1. A COMPARISON OF LEVELS OF SPIRITUAL DISTRESS IN IRANIAN AND AUSTRALIAN PEOPLE WITH CHRONIC PAIN Background It is increasingly recognised that spiritual and existential factors are an important component of the experience of chronic pain. 1 Recent findings have demonstrated that people with chronic pain have levels of spiritual distress that are equal to or higher than people with cancer or HIV/AIDS. Previous studies of spiritual wellbeing have focussed almost exclusively on populations in “Western” cultures and there is little information regarding this aspect from other cultural contexts. Results There were significant differences between the Iranian pain clinic, Australian pain clinic and Australian community groups in age, mean intensity, pain self efficacy and spiritual wellbeing (Table 1). There were no significant differences between the groups in measures of depression and anxiety. Further analysis revealed that the Australian community group was significantly different from both the Iranian and Australian pain clinic in all variables with the exception of age which was significantly different from the Iranian pain clinic but not the Australian pain clinic. Methods Participants included people with chronic non-cancer pain of various aetiologies attending a pain clinic in Iran (n=50) and people with chronic pain either attending a pain clinic (n=31) or living in the community (n=46) in Australia. Informed consent was obtained from each participant who was requested to complete a questionnaire assessing a number of pain- related variables. These included average pain intensity over the last week (0-10 numerical rating scale), mood (Depression Anxiety Stress Scale - 21) and pain self efficacy (Pain Self Efficacy Questionnaire). Spiritual well-being was assessed using the Functional Assessment of Chronic Illness Therapy – Spirituality Expanded Scale (FACIT-Sp) which is a widely used instrument in “Western” countries. It has also been recently validated using a Persian version. 2 Group comparisons were made using ANOVA statistical methods. Philip Siddall 1,2, Ali Asghari 3,4, Mandy Corbett 1, Melanie Lovell 5,2, Rebecca McCabe 1, Hojat Danially 3, Ghazal Akbarzade 6, Ziba Farajzadegan 7 1 Department of Pain Management, HammondCare, Greenwich Hospital, Sydney NSW Australia; 2 Sydney Medical School-Northern, University of Sydney, Sydney, NSW, Australia; 3 School of Psychology, Shahed University, Tehran, Iran; 4 Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Australia; 5 Department of Palliative and Supportive Care, HammondCare, Greenwich Hospital, Sydney NSW Australia; 6 School of Psychology, Shahid Behesti University, Tehran, Iran; 7 Ziba Farajzadegan, School of Medicine, Isfahan University, Isfahan, Iran. Hypotheses and aims The hypotheses underlying the project are: Persistent pain is a contributor to spiritual or existential distress that includes factors such as meaning and purpose. That the impact of pain on spiritual wellbeing will occur similarly across different cultural contexts. The aim of this study was to compare the levels of spiritual distress in two groups of people with chronic pain in different cultural contexts; one in Iran and one in Australia. Conclusions Spiritual wellbeing in people with chronic pain may be impacted to similar levels across different cultures. People attending pain clinics had higher levels of spiritual distress than people with chronic pain in the community even though there was no significant difference in mood. Previous studies have demonstrated that there is no correlation between levels of spiritual wellbeing and pain and therefore the higher levels of pain intensity in the pain clinic groups are unlikely to account for the levels of spiritual distress. It may be that spiritual distress is independent of pain intensity and mood and may be a key factor in the overall distress leading to pain clinic referral. Conversely, it may be that high levels of spiritual wellbeing are a key component of resilience that enables people to function at high levels despite the presence of pain without requiring pain clinic intervention. References 1.Siddall PJ, Lovell M, MacLeod R. Spirituality: What is Its Role in Pain Medicine? Pain Medicine, 2014 Aug 26. doi: 10.1111/pme.12511. [Epub ahead of print] 2.Jafari N, Zamani A, Lazenby M, Farajzadegan Z, Emami H Loghmani A. Translation and validation of the Persian version of the functional assessment of chronic illness therapy—Spiritual well-being scale (FACIT-Sp) among Muslim Iranians in treatment for cancer. Palliative & Supportive Care 2013;11: 29-35. Acknowledgments: This research was supported by a grant from the Australian & New Zealand College of Anaesthetists (Project grant #13/001) Community pain Australia Pain Clinic Australia Pain Clinic Iran FP Age66.2 SD 11.762.9 SD 17.043.1 SD12.4039.3.000 Mean Pain Intensity4.1 SD 2.25.9 SD 2.06.3 SD 2.611.63.000 Pain Self efficacy42.5 SD 13.429.4 SD 12.731.5 SD 16.59.58.000 Spiritual well being (meaning/peace ) 34.8 SD 8.828.5 SD 10.023.8 SD 7.228.27.000 Spiritual well being (total) 34.8 SD 8.828.5 SD 10.023.8 SD 7.219.93.000 P<0.000 P<0.003 P<0.001 P<0.002