Vitaly Napadow
Associate Professor at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital and Harvard Medical School in Boston, MA, United States of America.

Brain concordance supports patient/clinician therapeutic alliance and modulates placebo analgesia: a hyperscan fMRI approach.

The patient-clinician relationship and therapeutic alliance can significantly influence how the patient perceives pain. While this factor is acknowledged as significantly contributing (or even driving) analgesia for many clinical therapies, the neural mechanisms supporting this effect are unknown. We simultaneously recorded functional Magnetic Resonance Imaging (fMRI hyperscanning) in patient-clinician dyads, who interact via video transfer, during clinician-initiated treatment of evoked pain in chronic pain (fibromyalgia) patients. We hypothesized concordant activation of circuitry involved in social mirroring, such as ventrolateral Prefrontal Cortex (vlPFC) and anterior Insula (aINS) in both patients and clinicians during pain treatment. Patients’ pain significantly decreased during acupuncture treatment compared to overt no-treatment, which corresponded with lower vicarious pain ratings by clinicians.

Furthermore, patients’ analgesia correlated with clinicians’ estimation of patients’ pain reduction. A conjunction analysis of patients’ and clinicians’ brain response during pain and treatment demonstrated overlapping activation of vlPFC, aINS, and temporoparietal junction (TPJ), all regions previously linked with social mirroring circuitry. Using ROI extraction from the group conjunction mask, we found that association in trial-to-trial variability in activation between patients and clinicians (i.e. the degree of brain concordance) correlated with patients’ analgesia, within dyads. Thus, increased patient-clinician concordance in social mirror circuitry may support socially facilitated placebo analgesia. Our novel experimental design provides a viable framework by which brain-based mechanisms supporting therapeutic alliance can be evaluated in a systematic manner in future studies.



Vitaly Napadow is an Associate Professor at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital and Harvard Medical School in Boston, MA, where he is also the Director of the Center for Integrative Pain Neuroimaging (CiPNI). Vitaly received his Ph.D. in biomedical engineering from the Harvard-MIT Health Sciences and Technology program. Dr. Napadow’s laboratory has pioneered the application of non-invasive neuroimaging techniques to better understand the brain circuitry underlying aversive perceptual states, particularly chronic pain, and to better understand how non-pharmacological therapies ameliorate these states. Specifically, somatosensory, cognitive, and affective factors all influence the malleable experience of pain, and the Napadow Lab has applied human functional and structural neuroimaging to localize and suggest mechanisms by which different brain circuitries modulate pain perception. Dr. Napadow has more than 130 publications in leading peer-reviewed scientific journals and serves on numerous conference, journal, and NIH review panels.