ArticleProceedings of the National Academy of Sciences of the United States of America2023
Brain-to-brain mechanisms underlying pain empathy and social modulation of pain in the patient-clinician interaction.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Together we sync: a systematic qualitative and quantitative review of fMRI hyperscanning studies.Social cognitive and affective neuroscience · 2026Pooled it
- Guideline
- Empathetic solicitude attenuates the affective and sensory dimensions of COPsychophysiology · 2025Trial
- High-Definition Transcranial Direct Current Stimulation Improves Pain Empathy: A Randomized, Double-Blind, and Sham-Controlled Study Based on Event-Related Potentials (ERPs).Journal of pain research · 2025Trial
- Social interactions between people of same and different generations shape longitudinal changes in interpersonal neural synchrony, loneliness, and social connection.PLoS biology · 2026Article
- Conceptualisation of Empathy in Interactions Between Healthcare Professionals and People With Fibromyalgia Syndrome: A Mixed-Methods Study.Journal of clinical psychology in medical settings · 2026Article
- Patient-clinician communication and cardiovascular outcomes: An analysis of the hispanic community health study/study of latinos (HCHS/SOL), 2008-2019.American journal of preventive cardiology · 2026Article
- More Frequent Empathic Communication by Physical Therapists Is Associated With Improved Outcomes for Low-Impact Chronic Pain.Physical therapy · 2026Article
- Technologies to investigate the mechanisms of force-based manipulations: a narrative methods review.Frontiers in pain research (Lausanne, Switzerland) · 2026Review
- The impact of acupuncturists' experience level on the efficacy of acupuncture for functional dyspepsia: an exploratory secondary analysis of a randomized clinical trial.Frontiers in medicine · 2026Article
- How to design real-world functional near-infrared spectroscopy studies: a primer.Neurophotonics · 2026Article
- Oxytocin and vasopressin enhance social pain empathy via common and distinct of neural expressions, genetic pathways, and networks.Proceedings of the National Academy of Sciences of the United States of America · 2025Article
- The High-Risk Model of Threat Perception Modulates Learning of Placebo and Nocebo Effects and Functional Somatic Disorders.Brain sciences · 2025Review
- Neural Patterns of Social Pain in the Brain-Wide Representations Across Social Contexts.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2025Article
- Context is Complex: Challenges and opportunities addressing contextual factors in manual therapy mechanisms research.International journal of osteopathic medicine : IJOM · 2025Article
- Different ways to reach the same goal: Are the analgesic effects of different types of tactile stimuli similar?European journal of pain (London, England) · 2025Article
- Characteristic of cerebral hemodynamics and functional connectivity in patients with neuropathic pain after spinal cord injury: an exploratory study.Frontiers in neuroscience · 2025Article
- Exploring Pain Empathy Among Doctors, Nurses and Patients: A Scoping Review.Journal of multidisciplinary healthcare · 2025Review
- Relationship evolution shapes inter-brain synchrony in affective sharing: The role of self-expansion.Brain structure & function · 2024Article
- Improving Spiritual Well-Being of Polish Pain Outpatients: A Feasibility Mixed Methods Study.Journal of clinical medicine · 2024Article
Corrections and comments
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Authors and funding
14 authors at 4 institutions in 3 countries.
Funding
Abstract
Social interactions such as the patient-clinician encounter can influence pain, but the underlying dynamic interbrain processes are unclear. Here, we investigated the dynamic brain processes supporting social modulation of pain by assessing simultaneous brain activity (fMRI hyperscanning) from chronic pain patients and clinicians during video-based live interaction. Patients received painful and nonpainful pressure stimuli either with a supportive clinician present (Dyadic) or in isolation (Solo). In half of the dyads, clinicians performed a clinical consultation and intake with the patient prior to hyperscanning (Clinical Interaction), which increased self-reported therapeutic alliance. For the other half, patient-clinician hyperscanning was completed without prior clinical interaction (No Interaction). Patients reported lower pain intensity in the Dyadic, relative to the Solo, condition. In Clinical Interaction dyads relative to No Interaction, patients evaluated their clinicians as better able to understand their pain, and clinicians were more accurate when estimating patients' pain levels. In Clinical Interaction dyads, compared to No Interaction, patients showed stronger activation of the dorsolateral and ventrolateral prefrontal cortex (dlPFC and vlPFC) and primary (S1) and secondary (S2) somatosensory areas (Dyadic-Solo contrast), and clinicians showed increased dynamic dlPFC concordance with patients' S2 activity during pain. Furthermore, the strength of S2-dlPFC concordance was positively correlated with self-reported therapeutic alliance. These findings support that empathy and supportive care can reduce pain intensity and shed light on the brain processes underpinning social modulation of pain in patient-clinician interactions. Our findings further suggest that clinicians' dlPFC concordance with patients' somatosensory processing during pain can be boosted by increasing therapeutic alliance.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.