Stress and the body in patients with non-healing wounds

Nursing

Stress and the Body in Patients with Non-Healing Wounds

Walburn, J., Vedhara, K., Hankins, M., Rixon, L., & Weinman, J. (2009). Psychological

stress and wound healing in humans: a systematic review and meta-analysis. Journal of Psychosomatic Research, 67(3), 253-271.

This article is a review of existing research that has been done in relation to psychological stress and wound healing. Initially twenty-two papers were identified as meeting the inclusion criteria for a systematic review and a subsample of 11 were identified as being able to be included in a meta-analysis. The studies looked at the impact of stress on the healing of an assortment of wound types in dissimilar circumstances, including acute and chronic clinical wounds, experimentally produced punch biopsy and blister wounds, and small damage to the skin caused by tape stripping. Seventeen studies in the systematic review found that stress was associated with impaired healing. The conclusion drawn by the authors was that there needs to be research done towards investigating possible moderators of the relationship, intervening mechanisms supporting the association, as well as the demonstration of a causal link by the advance of experimental interventions in healthy people.

The authors present the idea that cutaneous wound healing is a multifaceted process composed of interdependent and overlapping stages, including clot formation, inflammation, proliferation, and remodeling. The initial post injury phase is characterized by the formation of a fibrin clot followed by the inflammatory stage, usually within 1 -- 3 days after injury which is dominated by immune cells that destroy bacteria and debride the wound. These substances are crucial if normal tissue repair is to progress.

It is believed that successful healing is dependent in part on a completely functioning immune system therefore making it susceptible to the myriad of factors which can damage immune performance. Since both acute and chronic psychological stress can modulate immune function, it becomes reasonable to consider that psychological stress might have an unfavorable effect on wound healing. As well as the assortment of different clinical wounds described previously there are presently two experimental paradigms used by researchers to examine wound healing in the laboratory, particularly, inflicting a standardized wound to the skin or oral mucosa using a punch biopsy or alternatively creating suction blisters. A third less invasive approach involves causing minor injury to the stratum corneum or outer layer of the skin by repeated application of cellophane tape. This damages the capability of the skin to standardize the movement of water in and out of the body known as its barrier function. Recovery of the barrier can be calculated by the level of water loss.

This review aimed to look at whether a common relationship with stress existed across different wound types and experimental models. There are a number of reviews in existence that look at the relationship between stress and wound healing; however, none is systematic in their methodology nor has attempted to quantify the relationship. The goals of this review were twofold. First it was intended to summarize existing research looking at the nature of the connection between stress and wound healing in a systematic review and it set out to quantify the size of the relationship in a meta-analysis of a subset of included studies.