Introduction

In recent years, the prevalence of chronic diseases has had a growing trend, which has resulted in many health problems (Mehrpoya et al. 2018; Sepahvand et al. 2015; Karimi et al. 2018), such as decreased quality of life (Strand et al. 2019; Ahmadzade et al. 2017), decreased life satisfaction (Goerlitz et al. 2018), decreased mental health (Sher 2019), decreased life expectancy (Bower et al. 2016), as well as increased stress, anxiety, depression (Gerogianni et al. 2019), increased chronic pain (Gerhart et al. 2018) and retinopathy (Mohammadi et al. 2019). One of the challenges of chronic patients is the presence of chronic pain that affects their quality of life (Bernfort et al. 2015). In fact, chronic pain (CP) is defined as a pain that lasts more than 6 months or more than the expected duration (Meredith et al. 2008). Chronic pain affects 20–30% of the western populations (Simon 2012), which is why paying attention to these patients is very important (Geneen et al. 2017).

Despite the advances in medical science, such as improvements in pain neurophysiology, as well as in psycholeptics, no measure is yet done to fully heal the pain in these patients and that’s why pain causes physical disabilities and emotional problems for this group of patients (Dansie and Turk 2013). On the other hand, the apeutic treatments available for reducing pain have various side effects for these patients, which is why non-pharmacotherapy and palliative medicine are needed to reduce pain (Piatt et al. 2018). Also, today, non-pharmacological treatments are given special attention (Hatefi et al. 2015). In order to perform necessary interventions in this regard, the factors affecting pain are to be well known (Hooshmand 2018).

Self-efficacy is rooted in social cognitive theory, and it is considered as an important prerequisite for behavior which is of great importance in the process of treatment of chronic diseases (Noroozi et al. 2018). Self-efficacy refers to the belief and ability to successfully performing a behavior and refers to the beliefs of the individual through which the individual can successfully achieve the desired goal (Mojahed and Navidian, 2018; Bandura, 1977). Individuals with low self-efficacy have pessimistic thoughts about their abilities and avoid any situation they consider to be higher than their abilities. In contrast, people with high self-efficacy dominate them against difficult situations and try to maintain it (Bandura 1977; Karademas and Kalantzi-Azizi 2004). Indeed, high self-efficacy is associated with better health, while low self-efficacy is associated with signs of anxiety, depression and psychosomatic symptoms (Schwarzer 2014; Damghanian et al. 2018). Also, increasing self-efficacy and pain management can improve chronic pain problems and decrease the feeling of frustration for patients with chronic pain by increasing the level of social and occupational activity (Archer et al. 2017; Firoozi et al. 2018).

Another variable that is efficient due to the long-term adaptive performance of the physical and psychological well-being of patients with chronic diseases is acceptance (McCracken and Eccleston, 2005). In patients with chronic pain, pain acceptance is of particular importance (Hatefi et al. 2019, 2018). Regarding the failure of chronic patients to control their pain, it seems that the adoption of pain against pain control has more importance (Veehof et al. 2011). One of the factors that may affect the pain of patients could be considering spirituality and religion (Sollgruber et al. 2018; Harris et al. 2017).

Considering that people who participate in religious activities or have positive religious beliefs have a higher mental health, the relationship between religion and health is important in many ways (Henningsgaard and Arnau 2008; You et al. 2019) and religion is considered as one of the factors effective on health (Idler et al. 2009). Level of belief in God is effective on people’s attitudes to life concepts, social deviations and psychological disorders, and improves them (Shameli et al. 2012; Rahmati et al. 2017). In fact, religious people who have positive beliefs in God are more likely to come along with living environments, have more resilience and have more resistance to stresses. On the other hand, those who consider God to be far from available and abstract do not have the power to calm down and cope with the tensions of life (Maynard et al. 2001; Tafti et al. 2019).

By creating meaning and concept in life and feeling belonged to God, increasing spirituality in the dimensions of human existence leads to adaptation to disease (Holloway et al. 2011; Oshvandi et al. 2018; Jalali et al. 2019a). The spiritual well-being is defined as the sense of communicating with others, having meaning and purpose in life, having a belief in transcendental power, and communicating with God, which is effective on physical and mental health of the individual (Abbasi et al. 2018; Tavan et al. 2015). Spiritual health (SH) has two dimensions of religious and existential. The religious dimension includes communication with the highest power and the individual’s perception of health in spiritual life, and the existential dimension includes the individual’s adaptation to himself, the environment and society (Mollaei et al. 2019; Shahrbabaki et al. 2017). Spirituality and religion play an important role among different groups of people (Ziapour et al. 2017; Darvishi et al. 2019; Jalali et al. 2019b).

Aim

Since the country of Iran is an Islamic country, research in the field of religion and health in the patients group of Iran has a special position. On the other hand, due to the importance of pain in patients and also the need to pay attention to the factors affecting pain and lack of sufficient information in this regard, the present research was conducted with the aim of determining the relationship between SH and the status of PSE in patients with CP in Ilam City in 2018.

Methods

Design and Participants

This study was a descriptive cross-sectional study in the group of patients with CP.

