Mind-Body Techniques in Wound Healing
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The Mind-Body-Spirit Relationship
Conventional medicine has a long history of breaking down physical and mental function into a mechanistic model. The emergence of a new paradigm, holistic medicine as a complement to conventional medicine, has lead to the acknowledgment of a so-called "ghost in the machine"1 - the role of human spirit or consciousness in the healing process. The placebo effect is an example of this theory. Without tangible explanation, the placebo transcends patient confidence in the caregiver and treatment into biochemical changes.2 Growing research in the field of psychoneuroimmunology suggests that the neuropeptide network is not linear in transmission, but rather numerous, spontaneous interconnections between ganglia, organs, immune system and skin.3 Thus, research is beginning to reveal communications between the nervous, endocrine, and immune systems.4 Although the immune system is still considered central, virtually all biological systems are considered part of the healing process, including the mind and emotion.3 The emergence of psychoneuroimmunology has been able to significantly demonstrate biochemical changes in the body that can be traced to emotion and/or repressed memories locked in the mind-body network.5 Often, this repression becomes the long-term coping strategy of the individual3; therefore, the manner in which human beings handle stress and form coping behaviors has a significant impact on their overall health. Likewise, it is inferred that the degree of stress on the immune system can be correlated to the quality of wound repair.5
Research by Marucha et al6 involving dental students demonstrated that examination stress resulted in a 40% slower healing rate of punch biopsies taken from the hard palate. Perhaps most interesting is that examinations for students at this level are relatively mild and predictable stressors to which they have become well accustomed. Despite this fact, examination stress was found to have statistically significant consequences for healing.6 Another study found that anxiety and depression have a distinct relationship to delayed wound healing.7 In addition to the possible psychoneuroimmunology explanation, the authors point out that indirect factors such as self neglect, disturbed sleep, and poor appetite also may be contributing to the delayed healing findings.
Various authors and researchers have explored the connection between physical ailments and a lack of self worth.8,9 These symptoms often are compounded by feeling overwhelmed and helpless in the face of illness.9 The loss of personal control and lack of self worth are described as paramount emotions linked with delayed wound repair.8-10
An ever-increasing body of knowledge points to the effect of stress on the body. More often than not, physical symptoms are not the first signs of an illness, but rather the last. Emotions and faith are being explored in their direct relation to healing. Stress stimulates the sympathetic nervous system; thus, inducing vasoconstriction, decreased tissue profusion, the release of glucose from the liver, and hormonal changes in the levels of cortisol.11-13 The secretion of cortisol, a glucocorticoid, will promote further constriction of arteries, inhibit inflammation, decrease the release of lymphocytes, and suppress the proliferation of fibroblasts.13 Although a study by Braden13 was not able to draw a causal relationship between cortisol and pressure ulcer formation, stress-induced negative thinking is believed to contribute to a diminished wound repair.
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