Introduction
Pain is a common medical symptom that poses significant challenges for hospitalized patients. According to a survey conducted in hospitals in Canada, approximately 70.4% of inpatients experience pain (Jabusch et al., 2015). In China, the rate is 63.36%, with 68% experiencing acute pain, 26% chron-ic pain, and 16% neuropathic pain (Xiao et al., 2018). Italy reports an even higher prevalence of 80.8%, both for acute and chronic pain, which tends to increase with age (Mitello et al., 2022). Other countries, such as Sweden and Spain, report high numbers, with 62% and 52.9%, respectively (Peter-son & Schaller, 2022; Becerra-Bolaños et al., 2023). A survey at a children’s hospital in Uruguay found a pain prevalence of 51.3% (Walther-Larsen et al., 2017). These data underscore that pain is a highly significant and widespread issue across various healthcare facilities worldwide, with a high incidence rate.
Uncontrolled pain can lead to detrimental physiological and psychological effects. Physically, pain can reduce physical activity, weaken the immune system, and disrupt sleep patterns (Peterson & Schaller, 2022). Psychologically, chronic pain is often associated with anxiety, depression, and sui-cidal thoughts (Mullins et al., 2023). Uncontrolled acute postoperative pain results in increased morbidity, functional impairment, delayed recovery, prolonged opioid use, and higher healthcare costs (Gan, 2017). Pain significantly impacts inpatients’ physical and mental condition, reducing the quality of life and increasing economic burdens (Das et al., 2020). Therefore, effective pain management is crucial to control pain successfully.
Many non-pharmacological approaches to pain management are commonly employed in hospitals, such as massage, acupressure, and temperature modulation. However, these treatments primarily focus on physical care. Effective pain management should consider the physical, psychological, emotional, cultural, and spiritual dimensions (Sjattar et al., 2024). Listening to the Quranic recitation is one form of therapy that can provide relaxa-tion and tranquility (Al-Galal & Fakhri Taha Alshaikhli, 2017) and enhance spirituality (Suwardi & Rahayu, 2019). Reciting Quranic verses and listening to the Quran has been found effective in reducing anxiety, depression, stress, pain, and fear among Muslim women during pregnancy (Si-monovich et al., 2022). Reciting the Quran has been shown to stimulate alpha brain waves associated with endorphin release, increase stress thresh-olds, create a sense of relaxation, and reduce negative emotions, which can lower postoperative pain levels (Eid Aburuz et al., 2023). This finding aligns with research by Keivan et al. (2019), demonstrating that listening to Quranic recitation effectively reduces pain during burn treatment. Addi-tionally, listening to the Quran is more effective in reducing headaches in hypertensive patients than listening to Mozart music (WirakhmiTin et al., 2018). 
Although numerous studies have investigated the use of Quranic recitation therapy for pain management, further mapping of the procedures for using Quranic recitation therapy in clinical settings is necessary. This need arises due to the high prevalence of pain in hospitals and the adverse effects of uncontrolled pain. Therefore, we conducted a scoping review to map the use of Quranic recitation therapy for hospital pain management.

Materials and Methods
The preferred reporting items for systematic reviews and meta-analyses extension for Scoping reviews (PRISMA-SCR) were utilized to optimize reporting and increase fidelity (Tricco et al., 2018). The review followed the guidelines of scoping review frameworks (Arksey & O’Malley, 2005), using the five stages of scoping reviews:

Stage 1. Identify research questions
This scoping review elaborates on the effectiveness of listening to Quranic recitation on pain management in a hospital setting.

Stage 2. Identify relevant studies and search terms
Five databases were used for the literature search: PubMed, Willey Online Library, Cochrane, Science Direct, and Garuda, plus a secondary search from 2014 to June 2024. This time frame was chosen to ensure relevance to current clinical practices and provide a comprehensive 10-year overview of the literature on Quranic recitation therapy for pain management. Boolean operators (“AND” and “OR”) were used to optimize the search strategy, focusing on the terms “Quran” OR “Qur’an” OR “Koran” AND “pain.” Our initial search was based on title, abstract, and content to identify terms and keywords (Table 1).



Table 2 shows a sample search strategy used in one of the databases, along with the number of hits for each keyword or Boolean combination.



Stage 3: Literature selection
This scoping review uses the population, exposure, outcome (PEO) framework. The inclusion criteria in this scoping review are shown in Table 3.



This review excluded literature reviews, study protocols, and non-peer-reviewed articles. Most included studies focused on Muslim populations, as Quranic recitation is inherently tied to Islamic cultural and spiritual practices. However, one study involving neonates (Marofi & Nikobakht, 2018) was included. While neonates are not yet oriented to religion, the study was considered relevant due to its focus on the physiological effects of Quranic recitation, which are not restricted by religious affilia-tion.
After obtaining the articles, a screening process based on inclusion and exclusion criteria was carried out. A total of 250 relevant abstracts were inserted into the Men-deley reference manager. After removing duplicate articles, 237 articles remained. Next, the titles were screened for relevance, resulting in 31 articles for further screening. Of these, 13 articles were categorized as directly related to the review question, followed by full article reading. Then, we removed articles that were not relevant. This selection stage resulted in 10 research studies being included and then analyzed (Figure 1).




