Spiritual Pain: Assessment

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5 minutes

This article has been developed from the original work of Revd Robert Lloyd Richards who wrote the material for the MSc in Pain Management when he was a Senior Anglican Chaplain at the University Hospital of Wales NHS Trust and from a dissertation completed by Jamie Given, a previous MSc Student.

For many individuals who suffer chronic disease, spirituality may be a useful coping style. Spiritual pain needs exploring and there are a variety of tools available that help us better understand what the individual’s needs are. Bussing et al [1] wanted to develop an instrument to measure spiritual, existential and psychosocial needs of patients with chronic diseases as most of the research has been undertaken on those at the end of life. They used the Spiritual Needs Questionnaire in a cross sectional survey  to patients with chronic pain conditions, cancer and other chronic conditions. In the group of people with chronic pain and cancer, needs for inner peace had the highest scores, followed by self competent attention and existentialistic needs (reflection/meaning) and the religious needs scored no interest. It appeared from this study that the underlying disease was of outstanding relevance for the patients’ spiritual needs and patients long for spiritual well being.

Borneman et al [2] highlighted the lack of standardised spirituality history tools in the management of palliative care and tested the feasibility for the Faith, Importance and Influence, Community and Address Spiritual History Tool in clinical settings. The framework of the tool includes faith or belief, importance of spirituality, individual’s spiritual community and interventions to address spiritual needs. They found that most patients rated faith or belief as very important in their lives and the quantitative ratings of this tool correlated well with the Quality of Life ratings of spirituality suggesting that this is a feasible tool for clinical assessment of spirituality.

A review of quality of life instruments that are used in palliative care and how spirituality was operationalised in these instruments was conducted by Albers et al [3].  In the domain of spiritual well-being was Purpose of life, meaning (fullness) of life, acceptance of death, feeling at peace with life, feeling at peace with God, preparation for death, religion, and evaluation of life. The authors found that the domain of psychological well-being was included in 18 of the instruments, followed by the domain of spirituality and the domain of social well-being, which were included in 15 and 11 instruments, respectively. Most of the spirituality items concerned the meaning and purpose of life and death but only two instruments contained items on religion, and this may be due to the lack of consensus about what spirituality is and how it relates to and with religion. Nowadays, spirituality is seen as a fundamental issue in palliative care and the following tools are those that examined issues of spirituality:

  • Demoralization Scale
  • Functional Assessment of Chronic Illness Therapy-Palliative subscale
  • Hospice Quality of Life Index
  • McMaster Quality of Life Scale
  • McGill Quality of Life Questionnaire
  • McGill Quality of Life Questionnaire-Cardiff Short Form
  • McCanse Readiness for Death Instrument
  • Missoula-VITAS Quality of Life Index
  • Needs Assessment for Advanced Cancer Patients
  • Patient Dignity Inventory
  • Problems and Needs in Palliative Care questionnaire
  • Problems and Needs in Palliative Care questionnaire-short version
  • Palliative care Outcome Scale
  • QUAL-E Quality of life at the end of life
  • Spiritual Needs Inventory

It is clear that some of the above tools would not be appropriate in a chronic non malignant setting or indeed, an acute pain setting but others may be; further investigation is needed.

Another tool that has been investigated for people with chronic diseases is the SpREUK-SF10 questionnaire [4]. The author wanted to investigate how patients with chronic diseases, living in secular societies, view the impact of spirituality on their health and how they cope with illness. The questionnaire appeared to be useful in assessing aspects of spirituality in a secular society and did not appear to be biased for or against a particular religious commitment. However, further research is required in other cultures.  

Bekelman et al [5] compared two spirituality instruments and their relationship with depression and quality of life in chronic heart failure. There are sufficient similarities between chronic heart failure and chronic non malignant pain to make this a relevant study to inform this section (fatigue, anxiety, depression, fear of movement, restricted movement, sleep problems, etc). The Functional Assessment of chronic Illness Therapy-Spiritual Well Being (FACIT-sp) and the Ironson-Woods Spirituality/Religiousness Index (IW) were compared to each other and to measures of depression and quality of life. The FACIT-sp measured aspects of spirituality related to feelings of peace and coping, whereas the IW measured beliefs, coping and relational aspects of spirituality. The study illustrated that there are several clinically useful constructs of spirituality in patients with heart failure and suggested  that psychological and spiritual well-being remain distinct phenomena.


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