Chronic wound-associated pain, psychological stress, and wound healing.

Pain is an unpleasant sensory experience that evokes negative emotions and erodes an individual's quality of life, constituting a significant amount of stress. Chronic-wound patients have described pain as most intense during dressing change and the worst part of living with an ulcer. Wound-related pain is complex, involving a multitude of physiologic and psychologic factors, such as emotional state, culture, personality, meaning, and expectation. Although the exact mechanism(s) remains elusive, a burgeoning body of evidence suggests a close link between stress/anxiety and pain. Wound healing can be compromised by overproduction of cortisol compromising the function of immune system in addition to catecholamines causing vasoconstriction and poor tissue oxygenation. The purpose of this paper is to review the relationships among pain, stress, and wound healing.