Reliability of study extraction
The article selection process was conducted using the Rayyan software program (Ouzzani et al., 2016) to facilitate systematic screening and manage inclusion criteria efficiently. The selection involved 3 rounds: initial screening, full-text review, and final inclusion. Three individuals (Sunarti Maming, Rosyidah Arafat and Saldy Yusuf) carried out the selection process. Subsequently, we thoroughly reviewed each article, including its title, abstract, and full text, employing the Jonna Briggs Institute (JBI) manual method. Any discrepan-cies in study selection were resolved through discussion. Of the 13 articles selected, 10 met our review criteria. 

Stage 4: Literature mapping
Data was extracted by entering important information; the variables measured can be seen in (Table 4).






Stage 5: Organize, summarize, and report results
Focusing on the analysis of Quranic recitation interventions in pain management, several pieces of literature formed the basis for data collection. The identification of essential themes was carried out when the analysis results were reported.

Results

Characteristics of the studies
Ten included studies consist of various research designs: 4 RCTs, 1 prospective study, and 5 quasi-experimental studies. Among the 10 reviewed articles, one is from Jordan (Eid Aburuz et al., 2023), one from Iran (Marofi & Nikobakht, 2018), one from Turkey (Kocak et al., 2022), 2 from Pakistan (Maarof et al., 2023; Pervaiz et al., 2024), one from Arab Saudi (Ahmed et al., 2022) and four from Indonesia (Kurniyawan et al., 2018; Hanafi et al., 2019; Priyanto et al., 2019; Fadholi &== Mustofa, 2020). The sample sizes varied from 12 (Hanafi et al., 2019) to 132 (Eid Aburuz et al., 2023). Most studies were conducted in Muslim-majority countries, suggesting that a significant proportion of participants were likely Muslim adults. However, one study (Marofi & Nikobakht, 2018) included neonates. 

Finding related Quranic recitation
Based on our findings, we categorized the outcomes of Quranic recitation therapy for pain (Table 5).



Pain and its measurement
The numerical pain scale (NRS) is the most widely used tool for measuring pain (Kurniyawan et al., 2018; Priyanto et al., 2019; Fadholi & Mustofa, 2020; Ahmed et al., 2022; Eid Aburuz et al., 2023; Pervaiz et al., 2024). Other measurement tools include VAS (Hanafi et al., 2019; Kocak et al., 2022) and the Wong-Baker Faces pain scale (Maarof et al., 2023). For neonates, pain measurement uses the neonatal infant pain scale (Marofi & Nikobakht, 2018), while the face pain rating scale and comfort scale measure pain in unconscious patients (Hanafi et al., 2019).
The procedure and technique for administering Quranic recitation therapy vary, including the choice of surahs and the duration of treatment. Surah Ar-Rahman is the most frequently used Surah (Marofi et al., 2018; Hanafi et al., 2019; Priyanto et al., 2019; Fadholi & Mustofa, 2020; Eid Aburuz et al., 2023). Other recited surahs include Surah Al Insyirah, which is recited for pregnant women about to give birth (Kocak et al., 2022), Ayatul Kursi for hematological cancer patients (Ahmed et al., 2022), Surah Yaa-Seen for patients in the recovery period post-anesthesia (Maarof et al., 2023) and Surah Al Fatiha recited during post-open reduction and internal fixation (ORIF) wound care (Kurniyawan et al., 2018). Procedures for usage include using headphones connected to an iPad (Eid Aburuz et al., 2023) and MP3 players (Marofi & Nikobakht, 2018). The duration of the Quranic recitation provision ranges from 10 minutes (Kurniyawan et al., 2018; Eid Aburuz et al., 2023) to 35 minutes (Hanafi et al., 2019).

