Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA.
Department of Psychological and Brain Sciences, Dartmouth College, 3 Maynard St, Hanover, NH 03755-3565, USA.
Cereb Cortex. 2023 Mar 21;33(7):3421-3436. doi: 10.1093/cercor/bhac281.
Trust is an important component of the doctor-patient relationship and is associated with improved patient satisfaction and health outcomes. Previously, we reported that patient feelings of trust and similarity toward their clinician predicted reductions in evoked pain in response to painful heat stimulations. In the present study, we investigated the brain mechanisms underlying this effect. We used face stimuli previously developed using a data-driven computational modeling approach that differ in perceived trustworthiness and superimposed them on bodies dressed in doctors' attire. During functional magnetic resonance imaging, participants (n = 42) underwent a series of virtual medical interactions with these doctors during which they received painful heat stimulation as an analogue of a painful diagnostic procedure. Participants reported increased pain when receiving painful heat stimulations from low-trust doctors, which was accompanied by increased activity in pain-related brain regions and a multivariate pain-predictive neuromarker. Findings suggest that patient trust in their doctor may have tangible impacts on pain and point to a potential brain basis for trust-related reductions in pain through the modulation of brain circuitry associated with the sensory-discriminative and affective-motivational dimensions of pain.
信任是医患关系的重要组成部分，与提高患者满意度和健康结果相关。此前，我们报告称，患者对其临床医生的信任和相似感预测了对疼痛热刺激的诱发疼痛的减轻。在本研究中，我们调查了这种效应的大脑机制。我们使用了以前使用数据驱动的计算建模方法开发的面孔刺激物，这些刺激物在可感知的可信度上有所不同，并将其叠加在穿着医生服装的身体上。在功能磁共振成像期间，参与者（n=42）与这些医生进行了一系列虚拟医疗互动，在此期间，他们接受了疼痛热刺激，作为疼痛诊断程序的模拟。当从低信任医生那里接受疼痛热刺激时，参与者报告疼痛增加，这伴随着与疼痛相关的大脑区域的活动增加和多变量疼痛预测神经标记物。研究结果表明，患者对医生的信任可能对疼痛产生切实影响，并指出通过调节与疼痛的感觉辨别和情感动机维度相关的大脑回路，信任相关的疼痛减轻可能存在潜在的大脑基础。
