Spirituality in pain medicine: A randomized experiment of pain perception, heart rate and religious spiritual well-being by using a single session meditation methodology

Learning how to explore spiritual aspects in encounters with patients with chronic pain: a pre-test post-test trial on the effectiveness of a web-based learning intervention

BACKGROUND

Integrating spiritual aspects into treatment plans can release essential resources for coping with chronic pain. However, some spiritual aspects may also induce distress and hinder the coping process. There is a lack of evidence regarding how to perform the clinical tasks of exploring spiritual aspects and of instruments assessing related competencies. Therefore, we developed a web-based learning module to provide education on the subject alongside corresponding assessment instruments. The module presents the InSpiRe (Integration of Spirituality and/or Religion in patient encounters) protocol. The instruments encompass cognitive, affective, and behavioral dimensions.

METHODS

This paper aims to determine (i) the learning effects associated with completing the web-based spiritual-care learning module and (ii) the reliability and validity of the instruments employed. To address these aims, we conducted a pre-test/post-test trial with N = 32 randomly selected fourth-year medical students. During the pre-test, we assessed the students' knowledge, attitudes, and self-efficacy regarding exploring spiritual aspects. For this purpose, we developed a short-answer knowledge test, an attitude questionnaire, and a self-efficacy scale. Additionally, the students explored spiritual aspects with a simulated patient portraying a person with chronic pain. Three trained raters evaluated the students' performances using a self-developed scale. In the intervention phase, the students completed the 45-minute learning module on a personal computer. The module presented InSpiRe-related content as text and step-by-step video demonstrations, including hints that denote critical actions. The subsequent post-test was identical to the pre-test.

RESULTS

The internal consistency was suitable for all respective instruments, and there was an indication of solid validity of the performance test. After completing the spiritual care learning module, the students showed statistically significant increases in knowledge scores and significant positive shifts in their attitudes and levels of self-efficacy regarding exploring spiritual aspects. They also attained significantly higher performance scores in the same regard.

CONCLUSIONS

Completing the spiritual-care module is associated with meaningful learning effects on cognitive, affective, and behavioral dimensions related to exploring spiritual aspects, as demonstrated in the post-test conducted shortly after the intervention. Due to good reliability and validity scores, the self-developed instruments can be applied appropriately.

Correlation between symptom status, health perception, and spiritual well-being in heart failure patients: A structural equation modeling approach

AIM

To explore predictors of spiritual well-being behaviors among heart failure patients based on Wilson and Cleary's conceptual model of health-related quality of life and to clarify the interrelationships among these variables.

DESIGN

A descriptive and correlational study design was used.

METHODS

This study included 202 heart failure patients treated between October 2020 and July 2021. Data were collected using the Symptom Status Questionnaire-Heart Failure, Perception of Health Scale, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale. Descriptive analysis, correlation, and structural equation modeling were performed.

RESULTS

Characteristic factors positively affected spiritual well-being both directly (β = 0.19, p = 0.007) and indirectly (β = 0.19; CI (0.106; 0.311)). The direct relationship between health perception and spiritual well-being was significant (β = 0.83, p < 0.05). Symptom status acted as an essential mediator between model variables and spiritual well-being (β = -0.28; CI (-0.449; -0.133)). Comorbidity and symptom status also influence spiritual well-being through health perceptions. These variables explain 77% of the variance in spiritual well-being.

CONCLUSION

The modified structural equation modeling based on Wilson and Cleary's conceptual model fits well in predicting spiritual well-being in patients with heart failure. Spiritual well-being was reported to be poor, and changes in spiritual well-being were predicted by age, educational level, marital status, comorbidity, symptom status, and health perception. The results can be applied to patients with heart failure and may serve as a guide for assessment and interventions for improving spiritual well-being.

CLINICAL RELEVANCE

This study mainly concludes that symptom status and perceived health status affect spiritual well-being in heart failure patients. Symptom relief and improvement in perceived health status interventions may help enhance spiritual well-being in this population. Future studies are needed to investigate the different predictor's effects on spiritual well-being and examine whether symptom management and health status-enhancing interventions result in improved spiritual well-being in the heart failure population.

REPORTING METHOD

This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Divine resilience: Unveiling the impact of religious coping mechanisms on pain endurance in arab older adults battling chronic pain

BACKGROUND

Chronic pain diminishes the quality of life for many Older Adults individuals. Identifying effective coping methods to enhance pain resilience is imperative as populations age. Older Adults commonly use religious faith and spiritual practices to endure pain, yet little research has explored their impact on pain tolerance.

