MRI scans show that physicians’ brains learn to edit out emotional reactions to patients’ pain during medical procedures, letting them do their jobs. 

Physicians are able to shut off the part of their brain that lets them empathize with a patient’s pain during medical treatment, a new study said.

Instead, their brains activate an area that controls emotions, enabling them to treat patients without being distressed or distracted by the pain they witness.

“If you have to use pain in a procedure and you had no mechanism to regulate [emotions], you would not be able to do your practice,” said study co-author Jean Decety, PhD, a professor in psychology and psychiatry at the University of Chicago. Doctors “have to learn that when they are medical students or else they would be overwhelmed, exhausted or burned out.”

Dr. Decety and Taiwanese researchers studied 14 doctors and 14 nondoctors in Taiwan. The subjects watched videos of people stuck with acupuncture needles in their mouth, hands and feet or people touched with cotton swabs.

Brain scans of nondoctors showed that the pain circuit comprised of the anterior insula, periaqueductal gray and anterior cigulate cortex was activated when they watched people pricked with needles.

“When you see someone else being hurt, you get this quick automatic reaction in the brain,” Dr. Decety said.

The pain region for nondoctors was not activated during the cotton swab touches, according to the study in the Oct. 9 Current Biology.

Physicians showed no increased activity in the pain portion of the brain while watching the needle or cotton swab videos. But they registered increased activity in the frontal brain areas related to emotion regulation and cognitive control.

“The benefit is doctors are not overwhelmed by the pain of others. They can work and be of assistance to them,” Dr. Decety said. “You keep a distance between yourself and [the patient].”

Researchers also asked study participants to rate the level of pain they thought people in the videos experienced. Nondoctors rated pain at seven on a scale of 10. Doctors gave a three rating.

Because they are able to shut down pain regions in their brains, doctors need to be careful not to underestimate the pain of their patients during medical procedures, Dr. Decety said.

“You may be less sensitive to the pain your patient is feeling,” he said. “It’s finding a balance between being sensitive and not too sensitive.”

By Damon Adams http://www.ama-assn.org/amednews/2007/11/12/prsd1112.htm