Page 37 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

10 Chapter 1. Psychosocial Consequences of Wounds

experience slower wound healing whilst also exhibiting larger
wound sizes. Similar outcomes have also been demonstrated
with patients suffering from burns (Wilson et al. 2011 ).
A wealth of research is also available which considers the
relationship between a patient’s perceived stress and the rate
of wound healing (Cole-King and Harding 2001 ; Gouin and
Kiecolt-Glaser 2011 ; Soon and Acton 2006 ; Woo 2010 ). This
work has linked both wound pain and treatment pain with
poorer patient outcomes. For example, Upton and colleagues
have suggested a link between pain, stress and healing in
those with a chronic wound (e.g. Upton 2011a ; Solowiej et al.
2009 , 2010a , b ). In particular, the evidence they present sug-
gests that the stress of dressing change can be a significant
factor in those with a chronic wound. Stress is thought to
influence healing partly through its impact on immune
functioning; stress reduces the levels of the many inflamma-
tory cytokines and enzymes that are necessary for tissue
repair (Upton 2011a ) and increases levels of cortisol. In addi-
tion to this physiological response, patients may have a
behavioural response to stress which impacts on healing. It
has been suggested that stress increases the likelihood of
patients making poor cognitive judgments such as avoiding
treatment because dressing removal is perceived as an
unpleasant experience. Thus negative emotional responses
affect biological and behavioural responses resulting in
delayed wound healing. The relationship between pain, stress
and wound healing is therefore both statistically significant
and clinically relevant (Gouin and Kiecolt-Glaser 2010;
Upton et al. 2012a , b , c ).
Sleep deprivation is also detrimental to the healing process.
As noted earlier, sleep disturbances are often associated with
the onset of psychological distress and with the pain accompa-
nying with living with a wound. This has significant implica-
tions for wound healing since even mild sleep deprivation has
been shown to impair immune functioning (Kahan et al. 2010 ;
Harlin et al. 2009 ). For example, just one night of sleep depri-
vation has been discovered to impact wound healing (Altemus
et al. 2001 ). It is thought that sleep disturbance, like stress,