METHODS

This cross-sectional study examined relationships between positive/negative religious coping styles and pain endurance in 200 Arab elders with chronic pain. Participants completed the Brief Arab Religious Coping Scale, Numeric Pain Rating Scale, WHOQOL-BREF, and demographic/medical history questionnaires.

RESULTS

Quantitative analysis demonstrated significant positive associations between positive religious reappraisal and active spiritual coping with higher self-reported pain endurance (p<.05). Negative religious coping styles lacked meaningful relationships with pain tolerance. Multiple regression confirmed the unique effects of reappraisal and spiritual practice on improving pain resilience, controlling for covariates.

CONCLUSIONS

Outcomes align with perspectives highlighting multidimensional neurocognitive, emotional, and psychosocial pain relief from religious coping. Findings underscore integrating positive faith-based resources in biopsychosocial paradigms for Older Adult's pain management. Additional research should investigate causal pathways and contextual factors influencing religious coping effects on diverse Older Adult subgroups.

Opioid use disorder and role of yoga as an adjunct in management (OUDARYAM): Study protocol for a randomized controlled trial

Background

The proposed research aims to test the effects and mechanisms of a six-month yoga-based intervention as an add-on to standard treatment in opioid use disorder (OUD) by conducting a randomized controlled study with the following primary outcome variables: 1) clinical: abstinence (opioid negative urine test), and reductions in pain and craving, and 2) mechanisms: reward circuit activation in response to opioid visual cue craving paradigm, activation in response to a cognitive control task, and resting state functional connectivity through fMRI, and plasma beta-endorphin levels. Secondary outcome variables are perceived stress, anxiety, sleep quality, cognitive performance, pain threshold, buprenorphine dosage and side effects, withdrawal symptoms, socio-occupational functioning, vedic personality traits, heart rate variability, serum cortisol, and brain GABA levels through magnetic resonance spectroscopy (MRS).

Methods

In this single-blinded, randomized, controlled, parallel-group superiority trial with 1:1 allocation ratio, 164 patients with OUD availing the outpatient/ inpatient clinical services at a tertiary mental healthcare hospital in India will be enrolled after giving informed consent. Consecutive consenting patients will be randomly allotted to one of the two groups - yoga arm (standard treatment + yoga-based intervention), or waitlist group (standard treatment alone). Allocation concealment will be followed, the clinicians, outcome assessors and data analysts will remain blind to subject-group allocation. A validated and standardized yoga program for OUD will be used as an intervention. Participants in the yoga arm will receive 10 supervised in-person sessions of yoga in the initial two weeks followed by tele-yoga sessions thrice a week for the next 22 weeks. The wait-list control group will continue the standard treatment alone for 24 weeks. Assessments will be done at baseline, two weeks, 12 weeks, and 24 weeks. Data from all randomized subjects will be analysed using intent-to-treat analysis and mixed model multivariate analysis.

Dissemination

Findings will be disseminated through peer-reviewed publication, conference presentations, and social media.

Trial registration number

The trial has been registered under Clinical Trials Registry-India with registration number CTRI/2023/03/050737.

Investigation of the Relationship Between Religious Attitude and Postpartum Physical and Perineal Pain in Iran

Postpartum pain is one of the most important and common problems of postpartum mothers who resort to non-pharmacological strategies to relieve it due to the side effects of painkillers. This study was conducted to investigate the relationship between religiosity and postpartum physical and perineal pain. The sample size in this cross-sectional study was 101 women giving birth in educational and medical centers of Shiraz, Iran, that was selected by purposive-convenience sampling. Then, a questionnaire was completed for each of them including demographic characteristics, religious attitude, and visual scale of postpartum pain. Data were analyzed by SPSS software. The frequency of the majority of the research population was found at moderate religious attitudes 65.4% (72 individuals). There is a positive and Statistical inverse correlation between religious attitude and perineal pain. According to Fisher's test, in mothers with a high religious attitude, 9.7% had severe perineal pain, 41.9% had moderate pain, and 48.4% had mild pain (p = 0.001). Besides, in the case of physical pain, 3.2%, 35.5%, and 61.3% had severe, moderate, and mild pain, respectively. Regarding physical pains, with the increase in the level of mothers' religious attitude, physical pains also decreased, but the statistical relationship was not significant (p = 0.32). The results showed that the religiosity and spirituality of pregnant women have relieving effects on postpartum pain. Therefore, more attention to the spiritual dimension of human existence and planning to improve it using prayer therapy, dhikr, and meditation is suggested as a strategy to deal with the fear of pain and childbirth and reduce psychological and physical changes before and after childbirth. These findings apply to women with ectopic pregnancies in Iran.

