Stress and Wound Healing
Individual differences in wound healing have long been recognized. Clinical observation has suggested that negative mood or stress is associated with slow wound healing. Basic mind-body research is now confirming this observation. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs), whose expression can be controlled by cytokines, play a role in wound healing.16 Using a blister chamber wound model on human forearm skin exposed to ultraviolet light, researchers have demonstrated that stress or a change in mood is sufficient to modulate MMP and TIMP expression and, presumably, wound healing.17 Activation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal medullary (SAM) systems can modulate levels of MMPs, providing a physiological link among mood, stress, hormones, and wound healing. This line of basic research suggests that activation of the HPA and SAM axes, even in individuals within the normal range of depressive symptoms, could alter MMP levels and change the course of wound healing in blister wounds.
Mind-body interventions are being tested to determine whether they can help prepare patients for the stress associated with surgery. Initial randomized controlled trials--in which some patients received audiotapes with mind-body techniques (guided imagery, music, and instructions for improved outcomes) and some patients received control tapes--found that subjects receiving the mind-body intervention recovered more quickly and spent fewer days in the hospital.18
Behavioral interventions have been shown to be an efficient means of reducing discomfort and adverse effects during percutaneous vascular and renal procedures. Pain increased linearly with procedure time in a control group and in a group practicing structured attention, but remained flat in a group practicing a self-hypnosis technique. The self-administration of analgesic drugs was significantly higher in the control group than in the attention and hypnosis groups. Hypnosis also improved hemodynamic stability.19
Evidence from randomized controlled trials and, in many cases, systematic reviews of the literature, suggests that: