Pediatric chronic pain: active versus passive religious coping

Abstract

Several studies have explored adult's use of religion in coping with chronic pain or illness, focusing on active religious coping techniques (social support, prayer, partnering with god or looking to God for support) and religion's enhancement of one's well-being with the subsequent reduction of physical and emotional pain. However, research has shown that when compared to an active style, passive religious coping (avoidance, denial, or deferring to or passively waiting for God to take control of the situation) is associated with negative mental health outcomes. We describe the clinical presentation of three adolescent girls (M age = 14.3) who came from low SES, ethnic minority intact families with fathers who were Christian pastors. They presented with chronic pain that was described by their rheumatologists as being excessive given their medical diagnosis (diagnosis; juvenile idiopathic arthritis, fibromyalgia, pain disorder NOS). The patients attended weekly individual therapy with their mothers, noting disapproval by their fathers who refused to participate. The patients all reported active religious coping for their pain management, using prayer in addition to outside support to help manage their chronic pain. However, they emphasized their fathers' preference towards passive religious coping methods for pain management, denying the presence of their pain and the aid of psychiatric, therapeutic, and/or medical treatment. As a result, high levels of anxiety, depression, guilt, self-blame, and negative religious appraisals were observed in the adolescents, with all three prematurely ending therapy within the year. Religion plays a strong role in many patients' lives, requiring medical staff to be attuned to coping methods used by not only the patients but their families as well. Future research should examine the role of religion in pain coping amongst the patient, family, and medical professionals. (Schumaker, Religion & Mental Health, 1992; Pargament, Koenig, & Perez, J Clinical Psychology, 2000.) Several studies have explored adult's use of religion in coping with chronic pain or illness, focusing on active religious coping techniques (social support, prayer, partnering with god or looking to God for support) and religion's enhancement of one's well-being with the subsequent reduction of physical and emotional pain. However, research has shown that when compared to an active style, passive religious coping (avoidance, denial, or deferring to or passively waiting for God to take control of the situation) is associated with negative mental health outcomes. We describe the clinical presentation of three adolescent girls (M age = 14.3) who came from low SES, ethnic minority intact families with fathers who were Christian pastors. They presented with chronic pain that was described by their rheumatologists as being excessive given their medical diagnosis (diagnosis; juvenile idiopathic arthritis, fibromyalgia, pain disorder NOS). The patients attended weekly individual therapy with their mothers, noting disapproval by their fathers who refused to participate. The patients all reported active religious coping for their pain management, using prayer in addition to outside support to help manage their chronic pain. However, they emphasized their fathers' preference towards passive religious coping methods for pain management, denying the presence of their pain and the aid of psychiatric, therapeutic, and/or medical treatment. As a result, high levels of anxiety, depression, guilt, self-blame, and negative religious appraisals were observed in the adolescents, with all three prematurely ending therapy within the year. Religion plays a strong role in many patients' lives, requiring medical staff to be attuned to coping methods used by not only the patients but their families as well. Future research should examine the role of religion in pain coping amongst the patient, family, and medical professionals. (Schumaker, Religion & Mental Health, 1992; Pargament, Koenig, & Perez, J Clinical Psychology, 2000.)