A Latin American consensus meeting on the essentials of mixed pain

OBJECTIVES

The term "mixed pain" has been established when a mixture of different pain components (e.g. nociceptive, neuropathic, and nociplastic) are present. It has gained more and more acceptance amongst pain experts worldwide, but many questions around the concept of mixed pain are still unsolved. The sensation of pain is very personal. Cultural, social, personal experiences, idiomatic, and taxonomic differences should be taken into account during pain assessment. Therefore, a Latin American consensus committee was formed to further elaborate the essentials of mixed pain, focusing on the specific characteristics of the Latin American population.

METHODS

The current approach was based on a systematic literature search and review carried out in Medline. Eight topics about the definition, diagnosis, and treatment of mixed pain were discussed and voted for by a Latin American consensus committee and recommendations were expressed.

RESULTS

At the end of the meeting a total of 14 voting sheets were collected. The full consensus was obtained for 21 of 25 recommendations (15 strong agreement and 6 unanimous agreement) formulated for the above described 8 topics (7 of the 8 topics had for all questions at least a strong agreement - 1 topic had no agreement for all 4 questions).

CONCLUSION

In a subject as complex as mixed pain, a consensus has been reached among Latin American specialists on points related to the definition and essence of this pain, its diagnosis and treatment. Recommendations for diagnosis and treatment of mixed pain in Latin America were raised.

The Effect of Listening to the Recitation of the Surah Al-Inshirah on Labor Pain, Anxiety and Comfort in Muslim Women: A Randomized Controlled Study

This study aimed to identify whether listening to the recitation of the Surah Al-Inshirah (94th Chapter of the Holy Qur'an) during labor had any effect on women's pain, anxiety and comfort levels. Designed as a randomized controlled trial, the study was performed with the participation of 126 pregnant Muslim women. The study showed that listening to the recitation of the Surah Al-Inshirah during labor had positive effects on the women's pain, anxiety and comfort levels. In this respect, it is recommended that based on individuals' religious beliefs, spiritual elements such as surahs, prayers and hymns be integrated into the midwifery care offered during labor.

Effect of Mindfulness-Based Art Therapy (MBAT) on Psychological Distress and Spiritual Wellbeing in Breast Cancer Patients Undergoing Chemotherapy

Objectives

Psychological distress and spiritual well-being (SWB) are directly related to the quality of life in cancer patients. Mindfulness-Based Art Therapy (MBAT) integrates mindfulness practices with art therapy and has shown to decrease distress levels and improve SWB in women with breast cancer. The objective of the study was to identify the effects of a 1-week MBAT intervention on psychological distress and SWB in breast cancer patients undergoing chemotherapy.

Materials and Methods

This was a single group, pre-test post-test study carried out in a clinical setting. The psycho-oncology assessment questionnaire, Distress Thermometer (DT) and Functional Assessment of Chronic Illness Therapy-SWB Scale 12 (FACIT-SP12) Version 4 were administered before, post1^st supervised MBAT session and post 1 week of home practice to breast cancer patients undergoing chemotherapy (n = 30). The MBAT intervention included mindfulness meditation for 15 min and mindful coloring for 30 min daily for 1 week. Data analysis was done using R i386 4.0.3.

Results

The median DT score significantly decreased from pre-session to immediate post-session and pre-session to post 1-week session. The median of meaning, peace, and faith subscales of FACIT SP12 scores along with total FACIT SP12 score significantly increased from pre-session to immediate post-session as well as from pre-session to post 1 week.

Conclusion

One-week MBAT intervention for breast cancer patients undergoing chemotherapy significantly decreased the psychological distress and significantly improved the SWB in terms of meaning, peace, and faith.

Gender Differences in Psychosocial, Religious, and Spiritual Aspects in Coping: A Cross-Sectional Study with Cancer Patients

Background: There is a growing awareness of religiosity and/or spirituality (R/S) as a possible resource in coping with cancer. Gender differences in religious coping have not yet been thoroughly examined. This study aimed to analyze differences in religious coping between men and women with cancer and compare the impact of R/S on anxiety and depression symptoms.

