Brain and Behavioral Correlates of the Patient-Clinician Relationship: A longitudinal fMRI hyper-scanning study of chronic pain patients

Abstract

Research suggests that a good patient-clinician therapeutic alliance can improve clinical outcomes. In this ongoing, longitudinal study, we applied fMRI hyper-scanning to determine whether behavioral, neural, and clinical variables associated with the therapeutic relationship between chronic pain patients and their clinicians influences clinical outcomes. Ten women with fibromyalgia (mean age=40, SD=10.71, each group N=5) were randomly assigned to either an Augmented (warm/attentive) or Limited (neutral/business-like) interaction style, and were treated with electro-acupuncture for 6 biweekly sessions. Before and after acupuncture therapy, each patient-clinician dyad underwent a simultaneously recorded fMRI hyper-scanning procedure with video connection between two scanners and an evoked cuff pressure pain/treatment paradigm. Clinical outcomes and the quality of the patient-clinician relationship were assessed by questionnaires targeting treatment-related changes in clinical pain levels, therapeutic alliance, trust, and the clinician's warmth and competence. Pooled therapeutic alliance (assessed after treatment sessions 1, 3, and 6; scale 0-50) in the Augmented group (mean=43.17, SD=2.97) was significantly higher than in the Limited group (mean=27.27, SD=10.44; t(8)=3.28, p=0.011). Similarly, clinicians’ warmth, as rated by patients, was significantly higher in the Augmented (mean=4.00, SD=0.0) than in the Limited group (3.02, SD=0.73; t(8)=3.00; p=0.017). Preliminary results show that over all 6 acupuncture treatment sessions, irrespective of group assignments, most patients experienced post-treatment clinical pain relief (p