Psychosomatic Aspects of Chronic Wounds

Abstract

Chronic wounds, such as ulcus cruris, decubitus and the diabetic foot are of great medical and socio-economic importance, since they affect 2–3 million people in Germany and have a prevalence of 1–2% in Western countries. Previous studies have primarily addressed the consequences of chronic wounds on quality of life, showing sometimes marked impairment in physical, social, psychological, and financial domains. There are few study data on the influence of psychosomatic factors on the onset and duration of chronic wounds. Experimental and psychosocial studies show, however, that emotional factors and stress may lead to increased pain and prolonged wound healing. Based on studies of patients undergoing minor surgical procedures, a perioperative stress model has been developed. This model explains the occurrence of complications as neuroendocrino-immunological interactions. Anxious patients report more severe pain and have higher cortisol and blood pressure values. Detailed explanations of the procedure, methods of muscle relaxation, music or pre-medication may be advantageous prior to surgical procedures. In chronic wounds, supportive communication, psychotherapy and psychopharmacological treatment are to be considered, depending on the indication. Looking at the studies from a psychosomatic point of view, it is clear that patients with chronic wounds suffer greater limitations of activity and mobility, more severe pain and increased worries about their health. Moreover, these patients show significantly lower self-esteem. In addition, there is also a secondary gain from illness. Improvement in compliance, which is very low in many patients, is thus an additional approach to improving the prognosis of a chronic wound. Adequate wound therapy and therapeutic device in wound care may, as confirmed by several studies, significantly improve patients’ quality of life and self-esteem. Likewise, structured follow-up care should be provided even after the wound has healed.

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