EFFECTS OF MUSIC AND STRESS ON HEALING OF INDUCED WOUND IN THE SKIN OF ADULT MALE ALBINO RATS

EFFECTS OF MUSIC AND STRESS ON HEALING OF INDUCED WOUND IN THE SKIN OF ADULT MALE ALBINO RATS

By

Mohamed Zakaria Eletreby, Mohamed El-Sayed Abd-El-Fattah, Hassan Sabry Ali Al-Dawy, Mohamed Abd-El-Hameed Khedr* and Mohamed Abd-El-Fattah El-Salamoni

Departments of Medical Physiology and Pathology*, Al-Azhar Faculty of Medicine

ABSTRACT

Background: Wound healing is a complex process involving intrinsic dermal and epidermal cells, and infiltrating macrophages and leukocytes.Noise and music exposure have long been used to investigate their effects on biological and biochemical responses.

Objectives: Studyingthe possible acceleration effect of the process of wound healing after exposure to music, and the stressor effect after exposure to noise.

Materials and Methods: Forty adult male albino rats of local strain were chosen as an animal model for this study. They were divided into four equal groups:Control group, wound group, stress-exposed group andmusic-exposed group. On the day of infection, superficial surgical wounds were produced on the shaved backs of anesthetized rats by making a longitudinal midline incision, 2.3 ± 0.2 cm in length and extending down to the panniculuscarnosus.At the end of the experiment (30 days), blood samples were obtained for estimation of WBC, neutrophils, lymphocytes and platelets count. Immediately after the animals were killed, 5-mm punch biopsy specimens of excised skin were taken, and immediately fixed in phosphate-buffered (pH 7.4) formalin (4%).

Results: Stress- exposed group showed significant increase in both WBCs and neutrophils counts, and significant decrease in both lymphocytes and platelets counts. In music-exposed group, WBCs significantly increased and platelets significantly decreased. Histopathological examination revealed that the exposure to noise resulted in significantly slowed inflammatory process. This effect was demonstrated by increased infiltration of wounds with polymorphnuclear leucocytes (PMNL). The music exhibited significant acceleration of wound healing activity as compared to noise exposed group .The wound closure time was lesser, as well as the percentage of wound contraction was more. The epithelization of wound was found to be earlier as compared tonoise exposed group.

Conclusion: Music has some antistressor effects and may accelerate wound healing. 

Key words: Noise, music, wound healing.

INTRODUCTION

     Music has been a part of human society at least for the past 40,000 years, and most likely much longer where people typically interact with music and value it for its capacity to evoke and regulate emotions, provide enjoyment, comfort, relieve stress, alter mood and elicit relaxation responses. Such music induced emotions are often accompanied by physiological reactions, such as changes in heart rate, respiration, skin temperature, conductance and hormone secretion e.g. cortisol, oxytocin and B-endorphin (Juslinand Laukka, 2010). On contrast, Stress can be defined as the psycho physiologic reaction of the organism to a variety of emotional or physical stimuli that threaten homeostasis, e.g. noise stress is implicated in various illness of human and it is responsible for increased morbidity associated with modern life style (Mahmood et al., 2008).

     It has been shown that rhythm and tempo of music can be used to synchronize or entrain body rhythms such as heart rate. Music with a fluid and regular rhythm of less than 80 beats per minute can be used to promote relaxation by causing body rhythms to slow down or “entrain” with the slower beat and regular, repetitive rhythm. However, individual responses to music can be influenced by personal preferences, the environment, education, and cultural factors, People have different socio-cultural backgrounds and like different kinds of music (Rentfrow et al., 2011).

     Wound healing and noise has thus far primarily been studied in animals. Although some potential effects on humans can be surmised, it is important to acknowledge that the response of humans to noise in general is more complex. One wound healing experiment exposed rats to 80 dB of rock music for a 22-hour time period and then measured changes of leukocyte function. The rock music was turned off periodically to prevent habituation. Lymphocyte function remained unchanged in the presence of noise. However, short-term noise exposure did cause an alteration of the superoxide anion and interleukin-1 secretion of neutrophils and macrophages, thus decreasing wound healing (McCarthy et al., 2010).

     The second phase of wound healing, the inflammatory phase, presents itself as erythema, swelling, and warmth, and is often associated with pain. The inflammatory response increases vascular permeability, resulting in migration of neutrophils and monocytes into the surrounding tissue. The neutrophils engulf debris and microorganisms, providing the first line of defense against infection. Neutrophil migration ceases after the first few days postinjury if the wound is not contaminated. If this acute inflammatory phase persists, due to wound hypoxia, infection, nutritional deficiencies, medication use, or other factors related to the patient’s immune response, it can interfere with the late inflammatory phase (Brown, 2015).