Discussion 
The Quran is the holy book of Muslims and is believed to provide psycho-spiritual therapeutic benefits to its readers and listeners (Kannan et al., 2022). In Muslim culture, the Quran serves as a spiritual guide and a resource for holistic healing, often utilized in alternative medicine through specific Quranic verses (Al-Jabi et al., 2021). According to a survey conducted by Abuelgasim et al. (2018) in Arab Saudi, 88.1% of cancer patients use the Quran as a form of treatment, with 11.9% stating that listening to Quranic recitations helps in controlling their pain.
Most studies included in this review involved adult participants, likely Muslim, given the cultural context of research conducted in Muslim-majority countries. However, this assumption is based on the geographical context, as not all studies explicitly mentioned the religious affiliation of participants. One study (Marofi & Nikobakht, 2018) included neonates who naturally lack a religious orientation, emphasizing the potential physiological benefits of Quranic recitation beyond spiritual or religious contexts. While neonates are not yet oriented to religion, the study was considered relevant due to its focus on the physiological effects of Quranic recitation, which are not restricted by religious affiliation.
In various literature sources that we have outlined above, listening to Quranic recitations has shown positive effects on pain control in hospitals, whether it be acute pain such as postoperative pain (Fadholi & Mustofa, 2020), post-CABG surgery pain (Eid Aburuz et al., 2023), pain during blood sample collection in neonates (Maarof et al., 2023), pain during wound care post-ORIF (Kurniyawan et al., 2018), pain in ICU patients (Pervaiz et al., 2024), and labor pain (Kocak et al., 2022). In addition to acute pain, Quranic recitations are also adequate for chronic pain control, such as in bone cancer patients and hematological cancer patients (Priyanto et al., 2019; Ahmed et al., 2022). However, only Hanafi et al. (2019) investigated the effect of Quran recitation on patients with reduced consciousness. They reported no statistically significant difference between pre- and post-pain scores as measured by the VAS, faces pain rating scale, and comfort scale. Although statistical significance was not observed, the intervention group exhibited a trend of lower pain scores post-intervention, and based on patient interviews, as consciousness gradually im-proved, listening to Quranic recitations provided comfort. This is evidenced by the increase in cortisol levels in the intervention group being higher than in the control group. This finding aligns with the study by Trevino et al. (2022), which stated that higher pain scores are associated with lower cortisol levels. 
Listening to Quranic recitations induces a calming and relaxing effect, evidenced by increased alpha waves and decreased diastolic blood pressure (Ul Ain Irfan et al., 2019). Similarly, Al-Galal and Fakhri Taha Alshaikhli (2017) stated that participants who listened to Quranic recitation produced higher alpha waves than beta waves, reflecting calmness and relaxation. Listening to Quranic recitation stimulates alpha waves, which increase endorphin levels, creating a sense of relaxation and alleviating pain (Eid et al., 2023). This finding aligns with Wahida’s (2015) research, which found that β-endorphin levels in laboring mothers who listened to Quranic recitation were higher compared to the control group. β-endorphins are a natural analgesic that alleviates pain and induces relaxation.
Of the 10 studies, 6 utilized Surah Ar-Rahman, chosen for its meaning of mercy and compassion. It reflects God’s majesty and ongoing mercy, even during illness, re-minding us always to appreciate Allah’s blessings (Hanafi et al., 2019). This finding aligns with the research by Suwardi and Rahayu (2019), which found that Surah Ar-Rahman has short verses, making it easy to understand and quickly enhancing one’s spirituality towards Allah Subhanahu Wa Ta’ala (SWT) (Allah, The Most Glorified and The Most High). Most verses in this Surah speak about Allah’s mercy, and one verse is repeated 31 times, emphasizing the immense blessings Allah has bestowed.
There are several limitations to this review. First, despite using broad search terms, we may have missed some articles due to variations in terminology. Second, our review is limited to English articles, so that we might have overlooked essential contributions in other languages. Additionally, the lack of standardization in interven-tion protocols, such as differences in the duration of Quranic recitation sessions and the choice of Surahs, complicates comparisons across studies.

Conclusion
According to this scoping review, listening to Quranic recitations can reduce pain in postoperative patients, patients with decreased consciousness, pregnant women in labor, cancer pain, and pain from procedural interventions such as wound care and blood sample collection in neonates. Surah Ar-Rahman is the most frequently used chapter in this therapy. Based on the results of this review, it is hoped Quranic recitation therapy can be integrated into pain management protocols in hospitals as a routinely used complementary therapy. Future research should focus on establishing standardized methodologies and exploring the therapy’s efficacy in non-Muslim populations to understand its universal applicability.

Ethical Considerations

Compliance with ethical guidelines
Ethical issues related to authorship were considered. Duplicate publications were avoided. In case of suspected plagiarism or fraudulent research, the article was excluded. The authors tried to write with inclusion, respect, and acknowledgment of diversity. Also, bias and exclusive language (sexist, racist, homophobic, etc.) were avoided.

Funding
This research received no specific grant from public, commercial, or not-for-profit funding agencies.

Authors' contributions
Conceptualization: Sunarti Maming; Study design: Sunarti Maming, and Rosyidah Arafat; Data analysis, Initial draft preparation, and final approval: All authors; Supervision: Rosyidah Arafat, and Saldy Yusuf;

Conflict of interest
The author declared no conflict of interests.

Acknowledgments
The authors would like to express deep gratitude to the faculty members, colleagues, and administrative staff of the Master of Nursing Study Program, Faculty of Nursing, and Hasanuddin University, Makassar, Indonesia, for their invaluable support and guidance during this research.




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