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Joe Tatta, PT, DPT

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Spirituality and pain management. Evidence-based or hocus pocus?

Why is there so much pain in life? And does collaborating with a higher power help to ease the suffering?

Most importantly, what impact do the spiritual beliefs of your patient have on their ability to cope with pain?

Spiritual beliefs of the patient are a valuable asset for helping manage pain. With anywhere from 41%-94% of patients wanting their practitioner to address spiritual factors in pain, there is a high demand for spiritual assistance in healthcare (1). In order to meet the needs of our patients, we must educate ourselves about spirituality and the role it plays in healthcare and pain management. Despite the common interest in spiritual coping mechanisms among patients, many clinicians are unable to define the concept of spirituality. By incorporating specific methods into practice, we can help patients strengthen their spirituality and increase their overall sense of well-being.

 

What is Spirituality?

Spirituality can be defined as how someone views the purpose of their life. By focusing on more than material objects in life, a spiritual person can maintain a bond with their spirit or soul. Some common ways that people can create a connection with spirituality may be through the following:

  • Religion
  • Meditation
  • Prayer
  • Family
  • Friends
  • Music
  • Art
  • Writing
  • Nature
  • Passions
  • Hobbies

People display different patterns of spiritual coping depending on the role of spirituality in their life. Coping patterns determine the strategies that may be utilized in adverse situations. When patients are faced with situations that are painful, a spiritual connection will most likely be one of the coping mechanisms they will want to use. For this reason, it is important for clinicians to know what spirituality is and how it can be used for the rejuvenation of the mind and body.

Coping patterns determine the strategies that may be utilized in adverse situations Click To Tweet

Different Patterns of Spiritual Coping

Different people view their control over the events that occur in their lives in different ways. Some may believe that they have complete control over everything that happens and assume full responsibility, while others believe everything happens depending on Gods plan. The locus of control that someone believes they have over their lives can be described by three different terms:

  • Self-Directing
  • Deferring
  • Collaborative

Determining which term may describe your patient would involve identifying the how passive or active they seem to be in causing the situations that arise in their life, and how much of an influence they seem to believe a higher power possesses.

 

Self-Directed Coping

If someone is in a painful situation and they believe that there is a higher power, but they have control over their circumstances, they would be utilizing self-directed coping for their pain. This coping pattern leads to a better ability to deal with adverse situations through problem-solving and raises overall satisfaction with life (2). These people may see their connection with a higher power as more of a friendship where they turn to God for emotional support and comfort but work to resolve problems on their own. These people may feel abandoned by their higher power in times of struggle and may become frustrated if things do not go according to their plan. It will be vital for you to remind them of the connection they have with their higher power and encourage them to seek comfort in this time of struggle. Motivate them to continue to do the best they can to achieve their goals, and assure them that their hard work will pay off.

 

Deferred Coping

You may come across patients who are entirely at ease with whatever diagnosis they receive. They may accept their pain and also adopt the idea that there is not much they can do about it because someone or something has a greater plan. Although these people do reap the benefits of less stress and less amplified symptoms, they may not be as motivated to take action in managing their pain. The higher power has complete control over people’s lives and often defer total responsibility for both the good and bad situations that arise throughout their lifetime. Their plan for managing their pain may be to “go with the flow” and let the higher power situate everything according to its plan. You may be able to assist a patient with this belief structure by comforting them with the thought that their higher power will help them find a way through their pain, and encourage them to explore what their higher power’s plan may be for them.

 

Collaborative Coping

spiritualityIn this form of coping the patient and their higher power work together to solve the problems collaboratively. This method can be quite useful because the patient believes a higher power is working to help them overcome their pain, but it is also their responsibility to take action.

For example, if a patient is diagnosed with rheumatoid arthritis and they use a collaborative approach with a higher power to overcome it, they may rely on their higher power to provide them with someone who possesses the knowledge to help them treat their arthritis. Rather than waiting for someone to show up without much searching, this patient has probably done an extensive amount of searching to find a clinician that they feel is the most qualified to help them. If they decide that you are the clinician who has these qualities, it will be your duty to continue to motivate them to do their part in taking care of their body while encouraging their belief that their higher power will do its part in helping them heal. This patient’s higher power’s role in the healing process may be providing the patient with opportunities to better their health and comforting them by assuring the patient they are never alone throughout the journey.

 

Spiritual Coping Strategies

When faced with challenges in life, many people may turn to particular religious or nonreligious beliefs, practices, or attitudes to help them overcome these challenges. Utilizing these coping strategies can be effective in reducing their symptoms and possibly speeding up their healing process (3). Some common coping mechanisms used by people to manage their physical or emotional pain may include:

  • Prayer
  • Meditation
  • Church Attendance
  • Connecting With Nature
  • Interacting With Loved Ones
  • Increasing Involvement With Hobbies
  • Strengthening Relationship With a Higher Power

It is vital that clinicians are aware of these strategies so they may be able to help their patients find the spiritual coping strategies that are the most effective for them.

