Study: Doctors rewire their brains so they don't perceive patients' pain
Dig this: Brain scans appear to show that doctors can shut down the parts of their brains that lets them empathize with pain in other people.
It makes sense, of course. Because doctors are often required to cause pain in patients -- as part of treating them -- doctors probably need to develop the ability to at least partly ignore the pain they're causing, or they'd never be able to deal with the stress. The neuroscientists decided to see if there was anything in doctors' brain activity that actually reflected this ability. So they put a bunch of doctors and a non-doctors into an fMRI machine, and had them look at randomly interspersed pictures of people being pricked with acupuncture needles and touched with Q-tips. The results? According to this write-up:
Among the control group, the scan showed that the pain circuit, which comprises somatosensory cortex, anterior insula, periaqueducal gray and anterior cigulate cortex, was activated when members of that group saw someone touch with a needle but not activated when the person was touched with a Q-tip.
Physicians registered no increase in activity in the portion of the brain related to pain, whether they saw an image of someone stuck with a needle or touched with a Q-tip. However, the physicians, unlike the control group, did register an increase in activity in the frontal areas of the brain--the medial and superior prefrontal cortices and the right tempororparietal junction. That is the neural circuit that is related to emotion regulation and cognitive control.
They also asked the two groups to rate the level of pain they felt people were experiencing while being pricked with needles. The control group rated the pain at about 7 points on a 10-point scale, while the physicians said the pain was probably at 3 points on that scale.
Now that latter paragraph is super interesting. It would appear that some of the doctors' ability to ignore pain isn't wilful -- it's also involuntary. It's not just that they can turn off their empathy; they can't turn it on again when specifically asked to do so. Thus, they're more likely than you or I to underestimate the amount of pain someone is experiencing.
Psychologists and patients-rights advocates have long argued that doctors don't take pain-alleviation seriously enough; Jerome Groopman wrote an article for the New Yorker on this subject a while back. These findings might help illuminate some of the reasons why pain-management goes on the backburner in medical backburner: Perhaps the doctors simply aren't perceiving it.
Posted by Clive Thompson at September 27, 2007 03:41 PM
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I'm not sure the conclusion you draw from that last paragraph is accurate. Couldn't it be argued that a doctor simply has a more accurate idea of the potential pain involved in taking a needle (which is, let's face it, not all that great), by virtue of administering shots so often? "There, that wasn't so bad, was it?"
Posted by: Mark Lerner at September 28, 2007 4:47 PM
Agree totally with the comment above.
The pain of a needle stick in no way is a 7 out of 10. Not only are doctors familiar with needles, they often see people in severe pain.
Posted by: Arrowyn at October 3, 2007 9:39 AM
I completely agree with the other two commenters.
The extrapolations of the final two paragraphs in the original post are laughable in their oversights.
Posted by: Jim Miles at October 6, 2007 11:07 PM
Actually I think you guys are missing something. The point is that the two groups performed differently. It's not a question of who is right or wrong about the amount of pain a person is experiencing (who's to judge except the patient? Actually this study would have been better if they'd got the subjects to also rate the pain they experienced wouldn't it? That would have shown which group was more "accurate"). But the point is that something has changed in the creation of a doctor - something that makes their brains function differently from non-doctors. That's worth understanding isn't it?
Posted by: bobleckridge at October 12, 2007 6:00 AM
"Thus, they're more likely than you or I to underestimate the amount of pain someone is experiencing."
If by "underestimate" you mean guessing a number below the true number, then this assertion sounds baseless, because we don't know a true number. Also we have reason to doubt there is any true number, in that pain in the moment depends on how closely a subject is attending to it and to an emotional as well as a sensory assessment, and in that "pain" is ambiguous as an assigned target of assessment, which makes it easy to imagine that subjects had different objectives in mind, and that pain alleviation professionals would be much more similar to one another in their understanding of the assignment than random controls would be to one another, which by itself would lead to different mean ratings for the two groups (although hopefully not to a claim of a statistically significant difference).
