Journal of Behavioral Medicine

, Volume 30, Issue 4, pp 311–318 | Cite as

Exploring the Relationship between Spirituality, Coping, and Pain

  • Amy B. WachholtzEmail author
  • Michelle J. Pearce
  • Harold Koenig


There is growing recognition that persistent pain is a complex and multidimensional experience stemming from the interrelationship among biological, psychological, social, and spiritual factors. Chronic pain patients use a number of cognitive and behavioral strategies to cope with their pain, including religious/spiritual forms of coping, such as prayer, and seeking spiritual support to manage their pain. This article will explore the relationship between the experience of pain and religion/spirituality with the aim of understanding not only why some people rely on their faith to cope with pain, but also how religion/spirituality may impact the experience of pain and help or hinder the coping process. We will also identify future research priorities that may provide fruitful research in illuminating the relationship between religion/spirituality and pain.


Religion spirituality chronic pain coping 


  1. Abraido-Lanza, A. F., Vasquex, E., & Echeverria, S. E. (2004). En las manos de Dios (In God’s hands): religious and other forms of coping among Latinos with arthritis. Journal of Consulting and Clinical Psychology, 72, 91–102.PubMedCrossRefGoogle Scholar
  2. Affleck, G., Urrows, S., Tennen, H., & Higgins, P. (1992). Daily coping with pain from rheumatoid arthritis: patterns and correlates. Pain, 51, 221–229.PubMedCrossRefGoogle Scholar
  3. Alexander, C. N., Rainforth, M. V., & Gelderloos, P. (1991). Transcendental meditation, self-actualization, and psychological health: A conceptual overview and statistical metaanalysis. Journal of Social Behavior and Personality, 6, 189–248.Google Scholar
  4. Alexander, C. N., Robinson, D. W., Orme-Johnson, R. H., Schneider, R. H., & Walton, K. G. (1994). The effects of transcendental meditation compared to other methods of relaxation and meditation reducing risk factors, morbidity, and mortality. Homeostasis, 35, 243–264.Google Scholar
  5. Astin, J. A., (1997). Stress reduction through mindfulness meditation: Effects on psychological symptomology, sense of control, and spiritual experiences. Psychotherapy and Psychosomatics, 66, 97–106.PubMedCrossRefGoogle Scholar
  6. Bandura, A. (1977). Social learning theory. New York: General Learning Press.Google Scholar
  7. Borg, J., Andree B., Soderstrom H., & Farde L. (2003). The serotonin system and spiritual experiences. American Journal of Psychiatry, 160, 1965–1969.Google Scholar
  8. Buenaver, L. F. (2003). Evaluating the role of religious coping in a self-reported headache population. Unpublished doctoral dissertation. Virginia Commonwealth University.Google Scholar
  9. Burke, M., & Flaherty, M. J. (1993). Coping strategies and health status of older arthritic women. Journal of Advanced Nursing, 18, 7–13.PubMedCrossRefGoogle Scholar
  10. Bush, E. G., Rye, M. S., Brant, C. R., Emery, E., Pargament, K. I., & Riessinger, C. A. (1999). Religious coping with chronic pain. Applied Psychophysiology and Biofeedback, 24, 249–260.PubMedCrossRefGoogle Scholar
  11. Carlson, C. A., Bacaseta, P. E., & Simanton, D. A. (1988). A controlled evaluation of devotional meditation and progressive relaxation. Journal of Psychology and Theology, 16, 362–368.Google Scholar
  12. Carver, & Harris (2000). How important is the perception of personal control? Studies of early stage breast cancer patients. Personality and Social Psychology Bulletin, 26, 139–149.CrossRefGoogle Scholar
  13. Contrada, R. J., Goyal, T. M., Cather, C., Rafalson, L., Idler, E. L., & Krause, T. J. (2004). Psychosocial factors in outcomes of heart surgery: The impact of religious involvement and depressive symptoms. Health Psychology, 23, 227–238.PubMedCrossRefGoogle Scholar
  14. Covic, T., Adamson, B., Spencer, D., & Howe, G. (2003). A biopsychosocial model of pain and depression in rheumatoid arthritis: A 12-month longitudinal study. Rheumatology, 42, 1287–1294.PubMedCrossRefGoogle Scholar