 

Spirituality and Chronic Pain

In addition to assessing the biological, psychological, and social aspects of someone’s pain, you must also determine if their spirituality could be a factor in their experience of pain. Some patients may view their pain as a punishment from their higher power because of something they may have done wrong earlier in their life. Whether or not a conflict in their spirituality may be the only cause of their pain, there are benefits in resolving spiritual strife and bringing back the spiritual harmony in the lives of your patients. Aiding your patients in accomplishing spiritual peace can lower the amount of stress they may be experiencing hand help them cope with their pain more effectively.

 

Common Spiritual Causes of Chronic Pain

Although often overlooked, the reason why your patient is experiencing pain could be due to an unresolved conflict in their spiritual life. The root of this conflict can vary depending on the beliefs of your patient. To get an idea of what the status of the stability of your patient’s spiritual aspect of their life is, you may need to ask them how they feel about where they stand spiritually. The may feel at peace, uneasy, uncertain about the condition of their spirituality and could need your assistance or the assistance of a spiritual counselor in helping them resolve spiritual conflict or obtain a sense of spiritual direction. Some common forms of unstable spiritual beliefs that could manifest themselves as pain in the body may include (4):

  • Guilt
  • Loneliness
  • Lack of Purpose
  • Low Self-Esteem
  • Feelings of Unworthiness
  • Ashamed of Past or Present Behavior
  • Deserving Punishment for Past Behavior
  • Abandonment by Higher Power or Loved One

When assisting a patient who is experiencing pain, you must ensure that the patient’s spiritual beliefs have been stabilized. Stabilizing spiritual beliefs can prevent them from following a paradigm of thought associated with negative spiritual beliefs.

 

 

Benefits of Spiritual Coping

spiritualityAn individual’s spirituality can affect how the individual perceives their pain. Utilizing some of the spiritual coping mechanisms described previously, have been shown to cause patients to report experiencing either decreased amounts of pain or a higher tolerance for the pain (5). For example, prayer and meditation can be an excellent way for a patient to strengthen the bond between them and their higher power or inner spirit. Strengthening this connection can comfort the patient and allow them to relax. Relaxation allows the parasympathetic nervous system to activate giving the body the opportunity to recover. If a patient is chronically stressed while attempting to eliminate pain, it can be difficult for them to do so because their body is not in a state of reconstruction. By allowing the body to relax through spiritual coping, the senses associated with pain are not as sensitive which may prevent a patient from catastrophizing pain.

Creating spiritual stability may not always take all of the pain away, but it can aid in decreasing the amount of pain experienced to a more bearable level. If the patient is better able to tolerate their pain, they may be more compliant with treatment and may feel less restricted by their pain in their everyday lives.

An individual's spirituality can affect how the individual perceives their pain. Click To Tweet

Integrating Spirituality Into Pain Care

Clinicians are responsible for treating their patients as a whole person. Holistic care would be impossible without considering the patient’s spirituality. Here are five steps you can take to help you have confidence in treating the spiritual aspect of a patient’s pain and determining what coping strategies may be the best for them:

  1. Utilize Outside Resources
  2. Obtain Insight on the Role of Spirituality
  3. Discuss Any Spiritual Questions Present
  4. Maintain Patient-Clinician Spiritual Boundary
  5. Encourage Involvement in Spiritual Practices

 

Step #1: Obtain Insight on Role of Spirituality

Spirituality is a touchy subject for many but should be something that can be openly discussed in a healthcare setting. It is not necessary to prod at a patient to obtain details of every aspect of their spiritual beliefs, but it is beneficial to ask short, simple questions that give you an idea of whether or not spirituality is something you believe could be a benefactor to the pain in your patient. Studies have shown that patients are not offended by the questioning of their spirituality and almost all of them found a spiritual discussion helpful (6). Little training is required to help a clinician feel confident in inquiring about a patient’s spirituality and isn’t something that takes much time. Some common questions that may be beneficial to ask your patient either directly or through a questionnaire completed before a session may include:

  • How comfortable are you discussing the impact of spirituality in your life?
  • Are you a part of a spiritual community?
  • Do you feel that your spirituality is an essential aspect of your life?
  • Are there any spiritual challenges that we may be able to help you address?
  • Is there anyone or any resources that we can utilize to help you obtain spiritual peace?

By asking these questions, you will be able to obtain insight on where a person stands spiritually, how much of an impact spirituality has on their life, and what resources you may be able to utilize for help in addressing spiritual concerns.

 

Step #2: Discuss Any Spiritual Questions Present

If you find through the questionnaire that there is some spiritual imbalance present and the patient is willing to allow you to help them regain their spiritual balance, it would be appropriate for you to talk with your patient about how these spiritual imbalances can be addressed. The patient may have no spiritual direction and need your help in finding purpose in their lives or is in the midst of some spiritual conflict that needs to be resolved with your guidance. In this discussion, you will want to obtain information related to what spiritual goals your patient wants to set and how they believe they can achieve those goals efficiently.

