Page 101 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Relationship Between Stress, Pain and Wound Healing 75

Much research has indicated a link between stress and
delayed wound healing in chronic wounds (Cole-King and
Harding 2001 ; Soon and Acton 2006 ; Walburn et al. 2009 ;
Solowiej et al. 2009 , 2010a , b ). Walburn et al. ( 2009 ) and
Solowiej et al. ( 2009 ), in their respective reviews of the scien-
tific literature reported that stress was associated with
delayed wound healing in older adults, particularly those suf-
fering with leg wounds and surgical patients. There is conse-
quently evidence from both lab studies and in the clinical
setting that stress delays healing. However, just as impor-
tantly- can reducing stress improve healing? One such study
has explored whether a traditional stress-reducing interven-
tion can improve healing. A study considering the effect of an
emotional disclosure intervention on biopsy wound patients
emphasised the positive impact of minimising stress on
wound healing (Weinman et al. 2008 ).
Although the above findings illustrate the importance of
reducing stress in relation to biopsy and surgical wounds, they
cannot be applied to that of chronic wounds. It would be pre-
sumptuous, particularly given the lack of exploratory research,
to assume that such findings would be illustrative of the
stress-chronic wound relationship, particularly as chronic
wound may not necessarily follow the same healing process
(Solowiej et al. 2009 ). Thus, wound–care professionals also
need to consider the studies that provide support for the
negative consequences of stress upon wound healing. For
example, the relationship between anxiety, depression and
chronic wound healing has been investigated by Cole-King
and Harding ( 2001 ). Patient’s depression and anxiety were
measured using the Hospital Anxiety and Depression Scale
(HADS; Zigmond and Snaith 1983 ) while also rating their
healing via a 5-point Likert scale. A statistically significant
relationship was discovered with higher HADS scores being
associated with delayed wound healing. Similar findings were
reported by Jones et al. ( 2006 ) who suggest that pain and
odour were the two most influential symptoms. Hence, such
stress management interventions are essential within clinical
wound-care practice. Not only could stress increase incidence,