Methods: This cross-sectional study was conducted at the Divisions of Hematology and Oncology of the Medical University of Vienna. In total, 352 patients with a cancer diagnosis, who regarded themselves as religious and/or spiritual, were interviewed at Vienna's university hospital with standardized questionnaires. To answer our research questions, we used the Hospital Anxiety and Depression Scale (HADS), the Benefit Through Spirituality/Religiosity (Benefit) questionnaire, and collected demographic characteristics.

Results: Of 689 cancer patients, 51% (352) regard themselves as religious and/or spiritual. Women with cancer tend toward R/S more significantly (57%) than men (45%). In patients with an R/S belief, women scored higher in almost all items of the Benefit questionnaire and showed higher prevalence of anxiety (p < 0.001) and depression than men. Regarding the socioeconomic characteristics, more women were widowed, and had significantly lower income than men.

Conclusions: The results show a significant gender gap concerning the importance of R/S for cancer patients and the effect on psychological well-being.

Women in this study were more religious/spiritual than men and scored higher on anxiety and depression. We support the notion that the gender perspective is essential and can contribute to better patient care in identifying gender-specific concerns.

Spiritual interventions for cancer pain: a systematic review and narrative synthesis

BackgroundPain is a common and debilitating cancer-related symptom. In palliative care, physical, psychological, social and spiritual factors are thought to contribute to individual experience of pain. Consequently, spiritual care interventions are advocated in the management of cancer-related pain.

AIM

To systematically review the published literature concerning spiritual interventions in the management of cancer-related pain.

METHODOLOGY

Seven databases (Medline, CINAHL, EMBASE, PsycINFO, Cochrane, Scopus and Web of Science) were searched for quantitative studies of pain in patients with cancer receiving spiritual care interventions, with additional reference and citation searches. Research quality and relevance was appraised using Gough's 'Weight of Evidence' framework prior to narrative synthesis.

RESULTS

The search identified 12 822 articles, of which 11 were included in the synthesis. Few studies have investigated spiritual interventions in the management of cancer pain: a minority of these demonstrate statistical benefit. Some evidence suggests spiritual care may aid in coping with pain, rather than altering pain intensity. Spiritual interventions are well received by patients with cancer and do not appear to cause harm.

CONCLUSION

Current evidence provides limited support for the use of spiritual care interventions in the management of cancer pain. The paucity and heterogeneity of literature points to a need for high-quality research with judgements of spiritual intervention efficacy made on an individual basis.

PROSPERO REGISTRATION NUMBER

CRD42020190194.

Prayer as a pain intervention: protocol of a systematic review of randomised controlled trials

BACKGROUND

Pain is a universal experience and the most common reason for seeking healthcare. Inadequate pain management negatively impacts numerous aspects of patient health. Multidisciplinary treatment programmes, including psychosocial interventions, are more useful for pain management than purely biomedical treatment alone. Recently, researchers showed increasing interest in understanding the role of spirituality/religiosity and spiritual/religious practices on pain experience, with engagement in religious practices, such as prayer, showing to positively impact pain experience in religious individuals. This systematic review will seek to summarise and integrate the existing findings from randomised controlled trials assessing the effects of prayer and prayer-based interventions on pain experience.

METHODS

The systematic review procedures and its report will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Electronic searches in nine databases (Web of Science Core Collection, MEDLINE, SCIELO Citation Index, PubMed, Cochrane Central Register of Controlled Clinical Trial, PsycINFO, Scopus, LILACS and Open-SIGLE) will be performed to identify randomised controlled trials of prayer-based interventions. Two independent researchers will assess studies for inclusion and extract data from each paper. Risk of bias assessment will be assessed independently by two reviewers based on the Consolidated Standards of Reporting Trials statement. Qualitative synthesis of the body of research will be conducted using a narrative summary synthesis method. Meta-analysis will be limited to studies reporting on the same primary outcome. Formal searches are planned to start in June 2021. The final report is anticipated to be completed by September 2021.

DISCUSSION

Findings will be useful to (1) understand the condition of our knowledge in this field and (2) provide evidence for prayer effectiveness in reducing pain intensity and pain-related stress and increasing pain tolerance in adults experiencing acute or chronic pain.

PROSPERO REGISTRATION NUMBER

CRD42020221733.

