Chronic pain is a critical health issue affecting millions of Older Adults individuals worldwide.1,2 As the population continues to age, the prevalence of chronic pain among Older Adults is expected to rise substantially.3 Unfortunately, chronic pain can significantly diminish one's quality of life by interfering with daily activities, disrupting sleep, exacerbating fatigue and depression, and even leading to disability.4,5 Finding effective coping mechanisms to manage chronic pain is therefore essential for the well-being of many older adults.6

One coping mechanism that a sizable proportion of the Older Adult population utilizes to endure chronic pain is religious faith and spiritual practices.7 Studies show that many Older Adults turn to prayer, meditation, participation in religious services, and other forms of religious coping when faced with persistent pain from arthritis, nerve damage, injuries, and other long-term medical conditions.8,9 The potential impact of religious and spiritual factors on pain tolerance has become an emerging area of research interest.10 However, much remains unknown regarding the underlying psychological and neurological mechanisms that may enable religious coping strategies to augment pain endurance among Older Adults and chronic pain sufferers.11,12

The number of Older Adults above 65 years battling chronic pain for extended periods has grown tremendously over the past few decades.5 In the United States alone, recent studies estimate that over 60 % of Older Adults experience persistent pain emanating from progressive degenerative disorders, past injuries, neurological conditions, musculoskeletal problems, and other age-associated diseases.13 The most common pain complaints revolve around osteoarthritis, spinal stenosis, compression fractures, diabetic neuropathy, post-stroke pain, post-amputation pain, and metastatic bone cancer.14,15 Apart from interfering with work, recreation, mobility, sleep, and other facets impacting the quality of life, uncontrolled chronic pain can also lead to anxiety, depression, social isolation, cognitive decline, and even suicide among Older Adults.16 Developing safe, affordable, accessible, and effective pain-coping methods is therefore a major healthcare priority for enabling healthy aging with dignity.17

Since antiquity, faith-based beliefs and religious practices have been utilized as coping mechanisms during times of crisis, hardship, and suffering.18,19 Even in predominantly secular modern societies today, statistics indicate that a majority of Older Adult citizens facing chronic health conditions continue to draw on religious and spiritual resources to make sense of and endure persistent pain arising from age-related disorders.20,21 Surveys show that prayer, meditation, participation in worship services, reading spiritual texts, religious imagery, and conversations with faith leaders often play a central role in reinforcing perseverance and resilience among Older Adults and individuals struggling with chronic pain.8,22,23

The reasons underlying the widespread reliance on religious coping strategies among Older Adults experiencing long-term pain highlight the significance of investigating this phenomenon from scientific and clinical perspectives.24,25 Firstly, in comparison to the general population, older individuals tend to demonstrate higher levels of religious commitment and spiritual engagement.25 Those aged 65+ also suffer from more chronic health problems. These factors predispose many Older Adults to access religious coping methods when dealing with pain.26 Secondly, religious beliefs and activities like prayer or meditation are convenient, inexpensive to access, and can provide quick psychospiritual solace.27 Such characteristics make religious coping tactics well-suited for geriatric patients who seek easily available, affordable means for persisting through pain arising from chronic medical ailments.28, 29, 30

Despite the widespread adoption of religious coping methods to manage pain among Older Adults, theoretical frameworks articulating potential mechanisms underlying the pain-modulating effects of spiritual practices remain underdeveloped.31,32 Nevertheless, researchers have put forth tentative models anchoring the postulated influences of religion and spirituality on bolstering pain tolerance.33,34

One perspective highlights the role of religious reappraisals in stimulating positive emotions that can inhibit the distress associated with chronic pain.35 This framework draws on Lazarus and Folkman's seminal transactional model, which emphasizes cognitive appraisals as critical mediators shaping an individual's emotional and coping reactions when confronted by taxing situations.36 According to this theory, Older Adults who cope with pain by reframing their situation through a religious lens can generate positive sentiments regarding personal growth, meaning-making, divine purpose, and existential consolation.37 Such affirmative appraisals are proposed to operate through complex neurobiological pathways involving the anterior cingulate cortex, amygdala, and related brain structures to attenuate perceived pain severity and distress.38,39

An alternate model known as the Neuropsychological Religious Coping framework underlines the potential for religious rituals to activate the brain's reward-motivation circuitry and stimulate the release of endogenous opioids that raise pain tolerance thresholds.40,41 This theory posits that spiritual practices valued by Older Adults such as prayer meditation, worship attendance, or religious imagery can trigger dopaminergic activity within neural networks encompassing ventral striatal and ventromedial prefrontal regions.42 Dopaminergic firing subsequently leads downstream nuclei including periaqueductal gray matter to release enkephalin, beta-endorphins, and other endogenous analgesic molecules that can transiently modulate pain.43 Through repeated activation of this neurobiological cascade, religious coping responses may strengthen Older Adults individuals’ capacity to endure chronic pain emanating from degenerative, inflammatory, and nerve disorders.44

Beyond appraisal and neurocognitive models, developmental perspectives highlight how the accumulation of positive religious experiences across the lifespan can crystallize into complex systems of beliefs, attitudes, memories, attachments, and coping repertoires held by Older Adults.22,45,46 This framework suggests that by drawing on profound theological insights and rich spiritual narratives cultivated through decades of existential questioning, interpersonal exchange, and ritual participation, geriatric patients can access psychospiritual resources to assign purpose and coherence to the chaos induced by chronic pain.45 Accordingly, the depth of religiosity and spirituality accrued over a lifetime primes many Older Adults to process pain through an interpretive lens imbued with sacred meaning and divine teleology.47 By contextualizing suffering within a theological framework emphasizing hope, renewal, salvation, or auspicious afterlife destinations, Older Adults s are posited to develop resilience enabling their perseverance through episodes of severe, persistent pain arising from age-associated disorders.48,49

A broad range of quantitative and qualitative studies provide persuasive evidence regarding the positive effects of religious and spiritual resources on boosting pain tolerance among Older Adults experiencing persistent suffering from chronic medical problems.50,51 Research methodologies encompass cross-sectional surveys, longitudinal cohort analyses, structured interviews, and ethnographic observations examining the relationships between various indicators of religious coping and subjectively rated pain severity, perceived life interference from pain, and pain-related disability.52

One major investigation utilized a large probability sample of over 1500 community-dwelling Older Adults dealing with arthritic pain.53 Results showed that Older Adults self-reporting high levels of religious coping demonstrated lower pain intensity ratings, fewer daily impediments due to pain, fewer physical limitations, and a lower likelihood of needing home healthcare services.54,55 Quantitative findings also indicated that intrinsic religiosity mediated by positive religious appraisals and meaning-focused coping reduced perceived pain severity beyond effects accounted for by demographics, social support, physical health, and mental health.56,57

Synthesizing insights across the spectrum of clinical, survey-based, phenomenological, and ethnographic investigations, current empirical evidence strongly confirms the multidimensional role religious coping responses play in boosting pain tolerance among Older Adult patients managing long-term afflictions.58 While additional research is required to disentangle the precise causal mechanisms and boundary contexts shaping the effects of specific religious coping methods on particular pain outcomes among varied Older Adult subgroups, available findings overwhelmingly highlight the pain-alleviating potentials of spiritual appraisals, beliefs, rituals, and experiences. These results underscore the vital importance of assessing and appropriately incorporating religious factors within psychosocial approaches to pain management tailored for geriatric populations. So, The primary objective of this study is to examine the correlation between biopsychosocial-spiritual variables and pain tolerance among individuals suffering from chronic pain.