Poster C18, Sunday, March 25, 1:00-3:00 pm, Exhibit Hall C
Patient-clinician concordance in social mirroring circuitry supports non-verbal communication and placebo analgesia in the context of pain treatment – a fMRI hyperscanning study
Dan-Mikael Ellingsen1,2, Changjin Jung1,2,3, Jeungchan Lee1,2, Kylie Isenburg1,2, Jessica Gerber1,2, Ishtiaq Mawla1,2, Roberta Sclocco1,2, Robert R Edwards4, John Kelley5, Irving Kirsch2, Ted J Kaptchuk2, Vitaly Napadow1,2; 1Massachusetts General Hospital, 2Harvard Medical School, 3Korea Institute of Oriental Medicine, Daejeon, Korea (the Republic of), 4Brigham and Women's Hospital, Boston, MA, 5Endicott College, Beverly, MA
The patient-clinician relationship can shape patients’ clinical outcome, but the brain basis for this is unknown, and psychosocial aspects of pain treatment have typically been studied in patients in isolation. We hypothesized that patient-clinician concordance in social mirroring circuitry, such as ventrolateral prefrontal cortex (vlPFC) and temporoparietal junction (TPJ), during pain treatment, supports non-verbal communication and placebo analgesia. We simultaneously recorded functional Magnetic Resonance Imaging (fMRI hyperscanning) in 21 patient-clinician dyads (fibromyalgia patients and acupuncturists), who interacted via video transfer, during clinician-initiated treatment (real/sham electro-acupuncture) of patients’ evoked pain. Using MRI-compatible cameras, participants were enabled to communicate non-verbally throughout the scan. Patients’ pain, as well as clinicians’ vicarious pain, was decreased during both real and sham treatment compared to overt no-treatment (pain+treatment, relative to no-treatment). Furthermore, patients’ placebo analgesia (no-treatment–sham) correlated with clinicians’ perceived efficacy (no-treatment–sham). A conjunction analysis of brain responses of patients (receiving pain+treatment) and clinicians (providing treatment) demonstrated activation of vlPFC, aINS, and TPJ for both patients and clinicians. Using ROI extraction from the group vlPFC conjunction cluster, we found that the number of co-activated voxels (treatment–no-treatment) between patients and clinicians correlated with patients’ placebo analgesia, within dyads. Furthermore, patient-clinician concordance in right TPJ correlated with self-reported emotional expressiveness, frequency of eye-contact, and patients’ placebo analgesia. In sum, increased patient-clinician concordance in vlPFC and right TPJ during pain treatment may support patient-clinician communication and ultimately placebo analgesia.
Topic Area: EMOTION & SOCIAL: Emotional responding