Chronic Pain

Empathy as a Medicine

Does the image of a particular person come to mind when you think of empathy?  Perhaps Abraham and his love for his people…or King David…or Jesus Christ…or Gandhi…or Winston Churchill…or Mother Teresa…they were all empaths.

But, have you ever thought of empathy as a medicine?  What would it mean to you if I could show you that the expression of empathy towards another can actually be shown to function as a medicine neuro-physiologically?  Would I have your attention?

When people think of empathy they usually think of it as an innate personality characteristic.  We often think of it as something that a person is born with…a genetic trait.  And when we see that another doesn’t have it, that should, we have a tendency to “write them off” as if there is no way to learn empathy.

Emotional Intelligence Quotient

Empathy is a constituent of a larger concept called the Emotional Intelligence Quotient or EQ.  EQ is more important to success and life contentment than IQ.  We all know very intelligent people who cannot relate socially or emotionally with other people…they have a high IQ but a low EQ.

In fact, a high IQ and a low EQ may result in the nullification of the benefit of intelligence as we usually think of it. If EQ is so important, not genetic, and can be learned, why is there not more emphasis placed on it in medical education?  The recent studies regarding physician empathy show it to decrease as a young Doctor progresses from medical school to residency training and to private practice.

EQ is not a new concept.  It became popular in 1995, when the “classic” book by Daniel Goleman (a New York Times science writer) was published, “Emotional Intelligence: Why It Can Matter More Than IQ.”  Little did he know how his book would be a catalyst for worldwide change in educational programs engendering what is now known as social and emotional learning or SEL.

SEL has been demonstrated to be associated with improvements in a student’s grade point average, reductions in school violence, improvements in school attendance, and reductions in school suspensions.  Kudos to Mr. Goleman.

I want to emphasize that empathy (the most important part of EQ) actually invokes changes neuro-physiologically that enhances the therapeutic relationship between a Doctor and their patient.  It actually functions like a pain medicine would.  But before we discuss the physiology, let’s define what is meant by empathy.

What Is Empathy?

When you begin to explore the topic of empathy you will find that there is some controversy as to its definition.  A good overall definition of empathy comes from The International Journal of Caring Sciences in an article entitled, “Empathy and Emotional Intelligence: What is it Really About?” by Ioannidou, F and Konstantikaki (click here for the link).

four elements of empahty

Ioannidou and Konstantikaki define empathy as, “the process of understanding a person’s subjective experience by vicariously sharing that experience, while maintaining an observant stance.”  They contend that the “therapeutic relationship” between a healthcare provider and the patient is dependent on this process being fully developed.  It would seem that the healing a pain healthcare provider can provoke in a patient begins before any medicine is given or surgery is performed.

That would mean that a pain practitioner would actually “feel the pain” of a patient with chronic pain, by understanding the patient’s perspective, if they were being empathic.  The field of neuroscience has been able to demonstrate that emotion has measurable effects on functional MRI examination.  Empathy can now be studied in a quantitative way.  The areas of the brain that energize when empathy is manifested can be analyzed.

This leads us to a discussion of the neurophysiology of empathy.

Where Is Empathy For Pain Processed In The Brain?

Empathy for different types of experiences causes different areas of the brain to activate (where blood flow is increased on functional MRI scanning).  When it comes to empathy for pain, the dorsal Anterior Cingulate Cortex and the Anterior Insula are commonly activated (click here for a link to the article on this research).

pain empathy

Similar areas of the brain are activated when experiencing the pain first hand and when a person has empathy for a patient experiencing pain.  This is consistent with the notion that imagining playing the piano activates similar neural pathways to actually playing the piano.

This also means that a pain healthcare provider does not have to actually experience firsthand the pain of their patients in order to empathize.  Understanding what a patient is feeling provokes the neuro-imprinting of empathy as if the provider was experiencing the pain themselves (without the sensory cortex stimulation).

What Happens When A Patient Perceives Empathy In Their Healthcare Provider?

So what would happen if a patient realizes that their pain healthcare provider empathizes with the pain they are experiencing?  There are a number of effects when a patient perceives empathy in their healthcare practitioner:

  • Patient compliance with the advice and instructions given by their healthcare provider goes up dramatically. This would include all aspects of prescriptive medical care.
  • Actual pain reported by the patient goes down (separate and apart from any change in prescribed therapies). The areas of the brain which process empathy are juxtaposed to the areas of the brain that modulate the perception of pain.  The empathy of the pain practitioner that is perceived by the patient is akin to taking a medicine to relieve the pain.
  • Healing rates of surgical techniques for chronic pain improve dramatically when the supervising provider is empathic.
  • Complication rates of surgical techniques for chronic pain are reduced when the supervising provider is empathic.
  • The sense of contentment and satisfaction with the care received from an empathic practitioner is perceived as much higher. This perception holds true even when the mechanical care given is the same between an empathic and non-empathic provider.
  • The complication rates of medicinal therapies prescribed by empathic pain providers is less than the non-empathic. This holds true even when the prescribed therapies are equivalent.
  • The practice retention rate of patients with empathic practitioners is very high. The malpractice rates with empathic physicians is also lower.

How To Teach Empathy ?

The following recommendations on teaching empathy are taken from the courses taught on empathy at the Drexel College of Medicine in Philadelphia, Pennsylvania.  “Medical students take part in empathy training during their first year. In their second year, that training is reinforced.”

“By the time they hit their third year, students take part in a webcam-based simulation developed at the College that uses actors portraying patients to test what the students have learned and determine how well they apply it” (according to Frank Otto the author of, “The 5 Things You Didn’t Know About Teaching Empathy”).

The course emphasizes:

  • Separating empathy from sympathy.

Sympathy is feeling what the patient feels without understanding…empathy is understanding what they feel but not necessarily feeling it.

  • Empathy is a skill that can be developed. Elements of empathy might include:

-Reflection:  ask about the patient’s emotions.

-Legitimization:  affirm the patient’s emotional reaction (which doesn’t require agreement).

-Partnership:  emphasizing that you will work with them through their present trial.

-Summarization:  retelling the patient’s story and checking with them for the accuracy of your summary.

  • Introspect and recognize personal biases.

Empathy does not require that a healthcare provider discard their own beliefs.  However, where those beliefs may conflict with the therapeutic relationship with a patient, a provider must put the patient’s perspective as a first priority.

  • A healthcare provider must be focused and present in an interview with a patient.

The patient must feel that, for whatever time the provider is with them, they have their undivided attention.  This may be very challenging given the many distractions that are competing for a Doctor’s attention (not to mention the electronic medical record).


I have included a TED talk digital video given by Dr. Paul Rosen on empathy.  I think you will like it and be encouraged that many of us will not rest until every patient is treated with empathy:

I have reviewed for you empathy as the most important aspect of emotional intelligence.  Empathy is not a genetic characteristic but a skill that must be taught and practiced by anyone who decides to be a member of the “helping professions.”

Empathy enhances the therapeutic effect of nearly any treatment.  It is, in effect, a medicine in its own right.

Empathy is also an essential life skill for anyone who wants to have happy and meaningful relationships in life.  I hope you have enjoyed this posting.


Wishing you much joy and peace,

Dr. Jeffrey Bado, D.O.

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