This story was originally published in The Tower – Volume 1, 2025
Positive interactions with healthcare providers are essential for individuals living with chronic pain as they often face social and emotional challenges related to their condition. Norman W. Kettner, DC (’80), DACBR, FICC, dean of research and professor emeritus of Logan’s Department of Radiology and a team of researchers from Harvard Medical School wanted to explore the brain mechanisms underlying these interactions and their link to pain-related outcomes.
“To optimize care outcomes, we need an improved understanding of all the variables involved in treatment, including the relationship between clinicians and patients,” Dr. Kettner said.
The researchers decided to use hyperscanning to estimate inter-brain connectivity in real time during clinical interactions. Hyperscanning is a neuroimaging technique that simultaneously records the brain activity of two or more people while they interact by using non-invasive methods like electroencephalography (EEG).
“The activity in your brain will mirror the activity in the brains of the people you are working with,” Dr. Kettner said. “Students and teachers, singing groups and bands often experience this brain wave synchrony. The question is: Why?”
The team’s EEG-hyperscanning study collected brain signals from 34 chronic low back pain patients and the licensed acupuncturists who were treating them. The patients were randomly split into two groups: augmented and limited. Those in the augmented group experienced a friendly and attentive clinician who engaged in active listening and delivered personalized treatment. Patients in the limited group saw a narrowly focused physician who intentionally remained neutral and impersonal throughout the visit.
In both groups, pain was administered via a cuff around the patient’s left leg followed by electro-acupuncture treatment from the clinician. After the treatment, therapeutic alliance was assessed using the Consultation and Relational Empathy (CARE) scale, and psycho-emotional affect was evaluated with the Positive and Negative Affect Schedule (PANAS). Brain data was collected using two 64-channel EEG systems. The researchers focused on six scalp regions: frontal, temporal, and central from both the left and right hemispheres.
Although the type of patient-clinician interaction did not impact pain relief, results showed the therapeutic alliance was stronger among those in the augmented group than the limited group. The augmented group reported better moods, higher expectations for pain relief, and more interest in future acupuncture therapy compared to those in the limited group.
“These findings indicate that patients who feel heard and respected by their provider experience higher satisfaction and increased loyalty and are more likely to follow treatment recommendations,” Dr. Kettner said. “Healthcare professionals should work with their patients in a more person-centered manner as well as cultivate their listening and communication skills.”
The brain-to-brain connectivity analysis revealed a greater linkage in the alpha and beta bands between right temporal central areas following augmented versus limited interaction during pain treatment. Additionally, after augmented interaction, clinicians’ right frontal cortex was highly connected with all the patients’ brain regions, particularly the cross-hemispheric left frontal areas.
“This suggests clinicians’ right frontal cortex plays a unique role in sustaining inter-brain synchrony during pain treatment and confirms its involvement in higher order social functions such as recognition of social cues,” Dr. Kettner said.
Dr. Kettner and his team presented their study, “Inter-brain connectivity differs between augmented versus limited patient-clinician interactions,” at the International Association for the Study of Pain (IASP) 2024 World Congress on Pain in Amsterdam on August 8. They hope to also publish it in a peer-reviewed journal covering pain.