substantial claims. One study does not supply sufficient data, and you definitely can't exaggerate the claims based on what you think the study shows.

I give this warning because I can see this study being misinterpreted by practitioners of alternative medicine. These quacks often claim to "treat the whole body" and often accuse science based physicians of being impersonal. A study that suggests the benefits of a personal connection could easily be exaggerated and misinterpreted to "show" that holistic medicine is superior. Let's remember how science works, though. This study doesn't show that a personal connection with your doctor speeds the healing process. It doesn't even show that a personal connection reduces the pain you will feel. It only shows that 9 women had reduced activity in an area of the brain associated with pain under these specific experimental conditions. However, this suggests that a personal connection may reduce the pain you feel. More research will help us better understand this effect. Until then, though, go ahead and strike up a conversation with your doctor. After all, what could it hurt?

[1] Randomized means they were split into different groups randomly. Randomization is an important part of clinical trials, because it helps us prevent biases. For example, if you gave the test medication to patients who had less severe symptoms your medication could do nothing at all and you'd see an "improvement" over the other group (because they were sicker to begin with).

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