Spiritual Pain: A Symptom in Search of a Clinical Definition

Journal of Religion and Health https://doi.org/10.1007/s10943-022-01645-y ORIGINAL PAPER Spiritual Pain: A Symptom in Search of a Clinical Definition Marta Illueca1 · Ylisabyth S. Bradshaw2 · Daniel B. Carr2 Accepted: 16 August 2022 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022 Abstract We conducted a literature search to identify and compare definitions of the experiential dimension of spiritual pain. Key databases were searched, up to the year 2021 inclusive, for papers with a definition of “spiritual” or “existential” pain/distress in a clinical setting. Of 144 hits, seven papers provided theoretical definitions/descriptions; none incorporated clinical observations or underlying pathophysiological constructs. Based on these findings, we propose a new definition for “spiritual pain” as a “self-identified experience of personal discomfort, or actual or potential harm, triggered by a threat to a person’s relationship with God or a higher power.” Our updated definition can inform future studies in pain assessment and management. Keywords Spirituality · Spiritual pain · Spiritual distress · Palliative care · Pain management Introduction Spirituality is becoming a focus of increasing inquiry in medicine. Currently, the National Center for Complementary and Integrative Health (NCCIH) has a comprehensive strategic plan for the years 2021–2025, that delineates a commitment to research programs on “the whole person and on the integration of complementary and conventional care,” although the plan omits clear terminology about the spiritual dimension of healthcare (NCCIH, 2021, p. 1). Important advances have been achieved by studies of the neuroscience of religious experience. Research from the past two decades provides a functional brain Portions of this manuscript were presented in poster form at the 46th International Association for the Study of Pain (IASP) World Congress on Pain, Virtual Congress, 2020. * Marta Illueca 1 The Episcopal Diocese of Delaware, 913 Wilson Rd, Wilmington, DE 19806, USA 2 Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111, USA 13 Vol.:(0123456789) Journal of Religion and Health mapping of spiritual practices (Newberg, 2014) and includes the delineation of related regional brain activity and EEG patterns (Beauregard & Paquette, 2008; Ferguson et al., 2021; Jegindø et al., 2013), religion’s neurologic substrate (Cristofori et al., 2016) and common neural pathways for physical and social pain (Eisenberger, 2012). These advances are occurring in tandem with the recent updating of the definition of pain (Raja et al., 2020) by the International Association for the Study of Pain (IASP) and proposals for new and/or reorganized pain-related terms in the 11th edition of the International Classification of Diseases (ICD-11) by IASP and the World Health Organization (Treede et al., 2019). Spirituality-related instruments or scales continue to emerge (Büssing, 2017). For example, the Pain and Palliative Care Service at the NIH Clinical Center developed and validated a scale for psycho-social spiritual healing of individuals with lifethreatening and life challenging situations, called the National Institutes of HealthHealing Experience of All Life Stressors or NIH-HEALS (Ameli et al., 2018). The latter is a welcome new measure of psycho-social spiritual healing, since there is a scarcity of scales that specifically assess spiritual practices or spiritual healing for patients with significant pain or suffering from life-threatening illnesses. The totality of the emerging data indicates a new appreciation for the potential importance of spiritual practices and highlights the need for dedicated terminology and instruments applicable to the clinical setting. To address this unmet terminological need, we surveyed the literature in search of descriptors to define and conceptualize a new taxonomy of spiritual pain. Such terminology may help define the experience or symptoms of spiritual pain within the context of each patient’s personal spirituality. Based on our findings, we aim to offer a practical and clinically applicable definition of spiritual pain in the hope of providing pathophysiological and ontological frameworks for healthcare providers. Our narrative review addresses the experiential dimension of spiritual pain, building upon existing theoretical or clinical definitions, including if and how this type of pain differs from the biological, psychological, and social dimensions of pain and/or distress. This review also addresses the extent to which spiritual pain is a component of other types of pain or whether it is a distinct entity. At the outset of this project, an initial survey of the Hospice and Palliative Care literature revealed an evolution in thinking that described the spiritual context of an individual. Until recently, the existence of a spiritual sphere of being was implicit in research focused on the terminally ill person, with a paradigm shift emerging. The last two decades point toward the distinctiveness of such a spiritual sphere. In this respect, data was reported from Australia, on the interventional work of staff and volunteer chaplains, employed by hospitals, church or government, dealing with pain patients (Carey et al., 2006). The authors underscore the use of pastoral skills in tackling non-physical aspects of the pain experience with exclusively religious interventions (e.g., prayer, devotions, ritual, and worship). Notably, recent research highlights the evolving nomenclature available from the World Health Organization’s (WHO) Pastoral Intervention Codings (now called Spiritual Intervention Codings: WHO-SPICs), as part of the International Classification of Diseases (ICD), where distinct spiritual interventions in healthcare are codified (Carey & Cohen, 2015). Without a doubt, the growing interest in the spiritual needs of 13 Journal of Religion and Health patients and their caretakers is becoming more explicit, and has gradually extended into other areas of clinical care. Early contributions to building a dedicated taxonomy for the spiritual aspects of healthcare are found in the nursing literature. In 1992, the North American Nursing Diagnosis Association (NANDA) meeting reviewed the terms “spiritual distress” and “risk for spiritual distress” as well as an early nursing definition of spiritual pain as a “disruption in the principle which pervades a person’s entire being and which integrates and transcends one’s biological nature" (North American Nursing Diagnosis Association (NANDA,1992 as cited in Boss et al., 2015, p. 918). Currently, “spiritual distress” remains as a listed term in the most recent NANDA Handbook (2021) but not “spiritual pain” (Herdman et al., 2021). Caldeira et al. (2013) characterized “spiritual distress” as a condition contrary to “spiritual well-bein (...truncated)