Inclusion Criteria

Inclusion criteria included: 1. residence in Ilam City; 2. informed consent for participation in the study; 3. being aged 18–65; 4. being able to communicate verbally; 5. being Shia; 6. a history of complaints of chronic pain; 7. lack of mental disorders; 8. no addiction to any type of drug.

Exclusion criteria

Exclusion criteria included: 1. patient’s tendency to exit from the study at any time of the research; 2. defect in the completion of the questionnaires.

Questionnaire

A: Demographic Characteristic

Questions on age, place of living, gender, employment status, education, income and marital status

B: Religion Well-Being Questionnaire

The questionnaire has 20 items designed by Paloutzian and Ellison. Ten items of this questionnaire are related to religious well-being, and 10 items are related to existential well-being. The scores of this questionnaire are in the form of 6-point Likert scale, and the range of scores for each dimension of this questionnaire is between 10 and 60. The total spirituality score is the sum of the dimensions of these two questionnaires, which is from 20 to 120. If the patients score between 20 and 40, in the low SH group, they will score in the range of 41 to 99 in the SH group and score 99 to 120 in the high SH group. Validity and reliability of this questionnaire have been confirmed in previous studies (Khairy et al. 2018; Rezaei et al. 2009; Aghahoseini et al. 2009; Ebrahimipour et al. 2015).

C: Chronic Pain Self-Efficacy Questionnaire (PSEQ)

The questionnaire has 10 items, and each item is the patient’s assessment of his ability to perform a group of activities despite the pain in 7-point Likert scale (0 to 6). In this study, patients scored between 0 and 60 about PSE; the higher the score, the greater the self-efficacy about pain. This questionnaire has the necessary validity and reliability (McCracken et al. 2004; Nicholas and Asghari, 2006; Firoozi et al. 2018).

Method of Research

In this study, the study population was patients with chronic disease in Ilam City and the study sample was 150 patients with chronic pain referring to public and private health centers in Ilam, which had all the criteria for participation in the study. After explaining the objectives of the study for the participants in the study, the researchers began to question if the patients had informed consent. In case the patient was in a suitable condition, the questionnaire was given to them and they were asked to answer the questions carefully. Patients were also trained to postpone completing the questionnaire to another time in case of fatigue or any other factor that may affect the process of completing the questionnaire. If the participants in the research did not have the ability to complete the questionnaire, the questionnaire was completed by interview method.

Statistic Analysis

To analyze the data and SH correlation with PSE with SPSS 16 software, descriptive and analytical tests were used. Descriptive statistical tests were used to assess the status of SH and PSE; statistical analyses were used for their correlation.

Result

The findings in Table 1 showed that mean (SD) of the total score of SH variables was 65.16 (9.88) and PSE was 34.48 (4.08).

Table 1 Comparison of mean (SD) of the SH and PSE based on demographic variables in patient with CP
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According to Pearson statistical analysis, there is a significant relationship between SH and PSE (r = 0.442, P = 0.000) (Table 2).

Table 2 Relationship between spiritual health and PSE
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With the findings in Table 3, the standard beta and non-standard beta coefficients for SH variables in PSE show that the non-standard beta coefficient in SH is equal to 0.183.

Table 3 Standardized beta coefficient for assessing the contribution of the spiritual health with PSE
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Discussion

The result showed that M(SD) of PSE score in patients with CP was 34.48(4.08). In the study of Boroumand et al., M(SD) of the pain score of patients was 36(9.94)(Boroumand 2012). In Karkkola et al., M(SD) of the PSEQ score was 56.57(10.37)(Karkkola et al. 2019). The result showed that there was a relationship between SH and PSE. As the score of SH increased, the PSE score increased. In the study of Jasemi et al. on a group of burned patients in Urmia in Iran, the result showed significant and inverse relationship between SH and pain severity and with the increase in SH scores, the pain score of patients was reduced (Jasemi et al. 2018). In the qualitative study of Moeini et al. on a group of heart patients in Iran, it was shown that heart patients participating in the study regard pain as divine destiny. Some patients believed in heart medications prescribed by physicians and nurses, and another group of patients believed merely in the power of God and hope and trust in God. Patients also believed that religious actions such as prayer, orison, resorting to the Imams, thanking God, and vowing were an important factor in the relief of pain (Moeini 2014), which is consistent with the results of the present study based on the relationship of SH and pain. On the other hand, in some studies, there was no relationship between SH and pain that is not consistent with the results of the present study. So, Tafazoli et al. showed no relationship between pain severity and SH (Tafazoli et al. 2019), where for the difference between the results of the present study with the study by Tafazoli et al. (2019), the difference in the research population can be mentioned, so that in the current study, chronic patients have been studied, while in the study of Tafazoli et al. (2019) it was not so.

From the strengths of this study, examining the patients with CP may be mentioned, which has been less considered in previous studies. Also, from other strengths of this research, the research sampling method can be pointed out. In this research, we tried to perform the sampling so that it is an introduction of the whole population of the research. Other strengths of this study are its innovativity.

Conclusion

The results of this study showed that SH is a predictor of pain acceptance, so that patients who were more religious were more likely to tolerate CP. For this reason, it is suggested that religious interventions be performed to reduce pain in patients with CP, in order to provide the necessary context for pain reduction in this group of patients.