The opiate of the masses

Abstract

“Believers go on rack to prove God relieves pain”. Behind this rather sensationalist headline lies an interesting study that is being planned at the new Centre for the Science of the Mind (OXCSOM) in Oxford, UK. A group of cognitive neuroscientists, brain imagers, and theologians has received $2 million from the John Templeton Foundation—a US philanthropic organisation—to study whether religious beliefs affect how pain is perceived and modulated in the brain. The research clearly will not prove whether God exists, but it could help to nail down whether faith has a neural basis. The debate over whether religious belief can mitigate pain has been raging for decades. Studies done in the 1980s and 1990s showed that prayer and attendance at church services can reduce pain. In a survey of patients with musculoskeletal pain (Arthritis Rheum 1989; 32: 1604–7), prayer was the most common “unconventional” method used for pain relief; about half of the patients who prayed said it was helpful in alleviating their pain. However, the confounding factors in these observational studies are huge, making definitive conclusions virtually impossible. On the one hand, there is a myriad of explanations for the reduction of pain reported in people with strong religious beliefs: externalising control decreases stress and anxiety; the power of belief reduces a person's suffering and consequently reduces their pain; and religious belief may help build a more robust coping strategy. On the other hand, if a person believes that pain is a punishment for sins, the accompanying guilt may amplify the pain they feel and prayer might only serve to make them focus on their discomfort. By studying brain activity, neuroscientists can probe complex phenomena such pain perception, meditation, and consciousness. In a study published last year (Proc Natl Acad Sci USA 2004; 101: 16369–730), researchers investigated the effect of meditation on brain waves in eight Buddhists who were experienced in meditation. Compared with control individuals, electroencephalographs recorded from the Buddhists' brains showed bursts of activity that suggested a synchronisation of diffuse neural networks during meditation. What's more, differences in electroencephalogram spectra were found between Buddhists and controls even when they weren't meditating, which suggests that this sort of mental training can induce long-term changes in the brain. In the OXCSOM study, volunteers will be subjected to a mildly painful stimulus, such as a heat pad applied to the hand, while their brain activity is recorded with functional MRI. Initially, the volunteers will be shown neutral pictures (eg, a coffee cup) when they receive the painful stimulus. But then the pictures will be switched to religious images. The researchers hypothesise that, in participants with religious beliefs, be they Christians, Hindus, or Jews, they will see a change in the pattern of brain activity, which may translate to a reduction in pain sensation. Although this will be the first study to use brain imaging to investigate the effect of faith on pain at the neural level, the effect of analgesics and placebos on pain processing in the brain have already been explored. During a painful stimulus, a vast network of areas is activated as the brain processes the sensory perception of pain (the type, intensity, and location of pain and whether a motor response is needed) and as higher cognitive functions become involved, such as attention and emotion. PET studies have shown that these regions of the brain are modulated by opioid analgesia and that the placebo effect acts through this same system (Science 2002; 295: 1737–40). Cognitive behavioural therapies have a similar effect by tapping into attentional systems and coping mechanisms. So, could religious belief be the cognitive equivalent of a sugar pill or a form of cognitive behavioural therapy? The OXCSOM study may provide a definitive answer to this question. But what then? Should doctors prescribe a dose of prayer or a course of religious service attendance for the treatment of chronic pain? There is no scientific evidence to support such advice. But bearing in mind that over 85% of the world's population are people of faith (http://www.odci.gov/cia/publications/factbook/geos/xx.html), we should perhaps appreciate that a more holistic approach to pain treatment may be more effective for many patients.