Abstract
ObjectivePsychological stress is known to impair skin barrier recovery, but little is known about the impact of pain on skin healing processes. Our primary goals were to examine the degree to which acute pain affects recovery from skin barrier disruption, and the potential mediating impact of cortisol and catecholamines. MethodsHealthy non-smokers aged 18–43 (N=53, 65% women) underwent a 3-minute cold pressor pain stimulus to their foot. Tape-stripping of forearm skin occurred at two separate locations: before (site 1) and after (site 2) the pain stimulus. Transepidural water loss (TEWL) was assessed at baseline (pre-stripping), immediately post-stripping, and at 75min to determine skin barrier recovery. Cortisol and catecholamine responses were obtained from multiple saliva and plasma samples, respectively. ResultsContrary to expectations, greater pain was associated with faster skin barrier recovery, even after controlling for demographics, mood, anxiety, and other factors. Those who reported higher pain showed faster recovery at site 2 compared to a) individuals who experienced lower pain; and b) their own recovery at site 1. Greater increase in norepinephrine (but not in cortisol) was also associated with faster recovery at site 2, and mediated the impact of pain on recovery. DiscussionResults bolster evidence that acute pain can affect immune-related processes. It is possible that acute pain may speed recovery from dermal abrasions, although pain is likely to impair recovery from more severe wounds. As pain is an important potential target for clinical intervention, further investigation of pain, stress, and healing processes is warranted.
Highlights
Psychological stress can slow healing of laboratory-induced wounds across a variety of different types of wounds and stress paradigms [1,2,3]
A majority (60.4%) of participants identified as being White/Caucasian, with 20.7% identifying as Black/African-American, 13.2% Asian, 1.9% Pacific Islander, and 3.8% other
Neither chronic anxiety nor depressive symptoms significantly moderated effects of pain on recovery within either gender. This is the first research to our knowledge to examine the effect of pain experienced from a mild, laboratory-induced pain stimulus on skin barrier recovery, a measure of the skin’s ability to heal from a superficial wound caused by tape-stripping
Summary
Psychological stress can slow healing of laboratory-induced wounds across a variety of different types of wounds (e.g., from minor to more substantial skin wounds as well as wounds of oral mucosal tissue) and stress paradigms (e.g., both chronic stress and relatively brief stressors) [1,2,3]. Stress symptomatology may even interact with pain experience to influence healing, chronic stress related to anxiety and depression that may aggravate emotional and inflammatory responses to pain [22] Pain, such as elicited experimentally with a cold pressor task (immersing the foot or hand in ice water), is known to produce a small to moderate increase in cortisol [23], along with a robust sympathetic nervous system response [24,25]. Garg et al [31] showed that skin barrier recovery was impaired among students during an academic examination period compared to vacation Other stressors, such as a relatively brief laboratory-induced social stressor (a modified Trier Social Stress Test), sleep deprivation, or marital dissolution have resulted in slower recovery of skin barrier function among healthy adults [32,33,34,35]. We examined whether catecholamine and/or cortisol changes to the cold pressor partially mediated effects of pain experience on skin barrier repair
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