Page 39 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

12 Chapter 1. Psychosocial Consequences of Wounds

(Upton 2011a , b ). For example, whilst it was found that a
3-day exercise programme did not positively impact wound
healing (Altemus et al. 2001 ), research implementing a 4
week programme resulted in a 25 % improvement in punch
biopsy wound healing (Emery et al. 2005 ).
As described earlier, the experience of living with a
chronic wound brings with it a number of factors (e.g. malo-
dour, exudate, restricted mobility, aspects of treatment)
which can lead to a patient reducing their participation in
social activities, often becoming isolated. When an individual
withdraws from social interactions, they forsake an important
aspect of psychosocial support. Thus there is a whole range of
practical and emotional support which is no longer accessible
to an individual. As social support has been found to be
important for emotional wellbeing and quality of life, acting
as a buffer against stress and enhancing physical health
(Thoits 2011 ) this has implications for wound healing. The
evidence from clinical populations suggests that social isola-
tion has an indirect effect on wound healing because of the
impact it has on our emotional health which was noted earlier
(Hawkley and Cacioppo 2003 ); this increased distress further
hinders healing by reducing inflammatory cytokines and
increasing cortisol concentrations as already described.
However, animal studies have identified a more direct path-
way for this influence. Detillion et al. ( 2004 ) found that stress
did increase cortisol concentrations, thereby impairing wound
healing in hamsters, but only in those animals that were kept
in isolation. Socially housed animals did not show this effect.
Furthermore, isolated hamsters that had been given an adre-
nalectomy, and therefore could not produce cortisol, did not
show delayed wound healing. In contrast treating isolated
hamsters with the hormone oxytocin, which is released dur-
ing social contact, blocked stress-induced increases in corti-
sol, and wound healing was facilitated. This suggests that
social isolation increases stress-related cortisol production
thereby slowing wound healing. Whilst studies with human
populations show inconsistent effects for oxytocin in social
behaviours, it seems increasingly likely that this is because
the oxytocin mechanism is controlled to some extent by
social contexts and individual differences (Bartz, et al. 2011 );