1. 2021;24;E1163-E1176Religious Beliefs and Attitudes in Relation to Pain, Pain-Related Beliefs, Function, and Coping in Chronic Musculoskeletal Pain: A Systematic Review
   Systematic Review
   Mira Meeus, PhD, Barbara Cagnie, PhD, Kayleigh De Meulemeester, PhD, Farah Ayoubi, PhD, Jessica van Oosterwijck, PhD, Naziru Bashir Mukhtar, MSc, and Charbel Najem, DPT.

BACKGROUND: The biopsychosocial-spiritual model recognizes the impact of religious factors in modulating the experience of pain. Religious beliefs are factors that can influence perceptions, emotions, and behavior, all of which have important implications on health, pain experience, and treatment outcomes.

OBJECTIVES: The aim of the present study was to identify if and how religious beliefs and attitudes can influence pain intensity, pain interference, pain-related beliefs and cognitions, emotions, and coping among patients with chronic musculoskeletal pain.

STUDY DESIGN: Systematic review.

METHODS: This systematic review was conducted and reported, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). An electronic search was conducted in 4 online databases (PubMed, Embase, Web of science, and PsychArticles) and complemented with a hand search (PROSPERO registry: CRD42020161289). Two reviewers independently performed eligibility screening, risk of bias assessment, and data extraction. The risk of bias of the included studies was assessed using the Newcastle Ottawa Scale.

RESULTS: Nine cross-sectional studies and one case-control study were included in the review. The methodological quality of the included studies ranged from low to high. The results gathered regarding the association between religiosity and pain intensity, disability, or pain interference were found to be conflicting. Limited evidence suggests that religiosity is positively associated with worse pain-related beliefs and cognitions, worse pain-related emotion, and better pain acceptance. There is insufficient data available to support the claim that religiosity is negatively associated with physical functioning and pain-related self-efficacy in people with chronic musculoskeletal pain.

LIMITATIONS: The number of included studies was small, with a low level of evidence, and a possible risk of bias.

CONCLUSION: This systematic review shows low evidence and conflicting results for the presence of associations between religiosity and different pain domains such as pain intensity, disability, and pain-related cognitions or emotions in people with chronic musculoskeletal pain.   

KEY WORDS: Chronic pain, musculoskeletal pain, religiosity, pain beliefs, pain cognitions, pain emotion, coping