The use of prayer in the management of pain - a systematic review
MARTA
 ILLUECA
MD, Mdiv, MSc
Curate, The Episcopal Church in Delaware

The availability of safe and effective non-pharmacological therapies for the chronic pain patient is an important unmet medical need. The medical literature on prayer, as a form of spiritual intervention for pain, has not been systematically evaluated. Furthermore, current medical research around the use of prayer by pain patients has characterized prayer as a coping strategy rather than as a therapy. Methods: A systematic review of the medical literature was conducted to assess the use of prayer as an intervention for pain management. All English language publications, dated after 2000 were searched in four databases (PubMed, Web of Science, PsychInfo and Scopus) using the PRISMA protocol. A stepwise search progressively narrowed the terms “pain and prayer” in content, abstract and title. Studies needed to include prayer as an intervention with at least one pre-specified outcome related to pain. Only studies with prayer implemented on-site (i.e. at the bedside) were included. Results: Four hundred and eleven articles were evaluated. Final review of papers was performed by two independent reviewers. Nine studies met inclusion criteria, covering a total of 912 subjects and spanned a period of 11 years (2008 to 2018). Four studies were from Middle Eastern Countries (Iran, Malaysia) and five from Western countries (Belgium, Denmark, Sweden and United States). The Eastern studies included four randomized controlled trials (RCTs), three were on postoperative pain and one on mental health and pain. All studies from Eastern countries utilized Muslim prayers. The Western studies included three RCTs with a crossover design, one prospective longitudinal cohort and one qualitative study. Two Western studies evaluated psychological mediators for pain and three studies prospectively evaluated pain intensity, unpleasantness and tolerance in healthy volunteers. Subjects included men and women of religious and non-religious backgrounds, aged 18-83 years old. The vast majority were from a monotheistic religious background (Christianity in the west, and Islam in the East). Three types of prayer dichotomies appeared based on the source, target and content of prayer, respectively: Scriptural-Mantric, religious-secular and active-passive. Two modes of implementation were used: receptive (patient listened to prayer) and pro-active (self-recitation of prayer). Psychological mediators of pain emerged indicating that the effect of prayer can be contradictory based on the patients’ background. In one study, prayer was a predictor for anxiety and depression. In another study prayer in religious participants was associated with positive reappraisal. One study performed fMRI imaging and controlled for opioid pathway involvement by using intravenous naloxone or saline. Conclusions: Overall, active prayer to God, either recited or listened to, emerged as a potentially beneficial intervention for patients with religious beliefs undergoing surgery or an experimental painful procedure. Prayer effect does not seem to be mediated by opioid pathways. Psychological mediation of prayer showed contradictory findings. More studies that discriminate in their definition and mode of implementation of prayer will help to delineate a patient profile most amenable to the reported benefits of prayer for pain management.