Stifling stress reactions
Indirectly, stressors such as anxiety, isolation and even postoperative pain can reduce wound-healing rates up to 40%.1 Such stressors release steroids, which stimulate the pituitary to release glucocorticoid hormones. These hormones diminish the amount of pro-healing cytokines such as interleukin (IL)-1, vascular endothelial growth factor (VEGF) and transformative growth factor beta (TGFb) available to reach the wound, Dr. Kirsner said.
Conversely, he said, physical and mental exercise, a positive attitude, social interaction and pain reduction all reduce stress, mediated by oxytocin. "Someday perhaps we'll be giving oxytocin to reduce stress and improve healing." For now, "consider creating a stress-free environment for our patients." This can include controlling operative and postoperative pain, he said, and perhaps postponing elective procedures if patients have recently experienced stressful life events.
Like steroids, catecholamines released during stress also delay healing. However, said Dr. Kirsner, the success of systemic propranolol in reducing childhood hemangiomas2 fueled the discovery that beta blockers block catecholamines – a mechanism that's proving useful in many indications. For instance, he said that in a well-done, randomized, controlled trial (RCT) involving 79 burn patients, those who received a systemic beta blocker healed faster (16.13 ± 7.4 days versus 21.52 ± 7.94 days, P = 0.004) than control-group patients.3