Differential Connectivity Associated with Pain Outcomes by Religious/Spiritual Belief

The biopsychosocial model of pain is a well-accepted framework to understand how all facets of life influence the pain experience, but one crucial sociocultural element is often missing from this approach. Religion/spirituality (R/S) can have a significant impact on an individual's perception of health and illness, but its role in the context of pain has thus far been de-emphasized. Further, the neurobiological processes underlying this relationship have not been explored. The purpose of this study was to examine differences in functional connectivity underlying pain severity and interference in R/S (n = 61) and atheist (n = 16) individuals with temporomandibular disorder. Participants self-reported religious affiliation and average pain severity and interference over the past week using the Graded Chronic Pain Scale (GCPS) prior to completing an anatomical and 8-minute, eyes-open resting-state functional MRI scan. There was no significant difference in pain severity or interference between R/S and atheist participants. For atheist participants, there was a larger negative association between pain severity and decreased medial prefrontal cortex (PFC)-left frontal pole connectivity than for R/S participants. Additionally, atheist participants exhibited large increased connectivity between the right lateral PFC-left middle frontal gyrus, anterior cingulate-left orbitofrontal cortex, and left periaqueductal grey-right superior lateral occipital cortex which were associated with increased pain interference as compared to R/S participants. Overall, these differences suggest that having R/S beliefs result in improved top-down emotional regulation and internal monitoring systems, whereas having no R/S beliefs may lead to an increased dependence on lower-level sensory input to interpret pain states. Funded by National Institute of Dental and Craniofacial Research (NIDCR, R01DE025946, L.C.) and by the University of Maryland Baltimore Institute for Clinical and Translational Research (ICTR) which is funded in part by grant number TL1 TR003100 from the National Center for Advancing Translational Sciences (NCATS).