Page 102 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

76 Chapter 3. Stress

but also reoccurrence of chronic wounds (Norman 2003 ). The
implementation of interventions can benefit the healing pro-
cess, while, in some instances, also reduce distress and
improve quality of life (Upton 2011a , b ).
As discussed earlier, research has highlighted the signifi-
cant impact of psychological stress on wound healing, with
further research suggesting a link between stress and
increased pain sensitivity (Leistad et al. 2006 ). However,
there is limited research available elucidating the link
between pain and stress in chronic wound patients (Upton
2011a , b ). Research conducted by Upton and colleagues
( 2011a , b ) has explored the link between pain and stress at
dressing change. Pain and stress were recorded (using psy-
chological and physiological measures) from 39 patients at
baseline and during dressing change. Significant differences
were discovered between baseline and dressing change
responses for heart rate, pain rating, stress rating and anxiety.
Furthermore, all measurements indicated higher scores dur-
ing dressing chance, highlighting increased pain and stress.
Additionally, it was discovered that chronic stress correlated
with stress at dressing change and pain at dressing change.
Based upon these results, it could be concluded that chronic
stress levels impact upon pain and stress intensity during
dressing change (Leistad et al. 2006 ), or that continual, regu-
lar experiences of pain and stress caused by the wound and
dressing chance contributes to chronic stress (see Fig. 3.5 ).
In a similar study to those conducted by Upton’s team (e.g.
Upton et al. 2013a , b ; Upton and Solowiej 2010 , 2012 ; Upton
and South 2012 ; Upton et al. 2012a , b , c ; Solowiej and Upton
2010a , b ), Parvaneh et al. ( 2014 ) reported that patients visit-
ing a DFU clinic experienced stress when attending the clinic.
Using a novel and innovative recording technique, the use of
wearable stress-monitors allowed for the physiological conse-
quences of stress to be recorded on a real-time basis. The
study reported that the highest stressful condition was during
wound dressing change, which was related to either the pain
or painful dressing. Again, confirming other studies (Upton
and Solowiej 2012 ) that suggests minimising pain and stress