 

Step #3: Maintain Patient-Clinician Spiritual Boundary

It is important to remember that your goal is to help the patient discover or stabilize their own unique beliefs. If your patient has spiritual ideas that are similar to yours, you may work to strengthen their beliefs by using some of the knowledge you may have about a specific belief structure. Be careful to avoid sharing your beliefs with a patient with the intent of changing their beliefs to adopt yours. The goal is to strengthen the beliefs of the patient to best suite them and increase their feeling of purpose and overall satisfaction with their life. By maintaining these religious boundaries separating your beliefs from the beliefs of the patient, you will be able to ensure that you do not come across as “preaching” at the patient, but rather working with the patient to help them gain more understanding of how they want their spirituality to be shaped.  

 

Step #4: Utilize Outside Resources

There may be instances where you may not feel equipped enough to answer some of the spiritual questions a patient may have. It is crucial for you to know what your boundaries are and how much reliable information you will be able to provide the patient in regards to their spiritual situation. Because of the utilization of the questionnaire, the patient may have provided you with outside resources that you can collaborate with to aid in helping the patient resolve any spiritual conflict. Some helpful resources a patient may present in their response to the questionnaire could include:

  • Friends
  • Spouses
  • Family Members
  • Religious Literature
  • Chaplains, priests, or clergy members

It may be necessary for you to recommend your patient to regularly meet with this outside resource either before or along with your treatment with the patient to achieve maximum pain management benefits.

 

Step #5: Encourage Involvement in Spiritual Practices

If the patient associates themselves with a certain religion, it can be beneficial for them to stay involved with some of the practices of their religion. If a patient enjoys spending time in nature, serving others, or spending time with loved ones as a means of achieving spiritual satisfaction, then you would want to encourage them to regularly engage in these activities to help them relax and relieve some of the pain they may experience. Prayer and regular church attendance have been shown to decrease the amount of pain felt and also increase a patient’s ability to cope with pain (7). When someone is experiencing chronic pain, they may see it as a hindrance from allowing them to continue to engage in some of their spiritual activities, and it is essential for you to help them find ways to keep incorporating these practices in their lives.

 

Spiritually Managing Pain

Pain is not always a result of imbalances that can be seen with the eye. Sometimes pain is caused by factors that are not concrete such as spiritual conflict. Even when spirituality may not be the cause of pain, it can be useful to look at spiritual coping strategies to aid in managing pain. Clinicians need to take responsibility for determining the spiritual status of their patients because it can help them decide if there may be more to their pain than just anatomical issues. It can also help them find ways to help their patients cope with any sort of illnesses or pain that they are experiencing and possibly decrease the severity of some of the symptoms making treatment a less arduous process. Pain at the spiritual level is not something that can be masked with medication and is not something that can go unnoticed for an evaluation. By educating clinicians about how spirituality can affect pain, we will be able to provide better quality care for our patients and help them cope with their pain with healthier methods.

 

Remember, reversing pain requires an integrated approach.

If you need help to better understand what to eat, how to move, or how your thoughts and emotions affect your pain, I hope you’ll consider attending my Free Webinar on Healing Pain Naturally. You’ll learn how to use the power of your mind to heal; as well how nutrition and gentle movement can reverse your pain. Does this sound like something you need? This webinar will provide you with the info to change your life, almost immediately.

Sign-up for the free webinar here (I’ll email you a recording, too!)

Dr. Joe TattaSpirituality and pain management. Evidence-based or hocus pocus?
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  • Lee-Ann Davenport - April 23, 2018 reply

    Thank you for this information! I rely on questionnaires to ask questions that aren’t for conversations… especially if there isn’t a rapport or trust developed yet. I find people are often guarded when asked a direct question that is personal and would answer with something short and vague or one word that means nothing which then leads to prodding. Most importantly, these important questions invite conversation!
    On my General Attitude page, the client is to rate their answers to the questions, How am I doing? And one is, In fulfilling my spiritual needs (Living up to my full potential, Needs some improvement or Needs significant improvement). I will usually watch their reaction to this one… if the person is stumped, I might say to them, It doesn’t mean in a religious way, but that’s ok if you don’t answer that. Then I know it’s not a conversation at this time because like all the questions, it gives me insight to how they are right now. These questions help the client understand the different components of a well balanced life, but I can see immediately their mental and emotion stability as a whole. Extremely valuable! For me, I will know then how to better communicate towards their sensitive personality or to be direct. All clients are to book an evaluation with me prior to starting any program which creates clarity and concise direction, but for the client, they get a sense of relief and feel very motivated at the same time.
    Thank you!!

    Dr. Joe Tatta - May 16, 2018 reply

    Thank you for your kind words Lee-Ann 🙂

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