  15. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136.PubMedCrossRefGoogle Scholar
  16. Engel, G. L. (1992). How much longer must medicine’s science be bound by a seventeenth century world view? Psychotherapy and Psychosomatics, 57, 3–16.PubMedGoogle Scholar
  17. Ferguson, P. C. (1980). An integrative meta-analysis of psychological studies investigating the treatment outcomes of meditation techniques. Unpublished doctoral dissertation, Univ of Colorado, Boulder, CO.Google Scholar
  18. French, D. J., Holroyd, K. A., Pinell, C., Malinoski, P. T., O’Donnell, F., & Hill, K. R. (2000). Perceived self-efficacy and headache related disability. Headache, 40, 647–656.PubMedCrossRefGoogle Scholar
  19. Harrison, M. O., Edwards, C. L., Koenig, H. G., Bosworth, H. B., DeCastro, L., & Wood, M. (2005). Religiosity, spirituality, and pain, in patients with sickle cell disease. Journal of Nervous and Mental Disorders, 193, 250–257.CrossRefGoogle Scholar
  20. Hill, P. C., & Pargament, K. I. (2003). Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. American Psychologist, 58, 64–74.PubMedCrossRefGoogle Scholar
  21. Idler, E. L., & Kasl, S. V. (1997). Religion among disabled and non-disabled elderly persons II: Attendance at religious services as a predictor of the course of disability. Journal of Gerontology, 52B, S306–S316.Google Scholar
  22. Keefe, F. J., Affleck, G., Lefebvre, J., Underwood, L., Caldwell, D. S., Drew, J., et al. (2001). Living with rheumatoid arthritis: The role of daily religious and spiritual coping. Journal of Pain, 2, 101–110.PubMedCrossRefGoogle Scholar
  23. Keefe, F. J., Caldwell, D. S., Martines, S, Nunley, J, Beckham, J, & Williams, D. A. (1991). Analyzing pain in rheumatoid arthritis patients: Pain coping strategies in patients who have had knee replacement surgery. Pain, 46, 153–160.PubMedCrossRefGoogle Scholar
  24. Keefe, F. J., Caldwell, D. S., Queen, K. T., Gil, K. M., Martines, S., Crissom, J. E., et al. (1987). Pain coping strategies in osteoarthritis patients. Journal of Consulting and Clinical Psychology, 55, 208–212.PubMedCrossRefGoogle Scholar
  25. Keefe, F. J., Kashikar-Zuck, S., Robinson, E., Salley, A., Beaupre, P., Caldwell, D., et al. (1997a). Pain coping strategies that predict patient’s and spouses’ ratings of patients’ self-efficacy. Pain, 73, 191–199.PubMedCrossRefGoogle Scholar
  26. Keefe, F. J., Lefebvre, J. C., Egert, J. R., Afflect, G., Sullivan, M. J., & Caldwell, D. S. (2000). The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain, 87, 325–334.PubMedCrossRefGoogle Scholar
  27. Keefe, F. J., Lefebvre, J. C., Maixner, W., Salley, A. N., & Caldwell, D. S. (1997b). Self-efficacy for arthritis pain: Relationship to perception of thermal laboratory pain stimuli. Arthritis Care and Research, 10, 177–184.PubMedCrossRefGoogle Scholar
  28. Koenig, H. G. (2001). Religion and medicine IV: Religion, physical health, and clinical implications. International Journal of Psychiatry in Medicine, 31, 321–336.PubMedCrossRefGoogle Scholar
  29. Koenig, H. G. (2002). An 83-year-old woman with chronic illness and strong religious beliefs. Journal of the American Medical Association (JAMA), 288, 487–493.CrossRefGoogle Scholar
  30. Koenig H. G. (2003). Chronic pain: Biomedical and spiritual approaches. Binghamton, NY: Haworth Press.Google Scholar
  31. Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. New York: Oxford University Press.Google Scholar
  32. Krause N. (2006). Church-based social support and mortality. Journals of Gerontology Series B-Psychological Sciences & Social Sciences, 61, S140–146.Google Scholar
  33. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
  34. Lefebvre, J. C., Keefe, F. J., Affleck, G., Raezer, L. B., Starr, K., Caldwell, D. S., & Tennen, H. (1999). The relationship of arthritis self-efficacy to daily pain, daily mood, and daily pain coping in rheumatoid arthritis patients. Pain, 80, 425–435.PubMedCrossRefGoogle Scholar