"Test Your Spirituality in One Minute or Less" Structural Validity of the Multidimensional Inventory for Religious/Spiritual Well-Being Short Version (MI-RSWB 12)

Background: The Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB 48) was developed in order to address a religious/spiritual dimension as being an important part of psychological well-being. In the meantime, the instrument has been successfully applied in numerous studies. Subsequently, a short version, the MI-RSWB 12 was constructed, especially for the use in clinical assessment. Here it is intended to contribute to the further development of the MI-RSWB 12 by investigating its structural validity through structural equation modeling.

Materials and Methods: A total sample of 1,097 German-speaking adults (744 females; 67.8%; Age range: 18–69 years) from the normal population filled in the MI-RSWB 12 via an online-survey. In line with theoretical assumptions 5 different factor structure models for the MI-RSWB 12 were tested: (1) a single-factor model, (2) a model with four correlated RSWB dimensions, (3) a single higher-order model with four lower order factors, (4) a two higher-order model with four lower order factors, (5) a bifactor model, which includes four specific RSWB dimensions.

Results: The single-factor model provided the poorest model fit, with no indices falling within the acceptable range. The four-factor, two higher-order factors and the bifactor models showed overall acceptable fit indices. With regard to the Akaike information criterion (AIC), the four-factor model demonstrated superiority compared to both the two higher-order factor model and the bifactor model, which in turn showed did not differ from each other.

Conclusion: Four different MI-RSWB 12 sub-scales should be calculated in future studies, while a general factor and two higher order factors are statistically valid as well. Further applications of the MI-RSWB 12, especially in the clinical patient groups, are encouraged.

Pain sensitivity and autonomic nervous system parameters as predictors of dry eye symptoms after LASIK

PURPOSE

Differences in pain processing and autonomic function among patients have been implicated in the development of chronic pain after surgery. This study was designed to evaluate whether pain and autonomic metrics predict severity of chronic dry eye (DE) symptoms after LASIK, as there is increasing evidence that DE symptoms may be manifestations of persistent post-operative ocular pain.

METHODS

Secondary analysis of prospective randomized clinical trial. Patients were treated with either pregabalin or placebo. As no significant differences in DE symptoms were detected by treatment allocation at six months, all participants were grouped together for the present analyses. Subjects were evaluated pre-LASIK with regard to evoked pain sensitivity (utilizing quantitative sensory testing), autonomic metrics and DE and ocular pain symptoms (via validated questionnaires). Measures of DE and ocular pain were assessed post-LASIK, and the Dry Eye Questionnaire 5 (DEQ5) score 6-months after surgery was the primary outcome of interest.

RESULTS

43 individuals were randomized to pregabalin (n = 21) or placebo (n = 22). 42 completed the 6-month visit. Several baseline autonomic metrics correlated with 6-month post-operative DEQ5 scores, including lower systolic (r -0.37, p = 0.02) and diastolic blood pressure (r -0.32, p = 0.04). Ocular pain at 6 months was also negatively correlated with blood pressure (r -0.31, p = 0.047). The presence of painful aftersensations was a significant predictor of chronic DE symptoms at 6 months (mean DEQ5 scores: 8.0 ± 1.9 versus 5.0 ± 5.0, p = 0.009).

CONCLUSIONS

Heightened parasympathetic tone and prolonged pain sensitivity measured prior to surgery predicted greater DE symptom severity 6 months after LASIK.

TRIAL REGISTRATION

NCT02701764.

Acute Effects of Brief Mindfulness Intervention Coupled with Carbohydrate Ingestion to Re-Energize Soccer Players: A Randomized Crossover Trial

Background: This field experiment investigated the acute effects of brief mindfulness-based intervention (MBI) coupled with carbohydrate (CHO) intake on players' recovery from half-time break in a simulated soccer competition. Methods: In a single-blinded randomized crossover experiment, 14 male players received 3 treatments (Control: non-carbohydrate solution + travelling introduction audio; CHO: CHO-electrolyte solution + travelling introduction audio; and CHO_M: CHO-electrolyte solution + MBI) during simulated half-time breaks. Vertical jump, sprint performance, mindfulness level, rate of perceived exertion, muscle pain, mental fatigue, blood glucose, and lactate were measured immediately before, during, and after the exercise. Results: (1) MBI significantly increased participants' mindfulness level (Control vs. CHO_M, p < 0.01; CHO vs. CHO_M, p < 0.01) and decreased mental fatigue for CHO_M condition (pre vs. post, p < 0.01); (2) participants in the CHO_M condition performed better in the repeated sprint tests than in the Control and CHO condition (Control vs. CHO_M, p = 0.02; CHO vs. CHO_M, p = 0.02). Conclusion: Findings of this study provide preliminary evidence of the positive effect of MBI coupled with CHO ingestion on athletes' recovery from fatigue in the early stage of the second half of a game.

