P-090 - Effectiveness of a systematic Iterative Imperative Prayer on pain intensity.

Abstract Title: Effectiveness of a systematic Iterative Imperative Prayer on pain intensity.


Background: Personal religious factors are very important in health and pain. Prayer is a devotional practice used across religions in communicating with the sacred to honor a higher power and seek benevolence. It can be practiced solo (individual) or in groups (community). Prayer is used as a coping technique for pain (Meints et al., 2023). It is part of complementary pain management strategies and second only to medication in terms of utility by patients in chronic pain clinics (Dezutter et al., 2011). Private prayer may be associated with lower pain intensity and greater pain tolerance.

The identified modes are categorized as active prayer, characterized by requests like "God, help me endure the pain," and passive prayer, involving pleas such as "God, take the pain away." These methods have been extensively explored in prior research, as demonstrated by studies conducted by Najem et al. (2022), Ferreira-Valente et al. (2021), and Ileuca & Doolittle (2020). A specific prayer style, Systematic Iterated Imperative Prayer (SIIP), remains unreported in the literature. SIIP involves directed speech, where prayers target specific body locations or the entire body.

Purpose/Objectives: This pilot study aims to assess Systematic, Iterated Imperative Prayer (SIIP) as a potential intervention for chronic pain management, addressing three key research questions:

1. Does SIIP intervention significantly reduce pain severity?

2. Can SIIP be integrated effectively into existing pain management practices?

3. What is the clinical significance of pain relief achieved through through SIIP?


Methods: Following IRB approval (IRB # 090420-048), the study was conducted in a small town over a period of 3 months. Recruitment was through advertisements on the radio and in the newspaper as well as by word of mouth. There was no remuneration for participating. The form of the prayer is “Pain leave in { faith object’s or/ selected healing source’s} name”, or in a more location-specific way, “Pain in {location on body} go in { faith object’s or/ selected healing source’s} name”. Jesus was the name used for cases in this pilot study.

The intervention involved repeated administration of Systematic, Iterated Imperative Prayer (SIIP), with participants providing pain severity ratings before and after each intervention iteration. Participants determined the frequency of prayer sessions, with a minimum interval of six to eight hours between applications, documented by the researchers. Pain localization was aided by diagrams provided to participants, using a grid system with coordinates for precise identification. Pain severity was measured on a scale of zero to ten for each identified location, recorded three times daily over a 48-hour period. Sixteen cases underwent a total of 25 interventions, preceded by five days of baseline data collection for each participant.


Results: In this pilot study, 16 participants underwent 25 prayer interventions. The average age of the participants was 62.6 years (standard deviation 14.66). 87.5% of the participants were female. The average duration of pain was 38.8 months.

The mean pre-intervention pain score was 40 (median pain was 37 and ranged from 6 to 100). The interquartile range preintervention was 36.9. The mean pain score post-intervention was 4.2 (median was 0.0 and range was 0 to 50). The interquartile range post-intervention was 0.0. The paired sample t was 7.172 and was significant at p < 0.001.

The study results should be interpreted in the light of its limitations. The study duration was short, the participants were community-based, and the average duration of pain was 38.8 months. Potential biases are inherent in a single-group pre-post design.

Conclusions/Implications for future research and/or clinical care: Chronic pain poses a substantial healthcare challenge, necessitating innovative approaches. SIIP offers a non-invasive, alternative therapy potentially aligned with patient-centered care.

The findings of this study suggest that, potentially, SIIP intervention has a significant and clinically meaningful reductive impact on pain severity. The large effect size, evidenced by Cohen's d of 1.434, and the statistically significant results from both the t-test and confidence interval analysis support this conclusion. This work introduces an alternative approach by grounding imperatives to pain in the belief that a Supreme being holds authority over pain.

Future research studies should explore the mechanisms underlying the efficacy of SIIP and investigate its long-term effects on pain management. Collaborative efforts between researchers, clinicians, and religious/spiritual communities can further enhance our understanding of prayer-based interventions and their role in holistic healthcare.


References:

• Meints SM, Illueca M, Miller MM, Osaji D, Doolittle B. The Pain and PRAYER Scale (PPRAYERS): development and validation of a scale to measure pain-related prayer. Pain Med. 2023 Jul 5;24(7):862-871. doi: 10.1093/pm/pnad020. PMID: 36808488; PMCID: PMC10321762.

• Dezutter J, Wachholtz A, Corveleyn J. Prayer and pain: the mediating role of positive re-appraisal. J Behav Med. 2011 Dec;34(6):542-9. doi: 10.1007/s10865-011-9348-2. Epub 2011 Apr 23. PMID: 21516338; PMCID: PMC6689415.

• Najem C, Meeus M, Cagnie B, Ayoubi F, Al Achek M, Van Wilgen P, Van Oosterwijck J, De Meulemeester K. The Effect of Praying on Endogenous Pain Modulation and Pain Intensity in Healthy Religious Individuals in Lebanon: A Randomized Controlled Trial. J Relig Health. 2023 Jun;62(3):1756-1779. doi: 10.1007/s10943-022-01714-2. Epub 2022 Dec 10. PMID: 36495356; PMCID: PMC9739350.

• Ferreira-Valente A, Jarego M, Queiroz-Garcia I, Pimenta F, Costa RM, Day MA, Pais-Ribeiro J, Jensen MP. Prayer as a pain intervention: protocol of a systematic review of randomised controlled trials. BMJ Open. 2021 Jul 5;11(7):e047580. doi: 10.1136/bmjopen-2020-047580. PMID: 34226225; PMCID: PMC8258549.

• Illueca M, Doolittle BR. The Use of Prayer in the Management of Pain: A Systematic Review. J Relig Health. 2020 Apr;59(2):681-699. doi: 10.1007/s10943-019-00967-8. PMID: 31912350.