The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms

Department of Psychology, The Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA.
Immunology and allergy clinics of North America (Impact Factor: 1.82). 02/2011; 31(1):81-93. DOI: 10.1016/j.iac.2010.09.010
Source: PubMed


Converging and replicated evidence indicates that psychological stress can modulate wound-healing processes. This article reviews the methods and findings of experimental models of wound healing. Psychological stress can have a substantial and clinically relevant impact on wound repair. Physiologic stress responses can directly influence wound-healing processes. Furthermore, psychological stress can indirectly modulate the repair process by promoting the adoption of health-damaging behaviors. Translational work is needed to develop innovative treatments able to attenuate stress-induced delays in wound healing.

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Available from: Jean-Philippe Gouin
    • "Anxiety or agitation is also commonly experienced and observed in ICU patients [10]. Their anxiety can also be triggered by mechanical ventilation or withdrawal status, potentially delaying wound healing [11]. Furthermore, patients in the ICU who require high, prolonged doses of sedatives and analgesics to reduce anxiety usually experience adverse effects, such as bradycardia , hypotension, gut dysmotility, immobility, weakness, and delirium [12] [13]. "
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    ABSTRACT: Little is known about the relationship between anxiety and pain in intensive care unit (ICU) patients despite its importance. The aims of the present study are to examine the correlation between pain and anxiety during ICU care and to investigate its effects on the dose of opioids and anxiolytics administered. The study subjects were awake critically ill patients admitted to an ICU over a 2-month period. Trained psychiatrists evaluated the nondelirious, noncomatose patients daily for anxiety and pain using the Numeric Rating Scale for Pain (NRS-Pain), Faces Anxiety Scale (FAS), and Hamilton Anxiety Rating Scale. Daily alterations of anxiety and pain were significantly correlated with one another among 123 patients. Both the FAS and the Hamilton Anxiety Rating Scale were positively correlated with the NRS-Pain (P < .001 for both). The NRS-Pain score (P = .016) and the FAS score (P = .007) both significantly correlated with the dose of anxiolytics. The dose of opioids was unaffected by the severity of pain or anxiety. Pain and anxiety among critically ill patients in the ICU were closely correlated. Pain and anxiety influenced the dose of anxiolytics administered. Therefore, a precise evaluation and comprehensive approach to the management of pain and anxiety are important for treating ICU patients. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jun 2015 · Journal of Critical Care
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    • "Acute stress can activate the immune system and cause inflammation through the complement cascade [9]. On the other hand, chronic stress can impair immune function and delay wound healing [10]. It is important that when people are in a state of healing their immune systems are functioning optimally, that is, neither overreacting nor underreacting. "
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    ABSTRACT: This study was performed to investigate the effect of live, spontaneous harp music on individual patients in an intensive care unit (ICU), either pre- or postoperatively. The purpose was to determine whether this intervention would serve as a relaxation or healing modality, as evidenced by the effect on patient's pain, heart rate, respiratory rate, blood pressure, oxygen saturation, and heart rate variability. Each consenting patient was randomly assigned to receive either a live 10-minute concert of spontaneous music played by an expert harpist or a 10-minute rest period. Spontaneous harp music significantly decreased patient perception of pain by 27% but did not significantly affect heart rate, respiratory rate, oxygen saturation, blood pressure, or heart rate variability. Trends emerged, although being not statistically significant, that systolic blood pressure increased while heart rate variability decreased. These findings may invoke patient engagement, as opposed to relaxation, as the underlying mechanism of the decrease in the patients' pain and of the healing benefit that arises from the relationship between healer, healing modality, and patient.
    Full-text · Article · Nov 2013 · Evidence-based Complementary and Alternative Medicine
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    • "Our main finding is that microbicidal potential of HMDM of the stressed subjects remained unchanged throughout the study period. Psychological stress has been repeatedly shown to delay the process of wound healing [1], [2] in which macrophages are known to play a pivotal role [6]. Skin wound healing characteristically runs in consecutive and overlapping phases with the inflammatory phase as an early phase beginning within hours after wound application [37]. "
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    ABSTRACT: Psychological stress delays wound healing but the precise underlying mechanisms are unclear. Macrophages play an important role in wound healing, in particular by killing microbes. We hypothesized that (a) acute psychological stress reduces wound-induced activation of microbicidal potential of human monocyte-derived macrophages (HMDM), and (b) that these reductions are modulated by stress hormone release. Fourty-one healthy men (mean age 35±13 years) were randomly assigned to either a stress or stress-control group. While the stress group underwent a standardized short-term psychological stress task after catheter-induced wound infliction, stress-controls did not. Catheter insertion was controlled. Assessing the microbicidal potential, we investigated PMA-activated superoxide anion production by HMDM immediately before and 1, 10 and 60 min after stress/rest. Moreover, plasma norepinephrine and epinephrine and salivary cortisol were repeatedly measured. In subsequent in vitro studies, whole blood was incubated with norepinephrine in the presence or absence of phentolamine (norepinephrine blocker) before assessing HMDM microbicidal potential. Compared with stress-controls, HMDM of the stressed subjects displayed decreased superoxide anion-responses after stress (p's <.05). Higher plasma norepinephrine levels statistically mediated lower amounts of superoxide anion-responses (indirect effect 95% CI: 4.14-44.72). Norepinephrine-treated HMDM showed reduced superoxide anion-production (p<.001). This effect was blocked by prior incubation with phentolamine. Our results suggest that acute psychological stress reduces wound-induced activation of microbicidal potential of HMDM and that this reduction is mediated by norepinephrine. This might have implications for stress-induced impairment in wound healing.
    Preview · Article · Feb 2013 · PLoS ONE
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