scholarly journals Dynamic brain-to-brain concordance and behavioral mirroring as a mechanism of the patient-clinician interaction

2020 ◽  
Author(s):  
Dan-Mikael Ellingsen ◽  
Kylie Isenburg ◽  
Changjin Jung ◽  
Jeungchan Lee ◽  
Jessica Gerber ◽  
...  
Keyword(s):  
Theory Of Mind ◽  
Brain Activity ◽  
Neural Mechanisms ◽  
Single Subject ◽  
Dynamic Coupling ◽  
Behavioral Mechanism ◽  
Chronic Pain Patients ◽  
Brain Correlates ◽  
Single Subject Designs ◽  
Pain Patients

AbstractThe 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, the specific behavioral and neural mechanisms underpinning the patient-clinician interaction are unknown. Using a two-person interactive design, we simultaneously recorded functional MRI (i.e. hyperscanning) in patient-clinician dyads, who interacted via live video while clinicians treated evoked pain in chronic pain patients. Our results show that patient analgesia is 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 where clinical rapport had been established prior to the interaction. These findings point to a putatively key brain-behavioral mechanism for therapeutic alliance and psychosocial analgesia.

scholarly journals Dynamic brain-to-brain concordance and behavioral mirroring as a mechanism of the patient-clinician interaction

2020 ◽  
Vol 6 (43) ◽  
pp. eabc1304
Author(s):  
Dan-Mikael Ellingsen ◽  
Kylie Isenburg ◽  
Changjin Jung ◽  
Jeungchan Lee ◽  
Jessica Gerber ◽  
...  
Keyword(s):  
Theory Of Mind ◽  
Scientific Inquiry ◽  
Brain Activity ◽  
Neural Mechanisms ◽  
Single Subject ◽  
Functional Magnetic Resonance ◽  
Dynamic Coupling ◽  
Behavioral Mechanism ◽  
Brain Correlates ◽  
Single Subject Designs

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 simultaneously recorded functional magnetic resonance imaging (hyperscanning) in patient-clinician dyads, who interacted via live video, while clinicians treated evoked pain in patients with chronic pain. Our results show that patient analgesia is 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.

scholarly journals Emotional and Motivational Pain Processing: Current State of Knowledge and Perspectives in Translational Research

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Susanne Becker ◽  
Edita Navratilova ◽  
Frauke Nees ◽  
Stefaan Van Damme
Keyword(s):  
Chronic Pain ◽  
Brain Activity ◽  
Pain Processing ◽  
Cellular Mechanisms ◽  
Related Information ◽  
Current State ◽  
Chronic Pain Patients ◽  
Fear And Anxiety ◽  
Chronic Pain Conditions ◽  
Pain Patients

Pain elicits fear and anxiety and promotes escape, avoidance, and adaptive behaviors that are essential for survival. When pain persists, motivational priority and attention shift to pain-related information. Such a shift often results in impaired functionality, leading to maladaptive pain-related fear and anxiety and escape and avoidance behaviors. Neuroimaging studies in chronic pain patients have established that brain activity, especially in cortical and mesolimbic regions, is different from activity observed during acute pain in control subjects. In this review, we discuss the psychophysiological and neuronal factors that may be associated with the transition to chronic pain. We review information from human studies on neural circuits involved in emotional and motivational pain processing and how these circuits are altered in chronic pain conditions. We then highlight findings from animal research that can increase our understanding of the molecular and cellular mechanisms underlying emotional-motivational pain processing in the brain. Finally, we discuss how translational approaches incorporating results from both human and animal investigations may aid in accelerating the discovery of therapies.

Neural mechanisms in chronic pain relevant for psychiatric interventions

2020 ◽  
pp. 1320-1329
Author(s):  
Chantal Berna ◽  
Irene Tracey
Keyword(s):  
Chronic Pain ◽  
Psychological Factors ◽  
Pain Perception ◽  
Neural Mechanisms ◽  
Optimal Care ◽  
Chronic Pain Patients ◽  
Psychiatric Intervention ◽  
Pain Patients ◽  
Multi Disciplinary Team

Chronic pain is a medical health problem affecting almost 20% of the population in Europe, with an important impact on patients’ function, quality of life, social interactions, and mental health. This chapter reviews the current understanding of the processes and neural mechanisms involved in nociception and the regulation of pain perception. Factors susceptible to affect the transition from acute to chronic pain are discussed. Neural and psychological factors, which may participate in maintaining chronic pain states and could be targets for psychiatric intervention, are also presented. These different points together clarify why optimal care for chronic pain patients requires a multi-disciplinary team, with an important role for the psychiatrist.

scholarly journals Modulation of the Somatosensory Evoked Potential by Attention and Spinal Cord Stimulation

2021 ◽  
Vol 12 ◽  
Author(s):  
Guiomar Niso ◽  
Marleen C. Tjepkema-Cloostermans ◽  
Mathieu W. P. M. Lenders ◽  
Cecile C. de Vos
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Brain Activity ◽  
Explorative Study ◽  
Brain Responses ◽  
Chronic Pain Patients ◽  
Electrical Pulses ◽  
Pain Patients

