Page 85 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Introduction 59

Chronic Wound

Wound treatment

PAIN

Stress

Delayed healing

Figure 3.1 A model illustrating link between psychological stress,
pain and chronic wound healing

In the Broadbent et al. study ( 2003 ), a sample of 47
patients with an inguinal hernia were given a standardised
questionnaire assessing psychological stress and worry about
the operation before undergoing open incision repair. Greater
worry about the operation predicted more painful, poorer
and slower recovery. These results also suggest that in clinical
practice, interventions to reduce the patient’s psychological
stress may improve wound repair and healing, and facilitate
recovery following surgery.
A similar pattern, albeit for different reasons, exists with
chronic wounds. Psychological stress can be experienced in
the presence of pain in chronic wounds so that the pain itself
is seen as a stressor. Stress can also be induced by the antici-
pation of pain, for example as a result of waiting to have a
dressing changed (Soon and Acton 2006 ). Thus, pain, or
anticipation of pain associated with treatment itself, may
have detrimental effects on the process of chronic wound
healing (see Fig. 3.1 ). In a series of studies Upton and col-
leagues suggested a link between pain, stress and healing in

those with a chronic wound (e.g. Upton 2011a , b ; Solowiej