Throughout human history, pain and disease have been associated with human life. Therapists have sought to achieve health, cure diseases and reduce patient’s pain [1]. Different civilizations, based on their own epistemology, philosophy approach and Knowledge, performed various therapeutic methods including: classical and non-medical treatments [2]. Classical medicine does not have a healing version for some of the human health threats [3]. Complementary medicine such as: prayer and faith therapy are the options when classical treatments fail or become unbearable due to adverse effects [4].

      Because cultures create life styles [5] and is effective in creating health and disease [6] study of the culture impact on the concept of health and illness, the etiology of diseases, the description of the symptoms, care and treatment methods is the subject of medical sociology [7]. Today, based on the findings of medical sociology, the treatment method of two patients with a similar disease who have different cultures, values and social beliefs are different [8]. Community-based health services emphasizes on the coordination of therapeutic measures with patient’s beliefs and culture [9].

      The impact of philosophy and culture on the concept of health and disease as social concepts was emphasized by the World Health Organization (WHO) at the Edinburgh conference [10]. Because philosophical attitudes can create different cultures, affect the knowledge, lead to the acceptance of assumptions [11], create scientific hypotheses, and produce different theories and sciences [12]. For improving the quality of care and patient’s satisfaction [13] the coordination of therapeutic measures with patient’s beliefs, is essential for religious culture societies [14].

Figure 1: flow chart

      In the philosophical view of Islam, human being has a soul from the unseen world, which gives him existence [15]. Perception, feeling, movement, consciousness originate from soul. The soul can relate man to God, so has the greatest impact on health and disease [16]. The Quran calls the soul as “heart” and the commander of the body, which is responsible for the members command and forbidding [17]. From the perspective of the Quran, cognition, awareness, judgment, decision-making, perception of pain is performed by the soul [18].

      But in clinical physiology, pain is caused by cells damage, releasing chemical intermediates and sensory neurons stimulations. The sensory stimulus are sent from the spinal cord to the thalamus and the brain cortex, and perception of pain is done by the brain’s cortex. In the view of Islam, brain is only a mediator for the pain signals, as the spinal cord is a “gate control “and “pain perception “ is performed by the soul [19]. Unfortunately, the deep impact of the soul on the body has been neglected in science [20]. This matter deprives the Muslim patients (both Shiite and Sunni religions), from spiritual treatments. The purpose of this study was “Explaining the spiritual methods of relieving pain from the perspective of Islam based on the belief in the existence of the soul”.

      This evolutionary study [21] has focused on this question: “what is the spiritual method of relieving pain from the perspective of Islam based on the belief in the soul existence? The following stages were carried out to promote and complete the available knowledge by using a non- systematic, scientific, and justifiable process according to the Sound Heart Model approach which emphasizes the strengthening of patient’s relationship with God through faith therapy to create optimism and hope for God’s mercy and create spiritual self-awareness and strengthen communication with people and nature for love and kindness.

      Specifying the needs, aim, and population: In this regard, initially, all the nursing care instructions about pain relief available in ministry of health and treatment and instructions of intensive units of Baqiyatallah hospital in Tehran were selected. Their quality was assessed by Agree and Glia standard tools [22].

      Reviewing the evidences: Searching and studying articles were done based on the PICO method during the following stages: - P [Patient, Population]: determining the patients’ characteristics and his related health issue. - I [Intervention]: determining desired intervention or treatment measure (one specific aspect of nursing care, which should be done by a nurse or health care team). - C [Comparison]: explaining another intervention, which can be compared with the desired intervention? - O [Outcome]: results achieved from performing a specific intervention in the study.

      Complete text of the related religious articles in the internal and external databases including: Magi ran, Cochrane, SID, Elsevier, Google Scholar, Pub Med (Request) were studied based on the evidence-based pyramid and in order of priority from the systematic review studies, meta-analysis, clinical trial tests, cohort, case study, case report, laboratory studies, as well as opinions of specialists and experts through purposive sampling method.

1. Inclusion criteria for selecting evidences and articles included:
2. Persian or English articles that focus on nursing spiritual care.
3. Articles have to be written in 2005-2017.
4. Essay based on evidence-based pyramid priorities.
5. Verses interpretations should have been collected from the authentic reference books.
6. Islamic evidences were taken from the verses related to pain and suffering by using Book Al-Mu’ajm, authentic Shia commentary books, related reliable Hadiths; Beharol-anvar, Kofi, resurrection.

      Accreditation: Reviewing articles and developing spiritual methods based on the latest texts were done in 3 Delphi rounds with the opinions of at least 10 faculty members, seminary professors, psychology professors, as well as intensive care specialists, and ICUs educational instructors as the expert group.

      Comparative study: determining the practicality of the spiritual method in the ward and assessing benefits and dangers for the patients and nurses, in the focus group, consisted of at least 15 nurses with B.A or M.A of nursing who have the experience of at least 1 year of clinical work in the ICU.

