Dartmouth Events

A social neuroscience perspective of the patient/clinician relationship: the role of hyperscan neuroimaging in the art of medicine

Bio:

Vitaly Napadow is a Professor at Harvard Medical School and the Director of the Scott Schoen and Nancy Adams Discovery Center for Recovery from Chronic Pain at Spaulding Rehabilitation Hospital and the Center for Integrative Pain Neuroimaging (CiPNI) at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital. Somatosensory, cognitive, and affective factors all influence the malleable experience of chronic pain, and Dr. Napadow’s Lab has applied human functional and structural neuroimaging to localize and suggest mechanisms by which different brain circuitries modulate pain perception. Dr. Napadow’s neuroimaging research also aims to better understand how non-pharmacological therapies, from acupuncture and transcutaneous neuromodulation to cognitive behavioral therapy and mindfulness meditation training, ameliorate aversive perceptual states such as pain. Dr. Napadow has more than 200 publications in leading peer-reviewed scientific journals, is past-President of the Society for Acupuncture Research, and serves on the board of the US Association for the Study of Pain (USASP) and numerous conference, journal, and NIH review panels.

Abstract:

The patient-clinician interaction can powerfully shape treatment outcomes such as pain but is often considered an intangible “art of medicine” and has largely eluded scientific inquiry. Although brain correlates of social processes such as empathy and theory of mind have been studied using single-subject designs, specific behavioral and neural mechanisms underpinning the patient-clinician interaction are unknown. Using a two-person interactive design, we have constructed both a fMRI and EEG setup to simultaneously record hyperscan neuroimaging data from patient-clinician dyads, who interacted via live video (for fMRI) or face to face (for EEG), while clinicians treated evoked pain in patients with chronic pain. Our recently published fMRI results (Ellingsen et al., 2020, 2021) showed that patient analgesia was mediated by patient-clinician nonverbal behavioral mirroring and brain-to-brain concordance in circuitry implicated in theory of mind and social mirroring. Dyad-based analyses showed extensive dynamic coupling of these brain nodes with the partners’ brain activity, yet only in dyads with pre-established clinical rapport. These findings introduce a putatively key brain-behavioral mechanism for therapeutic alliance and psychosocial analgesia. This talk will supplement our previously published results with results from ongoing hyperscan EEG studies and introduce future directions for this nascent field of research.