Religion. Is God Causing Your Low Back Pain?
Religion is sometimes asked for on admissions forms, usually as a form of monitoring who is gaining access to healthcare resources and sometimes so that religious preferences can be respected. However, religion has received only a little attention as a mediator of the pain experience.
1. The Low Back of a Buddhist and a Christian are Running On Different Software
Religion forms an important part of our “software”. This is a key way Paul Chek explains the importance of religion. Even stories we are told as a child may influence our behaviour and interpretation of events later in life. If you get back pain it is not unusual for someone to think what have I done to deserve this? Do I have bad Karma? Do I deserve this pain? Is it a test?
Wallden & Chek (2018) argue the case that currently medicine lacks “soul”. They highlight that the majority of clinicians and patients are not atheists. Furthermore an awareness of how unconscious behavioral programming accounts for the majority of lifestyle habits and perceptions, may facilitate more effective outcomes. Our religious beliefs greatly influence these behaviours. Meaning the “software” that runs a Christian is different to that of a Buddhist or and Atheist. For example In a meta-analysis of 147 independent studies of religiousness and depressive symptoms, religiousness appeared to protect against depression, particularly in times of major life stress. The Bio-Psycho-Social-Spiritual Model suggests individuals’ spirituality and spiritual forms may play an important role in coping with illness and pain (Wachholtz et al 2007). Whilst everyone enjoys adding new parts to models perhaps spirituality should just be considered as a potential mediator of pain in low back pain patients within whichever framework or model clinicians are already using.
2. Does Religion Affect Low Back Pain?
Johnstone et al’s (2012) study of Buddhists, Jews, Muslims, Christians and Protestants found no difference in health outcomes between groups.
The relationship between spirituality and mental health was strongest among those reporting higher levels of pain (Smith et al 2003). Potentially suggesting those in pain search more for a spiritual solution or perhaps the converse, but there may well be a relationship.
Religion may also moderate the pain experience through altered beliefs. Stompe et al (2006) examined guilt in 1006 schizophrenic subjects from Austria, Poland, Lithuania, Pakistan, Nigeria and Ghana. 15.5% of the Roman Catholic patients reported delusional guilt whereas only 3.8% of Muslim patients did.
3. Negative Religious Coping
Similarly, research has shown that negative spiritually based thoughts such as the perception, God is abandoning me, is related to increased pain sensitivity (Wachholtz et al 2010).
Baetz and Bowen (2008) obtained data from 37, 000 individuals, 15 years of age or older, with fibromyalgia, back pain, migraine headaches and chronic fatigue syndrome. In their study those who were spiritual but not affiliated with regular worship attendance were more likely to have those conditions. This may obviously have been affected by these conditions preventing them from attending services and practicing their spirituality. Alternatively it be that the lack of guidance led to use religion negatively and not positively. They also found that those with chronic pain and fatigue were more likely to use prayer and seek spiritual support as a coping method compared to other people. Pain sufferers who were both religious and spiritual were more likely to have better psychological well-being and use positive strategies (Baetz and Bowen 2008).
Rippentrop et al (2005) examined religious/ spiritual beliefs in 122 patients with chronic musculoskeletal pain, 55% back pain. Private religious practice such as prayer and reading religious materials were more common in those with pain and poor health. Pain patients feel less desire to reduce pain in the world and feel more abandoned by God. Forgiveness, negative religious coping, daily spiritual experiences, religious support, and self-rankings of religious/spiritual intensity significantly predicted mental health status. Religion/spirituality was unrelated to pain intensity and life interference due to pain.
McCabe et al (2018) found a significant negative correlation between the strength of meaning and purpose and depression and pain catastrophising. Similarly there were positive correlations with meaning and purpose and pain self-efficacy and satisfaction with life.
Bush et al (1999) found that positive coping was associated with better mental and physical health. Negative copers felt they were punished or abandoned by God, or saw the pain as retribution from God; this during the time when they most needed support. Religious coping efforts were more helpful than nonreligious coping (Bush et al 1999). However, some types of religious and/or spiritual coping strategies are adaptive while other types are maladaptive. Positive coping includes asking for help from God, praying to God for the strength to endure and seeking spiritual support from the community. Positive religious and/or spiritual interventions appear to play an important role in pain management and reduction of suffering (Wachholtz and Keef 2006). Negative coping includes deferring all responsibility to God, feeling abandoned or punished by God, and blaming God for difficulties (Pargament et al 1998, Bussing et al 2009). Prayer, when used as a means to relinquish control and responsibility for pain solutions, can negatively impact disability and perceived self-control (Ashby and Lenhart 1994, Sheehan 2005).
4. Possible Mechanisms For Religious Coping
Wiech et al (2009) famously demonstrated the benefits of religious idols in modulating the pain experience. Twelve practicing Catholics and twelve non-religious, non-spiritual individuals were shown two pictures of women in a similar pose, the Virgin Mary and an unknown woman, while they received a repetitive noxious electrical stimulation whilst undergoing Functional Magnetic Resonance Imaging (fMRI). Both groups were equally sensitive to the pain at baseline. However, the religious group reported less pain when looking at the picture of the Virgin Mary while the non-religious group reported the same amount of pain. On further questioning the Catholic participants described being in a more calm, meditative state when the religious image was presented to them. These researchers found that the right ventrolateral prefrontal cortex cluster in the brain was specifically activated in the religious sample when looking at the Virgin Mary, but not in the nonreligious sample. The ventrolateral prefrontal cortex is also involved in other cognitive processes, which is long-term memory and working memory maintenance. Fascinatingly the fMRI results suggested that the Catholics used self-focused reappraisal, to down regulate the perceived intensity of the pain when presented with a religious image (Wiech et al 2009).
5. Personality vs Religion
Johnstone et al (2012) found better mental health correlated with greater spirituality as measured on the brief multidimensional measure of religiousness/ spirituality, increased positive personality traits and decreased negative personality traits. Forgiveness appeared to be a key mediating factor. They also found religiousness was correlated with more positive personality traits such as extraversion and less negative personality traits such as neuroticism. When using hierarchical analysis it appeared that personality traits were superior predictors of health outcomes than spiritual variables.
6. Lack Of Forgiveness and Low Back Pain
Carson et al (2005) studied the relationship of forgiveness to pain, anger, and psychological distress in 61 patients with chronic low back pain. Patients with higher scores on forgiveness-related variables reported lower levels of pain, anger, and psychological distress. The association between forgiveness and psychological distress was medited largely by anger, as well as some of the associations between forgiveness and pain.
Clearly our spirituality can impact how we interpret sensations and events in both positive and negative ways. It seems that using positive religious coping may be better than no religious or spiritual practice. There are many mechanisms not discussed that likely play a huge role in particular the social elements. Similarly, the influence of these thoughts on the immune system and our inflammatory response likely have a relatively direct impact on the pain experience. Once I’ve stopped praying I will look at these.
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