      Application: The way of using this method at bedside, were determined during focus group discussions

      Findings
According to the Quran, one of the miracles of “the Prophet Jesus (as)” was the healing of patients and the resurrection of the dead with the permission of God. According to narrations, the Prophet Muhammad (peace be upon him), healed the patients with God’s permission. The patient or one of his family members can act in the way of the Prophet for reducing the pain. They should say:

      In the name of God the Beneficent the

1. “I apologize to God for my mistakes and ask forgiveness and I return to God.”
2. Thank God for countless blessings “Praise be to Allah, Lord of the Worlds”
3. “O Allah, bless Muhammad and the family of Muhammad”(Salavat)
4. Laying hand on the forehead or place of pain, and read this prayer seven times:
• O pain, calm down and relax, for the peace of God
• Stay calm and quiet, for the sake of God’s mercy
• Forbidden to be bad, for the sake of forbidding God.
• Quiet and calm, for the sake of God’s tranquility
• I will shelter you, human, to what God has given refuge to it, “God’s throne and angels” on the day of shocks and earthquakes, on the resurrection [23].
5. “O Allah, bless Muhammad and the family of Muhammad”(Salavat)
6. He/she should express the needs and demands
7. Saying: There is no power and authority beyond God’s power, and whatever God wants will happen
8. With Hope for God’s mercy
9. And waiting for healing and recovery, because God has said, “I am avoiding that my servant will ask me something between two Salavat (O Allah, bless Muhammad and the family of Muhammad) and I do not answer him.”

      Quran says: What comes to you from pain and suffering is all due to your wrong behaviors, and God forgives many mistakes (verse 30 of surah al-Shouri). Indeed, the sufferings and crises, only for the oppressor, are the means of politeness but for believers are a test, degree and dignity [24]. So the patient with believe in God kindness to all servants (even sinners), understands that every act has consequences. He/she desires forgiveness, recalls the God love to servants, thanks God for blessings, prays hopefully for pain relieving and treatment [25]. The patient sees God as the source of mercy and he pays attention to the impact of lifestyle, destructive excitement, unhealthy habits, and highrisk behaviors on the incidence of illness [26]. Therefore, pain control methods for Muslims patients in addition to: Preventing cell damage, reducing the effect of chemical mediators of pain with medications, Avoid transferring sensory message with localized anesthesia, Blocking transmission of message from spinal cord to higher levels with spinal and epidural anesthesia, Weaken the brain’s cortex during general anesthesia, are the use of spiritual methods, such as praying, to influence the soul [27].

      One of the interesting points in the prayer of the Prophet of Islam is putting hand on the point of illness and praying that it is in line with scientific findings. The most recent scientific sources have shown that when the therapist puts his hands on the patient’s part and prays for the improvement of the patient, Pulse electromagnetic fields with very low frequency are created on the floor of the therapist hand. Their wavelengths have frequencies whose therapeutic effects for body tissues have already been proven [28].

      Today, it has been determined that there is a defective cycle of pain that includes: fear of unknowns, stress and muscle spasm, and ischemia, exacerbation of pain due to ischemia and exacerbation of patient’s fear. Therefore, patient teaching, the use of stress management techniques, techniques for reducing muscle spasm and reducing tissue ischemia can be used to “relieve pain” [29]. But unfortunately, important points have been ignored in science, including:

• From the perspective of all the Abrahamic religions, all the universe creations have a degree of spirit and perception and all of them pray God. And in the whole world of creation, the voice of prayer is heard [30]. Prayer language is a universal and common language among all the human beings [31].
• Prayer is a spiritual activity and for many of the people is a religious activity, that is the easiest way to communicate with God which is possible to do in all modes, at all times and in all places [32].
• Prayer is one of the effective factors in improving and restoring health [33]. To the extent that the medication is effective in improving the physical condition, prayer also affects the healing of physical and mental illness [34].
• Prayer means a request from God. Sometimes praying is “friendly speaking with God”, and sometimes it’s a formidable one. In this case, even if it is not fulfilled, the prayer will benefit from it [35].
• Some of the prayer such as: Patient prayers, Father’s prayer for the child, Child prayer for parents, the prayer of the believer, will be fulfilled by God [36].
• The Best Time to Answer Prayers are: Before the “Azan for the morning prayer”, Before the dawn, At noon, after the Maghreb, After each obligatory prayer, At the time of reciting the Quran, When the rains come, Before the occurrence of difficulty and crisis [37].

     An investigation on the role of prayer as a personal religious factor in pain management showed that prayer is significantly related with pain tolerance, and there is a moderate effect of religious affiliation in the relationship between prayer and pain severity as well as pain tolerance [38]. And In another research when Twenty religious and twenty non-religious healthy volunteers were exposed to painful electrical stimulation during internal prayer to God, Prayer reduced pain intensity by 34% and pain unpleasantness by 38% for religious participants, but not for non-religious participants [39].

      Although Prayer strengthens the patient’s relationship with God and belief in God’s power and wisdom. During prayer patient feels God’s protection, calm and secure [40]. The fear, anxiety and sorrow caused by the prognosis of the disease is destroyed by the trust of God’s mercy and kindness [41]. Prayer interrupts the pain cycle. But attention to the impact of spiritual methods on pain relief has not yet been considered as one of the scientific evidence [42]. It is suggested that spiritual methods should be used as a community method in holistic care for relieving the pain of religious patients.

      Faith in the God’s mercy, wisdom, power, gives meaning to life events and sacred suffering from the disease. Prayer provides emotional compatibility with the pain by converting the emotions derived from fear and misery to sense of security, trust, hope, optimism.

Acknowledgement

     Sincere thanks and appreciation are to the professors who collaborated in conducting this study.