Posted by: MT at January 8, 2008 10:17 PM
Sorry: I used "the subject" to mean different things in the same sentence. I meant only to use it for the people asked to rate pain, but I used it first for the ones who were having the experience of pain ("subjected to pain"). Illustrates the challenge of talking about pain, I think. Anyway, I found it painful. But so I meant that the person experiencing pain will experience a different intensity and/or quality of pain from any physically specified stimulus (pressure, heat, etc) depending on where their attention happens to be directed and how engaged at the time, and depending as well on "how they're wired" emotionally and psychologically. All torture is psychological in that sense. Meanwhile, I was saying ambiguity affects the person tasked with watching the stimulation and response of another, and so the study's conclusions overall, since comparing scores doesn't prove much, if you don't know they're all for the same assignment.
Posted by: MT at January 9, 2008 1:04 AM
Post a comment
I'm not sure the conclusion you draw from that last paragraph is accurate. Couldn't it be argued that a doctor simply has a more accurate idea of the potential pain involved in taking a needle (which is, let's face it, not all that great), by virtue of administering shots so often? "There, that wasn't so bad, was it?"
Posted by: Mark Lerner![[TypeKey Profile Page]](http://www.collisiondetection.net/nav-commenters.gif)
at September 28, 2007 4:47 PM
Agree totally with the comment above.
The pain of a needle stick in no way is a 7 out of 10. Not only are doctors familiar with needles, they often see people in severe pain.
Posted by: Arrowyn![[TypeKey Profile Page]](http://www.collisiondetection.net/nav-commenters.gif)
at October 3, 2007 9:39 AM
I completely agree with the other two commenters.
The extrapolations of the final two paragraphs in the original post are laughable in their oversights.
Posted by: Jim Miles![[TypeKey Profile Page]](http://www.collisiondetection.net/nav-commenters.gif)
at October 6, 2007 11:07 PM
Actually I think you guys are missing something. The point is that the two groups performed differently. It's not a question of who is right or wrong about the amount of pain a person is experiencing (who's to judge except the patient? Actually this study would have been better if they'd got the subjects to also rate the pain they experienced wouldn't it? That would have shown which group was more "accurate"). But the point is that something has changed in the creation of a doctor - something that makes their brains function differently from non-doctors. That's worth understanding isn't it?
Posted by: bobleckridge![[TypeKey Profile Page]](http://www.collisiondetection.net/nav-commenters.gif)
at October 12, 2007 6:00 AM
"Thus, they're more likely than you or I to underestimate the amount of pain someone is experiencing."
If by "underestimate" you mean guessing a number below the true number, then this assertion sounds baseless, because we don't know a true number. Also we have reason to doubt there is any true number, in that pain in the moment depends on how closely a subject is attending to it and to an emotional as well as a sensory assessment, and in that "pain" is ambiguous as an assigned target of assessment, which makes it easy to imagine that subjects had different objectives in mind, and that pain alleviation professionals would be much more similar to one another in their understanding of the assignment than random controls would be to one another, which by itself would lead to different mean ratings for the two groups (although hopefully not to a claim of a statistically significant difference).
Posted by: MT![[TypeKey Profile Page]](http://www.collisiondetection.net/nav-commenters.gif)
at January 8, 2008 10:17 PM
Sorry: I used "the subject" to mean different things in the same sentence. I meant only to use it for the people asked to rate pain, but I used it first for the ones who were having the experience of pain ("subjected to pain"). Illustrates the challenge of talking about pain, I think. Anyway, I found it painful. But so I meant that the person experiencing pain will experience a different intensity and/or quality of pain from any physically specified stimulus (pressure, heat, etc) depending on where their attention happens to be directed and how engaged at the time, and depending as well on "how they're wired" emotionally and psychologically. All torture is psychological in that sense. Meanwhile, I was saying ambiguity affects the person tasked with watching the stimulation and response of another, and so the study's conclusions overall, since comparing scores doesn't prove much, if you don't know they're all for the same assignment.
Posted by: MT![[TypeKey Profile Page]](http://www.collisiondetection.net/nav-commenters.gif)
at January 9, 2008 1:04 AM