Chronic pain is the most common cause of disability in the United States with depression, anxiety, and stress often occurring co-morbidly. The purpose of the study was to explore how religion may modulate the frequency of back pain, influence inflammatory markers, influence the use of medications, and impact functional ability.

Participants were from the Biological Manifestations of Religion Study (BioMRS; N= 508) and the Psychological Manifestations of Religion Study (PsyMRS; N = 10,988). All participants completed a 20-page questionnaire and BioMRS participants provided blood, salivary, and urine samples, performance tests, and learning tests all collected within 1 week of completion of the questionnaire.

No association was found between religious coping and back pain frequency in the BioMRS sample. There were no associations between religious coping and inflammatory markers, anti-inflammatory markers, cortisol, or the medications aspirin or NSAIDS. Negative religious coping was associated with depression, neuroticism, and negative affect and positive religious coping with positive affect. There were no significant associations between religious coping and functional ability.

A small sample size resulting in low power may have led to the lack of effects in BioMRS so data were re-analyzed with the larger PsyMRS database resulting in a significant association between negative religious coping and higher frequencies of back pain. Negative religious coping was associated with increased use of NSAIDS. There were no associations with aspirin use and religious coping. A significant association was found for negative religious coping and decreased function. Depression mediated all of the above associations. Back pain frequency was related to increased medication use and decreased function. Also, when back pain was low, positive religious coping was associated with less NSAIDS use but not when back pain was high. Back pain and depression were significantly negatively associated with physical function and the two interacted to further decrease function.

Preventive care specialists should evaluate depression and religious coping for back pain patients and provide appropriate counseling regarding how religious expression can impact back pain and use of medication.


School of Public Health

First Advisor

Jerry W. Lee

Second Advisor

Denise L. Bellinger

Third Advisor

Lee S. Berk

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Low Back Pain; Chronic Pain -- immunology; Attitude to Health -- psychology; Religion and Medicine; Religion and Psychology; Health Surveys.



Page Count

xii; 128

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives