Spirituality and health is a topic in the frontier of scientific research and studies with increasing relevance and volume have been published¹1 Elmholdt EM, Skewes J, Dietz M, Møller A, Jensen MS, Roepstorff A, et al. Reduced pain sensation and reduced BOLD signal in parietofrontal networks during religious prayer. Front Hum Neurosci. 2017;11:337., ²2 Ferreira-Valente A, Sharmam S, Torres S, Smothers Z, Pais-Ribeiro J, Abbott JH, et al. Does religiosity/spirituality play a role in function, pain-related beliefs, and coping in patients with chronic pain? A systematic review. J Relig Health. 2019;18 (Epub Ahead Print). Erratum: J Relig Health. 2019;26., ³3 Goncąlves JP, Lucchetti G, Menezes PR, Vallada H. Religious and spiritual interventions in mental health care: A systematic review and meta-analysis of randomized controlled clinical trials. Psychol Med. 2015;45(14):2937-49., ⁴4 Illueca M, Doolittle BR. The use of prayer in the management of pain: a systematic review. J Relig Health. 2020;59(2):681-99., ⁵5 Meints SM, Mosher C, Rand KL, Ashburn-Nardo L, Hirsh AT. An experimental investigation of the relationships among race, prayer, and pain. Scand J Pain. 2018;18(3):545-53., ⁶6 Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care, reaching national and international consensus. J Palliat Med. 2014;17(6):642-56., ⁷7 Steinhauser KE, Fitchett G, Handzo GF, Johnson KS, Koenig HG, Pargament KI, et al. State of the science of spirituality and palliative care research Part I: definitions, measurement, and outcomes. J Pain Symptom Manage 2017;54(3):428-40., ⁸8 Tajadini H, Zangiabadi N, Divsalar K, Safizadeh H, Esmaili Z, Rafiei H. Effect of prayer on intensity of migraine headache: a randomized clinical trial. J Evid Based Complementary Altern Med. 2017;22(1):37-40., ⁹9 Wachholtz AB, Malone CD, Pargament KI. Effect of different meditation types on migraine headache medication use. Behav Med. 2017;43(1):1-8.. In this current issue, Moreira, Santana and Posso¹⁰10 Moreira RS, Santana Jr RN, Posso MB. Espiritualidade, enfermagem e dor: uma tríade indissociável. BrJP 2021;4(4):344-52. analyze in a literature review the clinical studies that evaluated the spirituality-based interventions for pain reduction used in nursing. Congratulations to the Brazilian Journal of Pain for accepting an article in this area and especially for highlighting it in an editorial.

In the article, the authors navigate through the difficult issue of defining spirituality and religiosity, a matter still under debate in the scientific field, and one that needs further understanding. After selection based on the established criteria, 10 articles were included in this review. Numerous clinical situations such as childbirth, burns, chronic renal failure, vascular diseases, and cancer were studied. Several interventions were performed, but despite the heterogeneity, all treatments focused on spiritual care through specific programs or prayer therapy. All resulted in positive outcomes in reduction of pain and related anxiety, as well as improving vital parameters.

This review has a relevant role in guiding future practices, as it gathers evidence that supports spirituality as a tool to reduce pain-related suffering, and it’s a starting point for a scientific approach towards the topic, so that further research can be conducted, addressing more clinical scenarios, more interventions and comparisons with treatments already established in the guidelines.

Are pain and suffering inseparable? To dissociate pain from suffering is as difficult as to give context to both. Viktor Frankl highlights the importance to give meaning to suffering, and religiosity and spirituality can provide that. The same author points out that suffering is not at all necessary to find meaning¹¹11 Moreira N, Holanda A. Logoterapia e o sentido do sofrimento: convergências nas dimensões espiritual e religiosa. Psico-USF 2010;15(3):345-56.. Meaning simply exists, it only needs to be found. Thus, we should look at the opportunity of positive religious coping and its targeted interventions presented but should not miss the other end: negative religious coping, which tends not to appear in studies and may generate worse outcomes.

Let more studies be conducted in this very challenging area that is spirituality and health, through rigorous practices and hypotheses evidenced in previous studies and reviews such as the one discussed here, establishing previous works as guidelines for future research.

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