Introduction: Spinal Cord Stimulation (SCS) is a last-resort treatment for patients with intractable chronic pain in whom pharmacological and other treatments have failed. Conventional tonic SCS is accompanied by tingling sensations. More recent stimulation protocols like burst SCS are not sensed by the patient while providing similar levels of pain relief. It has been previously reported that conventional tonic SCS can attenuate sensory-discriminative processing in several brain areas, but that burst SCS might have additional effects on the medial, motivational-affective pain system. In this explorative study we assessed the influence of attention on the somatosensory evoked brain responses under conventional tonic SCS as well as burst SCS regime.Methods: Twelve chronic pain patients with an implanted SCS device had 2-weeks evaluation periods with three different SCS settings (conventional tonic SCS, burst SCS, and sham SCS). At the end of each period, an electro-encephalography (EEG) measurement was done, at which patients received transcutaneous electrical pulses at the tibial nerve to induce somatosensory evoked potentials (SEP). SEP data was acquired while patients were attending the applied pulses and while they were mind wandering. The effects of attention as well as SCS regimes on the SEP were analyzed by comparing amplitudes of early and late latencies at the vertex as well as brain activity at full cortical maps.Results: Pain relief obtained by the various SCS settings varied largely among patients. Early SEP responses were not significantly affected by attention nor SCS settings (i.e., burst, tonic, and sham). However, late SEP responses (P300) were reduced with tonic and burst SCS: conventional tonic SCS reduced P300 brain activity in the unattended condition, while burst SCS reduced P300 brain activity in both attended and unattended conditions.Conclusion: Burst spinal cord stimulation for the treatment of chronic pain seems to reduce cortical attention that is or can be directed to somatosensory stimuli to a larger extent than conventional spinal cord stimulation treatment. This is a first step in understanding why in selected chronic pain patients burst SCS is more effective than tonic SCS and how neuroimaging could assist in personalizing SCS treatment.

scholarly journals Brain dysfunction in chronic pain patients assessed by resting-state electroencephalography

2019 ◽  
Author(s):  
Son Ta Dinh ◽  
Moritz M. Nickel ◽  
Laura Tiemann ◽  
Elisabeth S. May ◽  
Henrik Heitmann ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Resting State ◽  
Brain Activity ◽  
Control Group ◽  
Brain Areas ◽  
Frontal Brain ◽  
Disease Markers ◽  
Chronic Pain Patients ◽  
Gamma Frequencies ◽  
Pain Patients

AbstractChronic pain is a common and severely disabling disease whose treatment is often unsatisfactory. Insights into the brain mechanisms of chronic pain promise to advance the understanding of the underlying pathophysiology and might help to develop disease markers and novel treatments. Here, we systematically and comprehensively exploited the potential of electroencephalography (EEG) to determine abnormalities of brain function during the resting state in chronic pain. To this end, we performed state-of-the-art analyses of oscillatory brain activity, brain connectivity and brain networks in 101 patients of either sex suffering from chronic pain. The results show that global and local measures of brain activity did not differ between chronic pain patients and a healthy control group. However, we observed significantly increased connectivity at theta (4 – 8 Hz) and gamma (> 60 Hz) frequencies in frontal brain areas as well as global network reorganization at gamma frequencies in chronic pain patients. Furthermore, a machine learning algorithm could differentiate between patients and healthy controls with an above-chance accuracy of 57%, mostly based on frontal connectivity. These results implicate increased theta and gamma synchrony in frontal brain areas in the pathophysiology of chronic pain. While substantial challenges concerning accuracy, specificity and validity of potential EEG-based disease markers remain to be overcome, our study identifies abnormal frontal synchrony at theta and gamma frequencies as promising targets for non-invasive brain stimulation and/or neurofeedback approaches.

scholarly journals Acute Stress Contributes to Individual Differences in Pain and Pain-Related Brain Activity in Healthy and Chronic Pain Patients

2013 ◽  
Vol 33 (16) ◽  
pp. 6826-6833 ◽  
Author(s):  
E. Vachon-Presseau ◽  
M.-O. Martel ◽  
M. Roy ◽  
E. Caron ◽  
G. Albouy ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Individual Differences ◽  
Acute Stress ◽  
Brain Activity ◽  
Chronic Pain Patients ◽  
Pain Patients

Pain Influences Several Levels of Attention

2005 ◽  
Vol 16 (4) ◽  
pp. 235-242 ◽  
Author(s):  
Astrid von Bueren Jarchow ◽  
Bogdan P. Radanov ◽  
Lutz Jäncke
Keyword(s):  
Chronic Pain ◽  
Divided Attention ◽  
Covert Attention ◽  
Attention Task ◽  
Attentional Deficits ◽  
Control Subjects ◽  
Chronic Pain Patients ◽  
Divided Attention Task ◽  
Pain Stimuli ◽  
Pain Patients

Abstract: The aim of the present study was to examine to what extent chronic pain has an impact on various attentional processes. To measure these attention processes a set of experimental standard tests of the “Testbatterie zur Aufmerksamkeitsprüfung” (TAP), a neuropsychological battery testing different levels of attention, were used: alertness, divided attention, covert attention, vigilance, visual search, and Go-NoGo tasks. 24 chronic outpatients and 24 well-matched healthy control subjects were tested. The control subjects were matched for age, gender, and education. The group of chronic pain patients exhibited marked deficiencies in all attentional functions except for the divided attention task. Thus, the data supports the notion that chronic pain negatively influences attention because pain patients` attention is strongly captivated by the internal pain stimuli. Only the more demanding divided attention task has the capability to distract the focus of attention to the pain stimuli. Therefore, the pain patients are capable of performing within normal limits. Based on these findings chronic pain patients' attentional deficits should be appropriately evaluated and considered for insurance and work related matters. The effect of a successful distraction away from the pain in the divided attention task can also open new therapeutic aspects.

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