The Effects of Quran Recitation on Sedation and Pain in Children

Optimizing the comfort of pediatric patients during a critical illness is an essential facet of day-to-day care in the pediatric intensive care unit (PICU). Optimum delivery of comfort in the complex ecosystem of the PICU remains elusive. A great deal has been published on (1) standardizing measures of comfort; (2) the best non-pharmacologic and pharmacologic therapies to use; (3) the best way to deliver these therapies; and (4) how to ensure quick and appropriate responses to changes in a patient’s comfort level.1 Analgesia-based, multimodal sedative approaches are the foundation for comfort, whereby pain is addressed first and then sedation titrated to a predefined target based on the goals of care.1 Non-pharmacological interventions can reduce the total requirement and associated side effects of sedation and analgesia medications and have been recommended by international sedation guidelines in PICU.2 For example, use of musical intervention has beneficial effects on the level of sedation in children admitted to PICU.3,4 The majority of parents thought that music therapy helped their child to communicate (89%), feel less isolated (100%) copewith stress during hospitalization (100%), contributed to physical recovery (90%), and alleviated feelings of anxiety (90%).5 A metaanalysis showed that music intervention significantly decreased the pain levels, both in the newborn group and in the infant/children group. Music intervention significantly reduced heart rate and respiratory rate and increased peripheral capillary oxygen saturation. In subgroup analyses of types of pain, music intervention had significant effects on prick pain, chronic and procedural pain, and postoperative pain.6 Herein we discussed the effects of Quran recitation, a non-pharmacological intervention, on sedation and pain in children followed in intensive care unit to attract attention to the fact that the Quran is not only a book containing religious teachings, but also a Shifa (healing) book. Parents exhibit different attitudes toward their children’s pain. Mariyana et al7 defined eight themes in managing the pain of childrenwith cancer during palliative care as follows: the dimensions of pain experienced by children undergoing palliative care; mothers’ physical and psychological responses; mothers’ emotional responses; barriers encountered by mothers when taking care of their child at home; mothers’ interventions to reduce their child’s pain; mothers’ efforts to distract their child from pain; giving encouragement when the child is in pain; and mothers’ efforts and prayers to make their child comfortable.7 In another study, six themes related to parents’ attitudes toward their children’s pain were reported as follows: pain can and should be managed; Allah’s will; parent’s worst pain was emotional pain due to child’s diagnosis; belief that their presence could ameliorate their child’s pain; desire for shared decision making; and the child’s responsibility to express pain. In this series, some parents expressed the belief that pain and suffering were from Allah and described pain as “a test from Allah” and that “everything from Allah is good.” The parents believed that praying and reading the Qur’an could reduce the child’s pain, and they also wanted the pain to be treated with medication.8 Lim et al9 noted that the Christian and Muslim parents achieved a sense of assurance from their religious beliefs and practice in managing their children’s postoperative pain. Farrag et al10 studied non-pharmacological strategies including “rewarding a child for his brave behaviors,” “steps in the sky,” “frog breathing,” and “listen Holy Quran” among children on dialysis. Quran listening was the most effective