  35. McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., & Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19, 211–222.PubMedCrossRefGoogle Scholar
  36. McKee, D. D., & Chappel, J. N. (1992). Spirituality and medical practice. Journal of Family Practice, 35, 205–208.Google Scholar
  37. Melzack, R. (1999). From the gate to the neuromatrix. Pain, S6, S121–S126.CrossRefGoogle Scholar
  38. Melzack R, & Wall P. D. (1965). Pain mechanisms: a new theory. Science, 150, 971–979.PubMedCrossRefGoogle Scholar
  39. Middleton, P., & Pollard, H. (2005). Are chronic low back pain outcomes improved with co-management of concurrent depression? Chiropractic and Osteopathy, 13, 8.PubMedCrossRefGoogle Scholar
  40. Pargament, K. (1997). The psychology of religion and coping: Theory, research, practice. Guilford Press: New York, NY.Google Scholar
  41. Pargament, K. I. (2002b). Is religion nothing but…? Explaining religion versus explaining religion away. Psychological Inquiry, 13, 239–244.CrossRefGoogle Scholar
  42. Pargament K. I., Koenig H. G., & Perez L. M. (2000). Comprehensive measure of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56, 519–543.PubMedCrossRefGoogle Scholar
  43. Pargament, K. I., Koenig H. G., Tarakeshwar, N., & Hahn, J. (2001). Religious struggle as a predictor of mortality among medically ill elderly patients: A 2-year longitudinal study. Archives of Internal Medicine, 161, 1881–1885.PubMedCrossRefGoogle Scholar
  44. Pargament, K. I., McCarthy, S., Shah, P., Ano, G., Tarakeshwar, N., Wachholtz, A. B., et al. (2004). Religion and HIV: A Review of the Literature and Clinical Implications. Southern Medical Journal, 97, 1201–1209.PubMedCrossRefGoogle Scholar
  45. Powell L. H., Shahabi L., & Thoresen C. E. (2003). Religion and spirituality: Linkages to physical health. American Psychologist, 58, 36–52.PubMedCrossRefGoogle Scholar
  46. Rapp, S. R., Rejeski, W. J., & Miller, M. E. (2000). Physical function among older adults with knee pain: the role of pain coping skills. Arthritis Care & Research, 13, 270–279.CrossRefGoogle Scholar
  47. Rippentrop, E. (2005). A review of the role of religion and spirituality in chronic pain populations. Rehabilitation Psychology, 50, 278–284.CrossRefGoogle Scholar
  48. Rippentrop E. A., Altmaier E. M., Chen J. J., Found, E. M., & Keffala, V. J. (2005). The relationship between religion/spirituality and physical health, mental health, and pain in a chronic pain population. Pain, 116, 311–321.PubMedCrossRefGoogle Scholar
  49. Rosenstiel, A. K., & Keefe, F. J. (1983). The use of coping strategies in chronic low back pain patients: relationships to patient characteristics and current adjustment. Pain, 17, 33–44.PubMedCrossRefGoogle Scholar
  50. Skevington, S. M., Carse, M. S., & Williams, A. C. (2001). Validation of the WHOQOL-100: Pain management improves quality of life for chronic pain patients. Clinical Journal of Pain, 17, 264–275.PubMedCrossRefGoogle Scholar
  51. Sulmasy, D. P. (2002). A biopsychosocial-spiritual model for the care of patients at the end of life. The Gerontologist, 42, 24–33.PubMedGoogle Scholar
  52. Turner, J.A, & Clancy, S. (1986). Strategies for coping with chronic low back pain: relationship to pain and disability. Pain, 24, 355–364.PubMedCrossRefGoogle Scholar
  53. Wachholtz A. B. (2006). Does spirituality matter? Effects of meditative content and orientation on migraineurs. Doctoral Dissertation, Bowling Green State University. Available at: Retrieved April, 2006.
  54. Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369–384.PubMedCrossRefGoogle Scholar
  55. Yates, J. W., Chalmer, B. J., St. James, P., Follansbee, M., & McKegney, F. P. (1981). Religion in patients with advanced cancer. Medical and Pediatric Oncology, 9, 121–128.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Amy B. Wachholtz
    • 1
    • 2
    Email author
  • Michelle J. Pearce
    • 1
  • Harold Koenig
    • 1
  1. 1.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA
  2. 2.Duke University Health System, Duke Diet and Fitness CenterDurhamUSA

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