Outcomes of Randomized Clinical Trials of Interventions to Enhance Social, Emotional, and Spiritual Components of Wisdom: A Systematic Review and Meta-analysis

Importance

Wisdom is a neurobiological personality trait made up of specific components, including prosocial behaviors, emotional regulation, and spirituality. It is associated with greater well-being and happiness.

Objective

To evaluate the effectiveness of interventions to enhance individual components of wisdom.

Data Sources

MEDLINE and PsycINFO databases were searched for articles published through December 31, 2018.

Study Eligibility Criteria

Randomized clinical trials that sought to enhance a component of wisdom, used published measures to assess that component, were published in English, had a minimum sample size of 40 participants, and presented data that enabled computation of effect sizes were included in this meta-analysis.

Data Extraction and Synthesis

Random-effect models were used to calculate pooled standardized mean differences (SMDs) for each wisdom component and random-effects meta-regression to assess heterogeneity of studies.

Main Outcomes and Measures

Improvement in wisdom component using published measures.

Results

Fifty-seven studies (N = 7096 participants) met review criteria: 29 for prosocial behaviors, 13 for emotional regulation, and 15 for spirituality. Study samples included people with psychiatric or physical illnesses and from the community. Of the studies, 27 (47%) reported significant improvement with medium to large effect sizes. Meta-analysis revealed significant pooled SMDs for prosocial behaviors (23 studies; pooled SMD, 0.43 [95% CI, 0.22-0.3]; P = .02), emotional regulation (12 studies; pooled SMD, 0.67 [95% CI, 0.21-1.12]; P = .004), and spirituality (12 studies; pooled SMD, 1.00 [95% CI, 0.41-1.60]; P = .001). Heterogeneity of studies was considerable for all wisdom components. Publication bias was present for prosocial behavior and emotional regulation studies; after adjusting for it, the pooled SMD for prosocial behavior remained significant (SMD, 0.4 [95% CI, 0.16-0.78]; P = .003). Meta-regression analysis found that effect sizes did not vary by wisdom component, although for trials on prosocial behaviors, large effect sizes were associated with older mean participant age (β, 0.08 [SE, 0.04]), and the reverse was true for spirituality trials (β, -0.13 [SE, 0.04]). For spirituality interventions, higher-quality trials had larger effect sizes (β, 4.17 [SE, 1.07]), although the reverse was true for prosocial behavior trials (β, -0.91 [SE 0.44]).

Conclusions and Relevance

Interventions to enhance spirituality, emotional regulation, and prosocial behaviors are effective in a proportion of people with mental or physical illnesses and from the community. The modern behavioral epidemics of loneliness, suicide, and opioid abuse point to a growing need for wisdom-enhancing interventions to promote individual and societal well-being.

Relationship Between Spiritual Health and Pain Self-Efficacy in patients with Chronic Pain: A Cross-Sectional Study in West of Iran

In recent years, the prevalence of chronic diseases has had a growing trend, which has resulted in many health problems. Level of belief in God is effective on people's attitudes to life concepts, social deviations and psychological disorders, and improves them. Therefore, the present research was conducted with the aim of determining the relationship between spiritual health (SH) and pain self-efficacy (PSE) in Ilam City in 2018. This study was a descriptive cross-sectional study in the group of patients with chronic pain (CP). In this study, the study population was patients with CP in Ilam City and the study sample was 150 patients with CP referring to public and private health centers in Ilam, which had all the criteria for participation in the study. The findings showed mean (SD) of the total score of SH variables was 65.16 (9.88), and PSE was 34.48 (4.08). According to Pearson statistical analysis, there is a significant relationship between SH and PSE (r = 0.442, P = 0.000). Also, the standard beta and non-standard beta coefficients for SH variables in PSE show that the non-standard beta coefficient in SH is equal to 0.183. The results of this study showed that SH is a predictor of pain acceptance, so that patients who were more religious were more likely to tolerate CP. For this reason, it is suggested that religious interventions be performed to reduce pain in patients with CP, in order to provide the necessary context for pain reduction in this group of patients.