A Biopsychosocial-Spiritual Model of Chronic Pain in Adults with Sickle Cell Disease

Abstract

Chronic pain in adults with sickle cell disease (SCD) is a complex multidimensional experience that includes biological, psychological, sociological, and spiritual factors. To date, three models of pain associated with SCD (i.e., biomedical model; biopsychosocial model for SCD pain; Health Belief Model) are published. The biopsychosocial (BPS) multidimensional approach to chronic pain developed by Turk and Gatchel is a widely used model of chronic pain. However, this model has not been applied to chronic pain associated with SCD. In addition, a spiritual/religious dimension is not included in this model. Because spirituality/religion is central to persons affected by SCD, this dimension needs to be added to any model of chronic pain in adults with SCD. In fact, data from one study suggest that spirituality/religiosity is associated with decreased pain intensity in adults with chronic pain from SCD. A BPS-Spiritual model is proposed for adults with chronic pain from SCD since it embraces the whole person. This model includes the biological, psychological, sociological, and spiritual factors relevant to adults with SCD based on past and current research. The purpose of this paper is to describe an adaptation of Turk and Gatchel’s model of chronic pain for adults with SCD and to summarize research findings that support each component of the revised model (i.e., biological, psychological, sociological, spiritual). The paper concludes with a discussion of implications for the use of this model in research.

The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain

“…250 Other researchers have noted that the biopsychosocial model, as commonly described, may be too restrictive as it fails to capture important elements of quality of life, such as spirituality and religion, which has led to the development of a biopsychosocial-spiritual model of chronic pain that was recently applied to patients with sickle cell disease. 219 Still other approaches have emphasized behavioral aspects of pain, with a biopsychomotor model highlighting the critical roles of communicative pain behaviors, protective pain behaviors, and social response behaviors. 216 Despite these criticisms, however, the biopsychosocial model of pain has been enormously valuable in shaping our understanding of individual differences in pain, and in guiding the development of efficacious and effective psychosocial and behavioral interventions to reduce the suffering and sequelae associated with persistent pain.…”

“…Overall, these various models postulate that patterns of affect, cognition, and behavior interact with an array of neurobiological pathways to shape long-term pain outcomes such as disability. 87;198 For examples of other disease-related biopsychosocial models, the reader is referred to publications on multiple sclerosis pain 165 , sickle cell pain 219 , cancer pain 176 , and HIV-related neuropathic pain. 154 A comprehensive assessment of the overlap and the unique features of these models would be well beyond the scope of the present article, but we note that many influential psychosocial factors are common to most of these disease-related models.…”

Literature Review of Spiritual Care in Islamic Cultural Perspective

“…Spiritual care is a series of activities to facilitate a harmonious balance between bio-psychosocial and spiritual aspects (Ramezani et al, 2014;Taylor et al, 2013). Other researchers added that spiritual care involves identifying spiritual needs, being able to understand stress, patient anxiety, and family problems (Chiang et al, 2016).…”

“…Some researcher considered disease as a stressor. This has an impact on the meaning of life so that a commitment is needed to understand spiritual care (Taylor. et al, 2013).…”

Sickle Cell Disease in Adults: Developing an Appropriate Care Plan

“…Patients in pain may respond by crying, grimacing, laughing, or by simply ignoring the pain. Individuals with SCD tend to use more passive coping, such as prayer (Thompson & Eriator, 2014) and spirituality (Taylor, Stotts, Humphreys, Treadwell, & Miaskowski, 2013), in response to pain. Young adults, in particular, tend to use a mixture of active and passive strategies.…”