Page 65 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

38 Chapter 2. Pain

Pathophysiological causes of pain can include
wound aetiology, pressure from neoplasms, prolonged
inflammation, hypersensitivities, venous insufficiency and
vacuities, or even local infection (Hollinworth 2005 ).
Additionally, pain can be exacerbated through psychologi-
cal causes. For example, the experience of pain can cause a
patient to experience an abundance of negative emotional
states including those of fear, anxiety and depression (Woo
et al. 2008 ). Through a complex interaction, such negative
states can lead to psychological stress and the reduction of
a patient’s pain threshold and subsequent pain tolerance
(Woo et al. 2008 ). This results in a continuous cycle of
increased pain – stress – and subsequent pain, negatively
impacting upon wound healing.

Psychological Influences, Pain and Stress

It has been found that the chronic pain, as highlighted above,
can lead to inadequate adaption to living with a wound,
negatively impacting upon a patient’s psychological
functioning (Upton 2011a , b ). Extreme or exaggerated wound
pain can lead to patient’s experiencing higher forms of
distress, frustrations and lowered self-esteem. In addition to
this, patients can experience severe emotional and physical

stress (see Chap. 3 ). Such psychological factors (stress in
particular) can have a significant impact on the way that a
patient perceives their experience of pain. This emotional
response can affect both biological and behavioural responses,
subsequently impacting, again, on the emotional response to
pain, resulting in a continuous negative cycle.
There is a recurring theme with regards to a patient’s
experience of pain: stress and subsequent further pain. The
initial pain that patients experience due to their wound can
lead to heightened levels of stress and anxiety. In turn, this
stress lowers the patient’s tolerance and pain threshold,
subsequently resulting in the experience of worsened pain
(Woo 2010 ).