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Wednesday July 28 1:41 PM ET

Stress slows wound-healing process

NEW YORK, Jul 28 (Reuters Health) -- Researchers believe they have solved the mystery of why physical wounds heal best when patients are feeling calm and stress-free.

Emotional upset appears to reduce the activity of compounds important to the healing process, explain Dr. William Malarkey and colleagues at Ohio State University in Columbus. The finding may help explain why ``greater fear or distress before surgical procedures is associated with poorer (results),'' they write in a recent issue of the Archives of
General Psychiatry.

Malarkey's team asked 36 women to complete psychological questionnaires focused on levels of personal stress and the number and type of stressors in their lives.

Each woman then received 'wounds' -- a series of small blisters on the forearm, induced in a relatively painless manner through the use of a special suction device.

The investigators gathered fluid from these blisters as they began to heal.

They found that fluid levels of two key 'healing compounds' -- interleukin-1 and interleukin-8 -- were ``significantly lower'' in samples gathered from women with the highest levels of stress versus women with lower levels of stress.

The researchers also measured concentrations of the stress hormone cortisol in the saliva of each subject. As expected, women with the highest reported stress levels also had the highest cortisol levels.

Numerous studies have suggested that blood concentrations of interleukin-1 and -8 decline with increasing levels of cortisol. According to the authors, interleukin-1 and -8 ``help protect against infection and prepare injured tissue for repair.'' As stress (and cortisol) levels rise, interleukin levels fall -- triggering a slowdown in the healing process.

The findings may have important implications for the treatment of wounds and for patients undergoing surgery. Study co-author Dr. Janice Kiecolt-Glaser notes that ``there is a lot in the medical literature suggesting... that a patient should not be under stress before surgery.'' The study authors comment that stress-reducing therapies -- such as drugs or psychotherapy -- might enhance post-surgical recovery.

Kiecolt-Glaser believes the immune system may be extremely sensitive to even subtle changes in emotional health. ``The women in this experiment were really average in terms of the stress they were experiencing,'' she points out. ``So this doesn't require desperate, terrible stress levels to see effects on the immune system.''

SOURCE: Archives of General Psychiatry 1999;56:450-456.

last update 24 Oct 1999

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