Background: Chronic pain affects 20% to 35% of the global population, negatively impacting sleep quality, cognitive function, and psychological well-being. Self-forgiveness and interpersonal forgiveness serve as spiritual coping mechanisms that facilitate emotional regulation and psychological stability. While the inability to forgive functions as a chronic stressor, forgiveness is associated with reduced anxiety and improved immune function. Furthermore, a bidirectional relationship exists where pain disrupts sleep patterns, and poor sleep increases psychological sensitivity to pain.
Aims: This study aims to analyze the influence of self-forgiveness (SF) and forgiveness of others (FO) on sleep disturbances (SCI), mental health indicators —depression (PHQ-9), anxiety (GAD-7), and stress (PSS)— and physical health variables—including pain intensity (VAS), fatigue (MFI), and life satisfaction (0–10)—in a large cohort of patients with chronic pain conditions such as ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, and fibromyalgia, among others.
Materials and Methods: An observational study was conducted with 1,764 participants with chronic pain, aged 20 to 85. Validated instruments were used to measure forgiveness (self-forgiveness and interpersonal forgiveness), sleep quality, pain, fatigue, and psychological well-being.
Results: Women reported higher levels of pain, fatigue, sleep disturbances, and perceived stress. Significant negative correlations were found between sleep disturbances and self-forgiveness (r = -0.19, p < 0.001) and the forgiveness of others (r = -0.19, p < 0.001). Sleep disturbances were negatively associated with health status (r = -0.36) and life satisfaction (r = -0.34). Conversely, they were positively linked to pain (r = 0.41), depression (r = 0.39), anxiety (r = 0.37), and fatigue (r = 0.47).
Conclusion: Forgiveness is a critical spiritual determinant of sleep quality and life satisfaction in patients with chronic pain. These findings underscore the importance of integrating forgiveness-based interventions into multimodal clinical care to improve health outcomes and foster patient inner peace.