     In the late inflammatory phase, monocytes converted in the tissue to macrophages, which di- gest and kill bacterial pathogens, scavenge tissue debris and destroy remaining neutrophils. Macrophages begin the transition from wound inflammation to wound repair by secreting a variety of chemotactic and growth factors that stimulate cell migration, proliferation, and formation of the tissue matrix (Brown, 2015).

MATERIALS AND METHODS

Experimental animals: This study was done in the postgraduate laboratory of Medical Physiology Department, Faculty of Medicine, Al-Azhar University on 40 adult male albino rats of local strain obtained from Helwan animal house, used in the present work. Rats were weighing from 120 to 140 grams, kept for 10 days to adapt to conditions before the start of any experimental procedure. Each two rats were housed in a cage (30X42X30 cm). They were fed the standard balanced diet with water ad lib with normal dark/light cycle.

Experimental protocol: Animals were divided into 4 equal groups in this study as follows:

Group I (Control group): Each rat received regular diet and tap water for 21 days.

Group II (Wound group): Incisions were made on the backs of rats.

Group III (Stress exposed group): Incisions were made on the backs of rats,then exposed to 90 dB of prerecorded noise delivered via the highest volume setting stereo speaker placed one meter and half from the cages as described by McCarthy et al. (2010).

Group IV (Music exposed group): Incisions were made on the backs of rats, then exposed to prerecorded pieces of light music delivered via stereo speaker placed one meter and half from the cages , mild sound intensity levels at 60 dB. Rats were exposed to music for one hour daily throughout the designed experimental period (Angelucci et al., 2008).

     At the time of sacrification, rats were anesthetized with isoflurane, and then blood samples were collected from the retro-orbital plexusesin day 30.

     About 4 ml of blood was collected from each rat into a labelled clean sample bottle containing 1 mg of Na-EDTA powder, as an anticoagulant, for measuring WBCs, neutrophils, lymphocytes and platelets counts.

Histopathological examination of wound healing:

Excision wound was inflicted by cutting away a 300 mm2 full thickness of skin from a predetermined area. The wound was leftundressed to the open environment, and thencalculatedas percent reduction in wound area:

% Wound contraction = healed area ⁄ total area ×100

     The progressive changes in wound area were monitored planimetricallyby tracing the woundmargin on graph paper every alternate day.Epithelialisation time was noted as a number of daysafter wounding required for the scar to fall off leaving no raw wound behind.From the healedwound, a specimen sample of tissue is isolated from each group of rats for Histopathological examination (Gangopadhyayet al, 2014).

     In order to characterize the histopathology of the model, biopsy specimens were taken after 30 days. Immediately after the animals were killed, 5-mm punch biopsy specimens of excised skin were taken and immediately fixed in phosphate-buffered (pH 7.4) formalin (4%). The formalin-fixed biopsy specimens were embedded in paraffin and stained with hematoxylin and eosin.

Statistical analysis:

     All the statistical analysis were processed using Statistical Program of Social Sciences (SPSS) for windows (version 17, SPSS Inc., Chicago, IL, USA), Values of the measured parameters were expressed as mean value ± standard deviation (SD), and the differences and significance were verified by one-way ANOVA, followed by the Fisher’s least significant difference (Tukypost hoc test). P values ≤ 0.05 were considered statistically significant.

RESULTS

Differences in WBCs count (Table 1):

In group I (control group), the mean ± standard deviation (S.D) of WBCscount was 8.179 ± 0.328 (×10³/mm³).

In group II (wound group), the mean ± S.D of WBCs count was9.987 ± 0.387(×10³/mm³).This level showed insignificantincrease inWBCs counts as compared with the control group.

In groupIII (stress exposed group), the mean ± S.D of WBCs count was 16.987 ± 0.528 (×10³/mm³).This level showed significant increase in WBCs count as compared with the control group .

In comparison to group II, WBCs count significantly increased.

In group IV (music exposed group), the mean ± S.D of WBCs count was 10.230 ± 0.276 (×10³/mm³).This level showed insignificant increase in WBCscount as compared with the control group.

In comparison to group II, WBCs count insignificantly increased.

In comparison to group III, WBCs count significantly decreased.

Difference in neutrophil counts (Table 2):

In group I (Control group), the mean ± standard deviation (S.D) of neutrophil count5.60± 0.50mg%.

In group II (Wound group), the mean ± S.D of neutrophil countwas6.9 ± 0.60 mg%. This level showed insignificant increase in neutrophil counts as compared with the control group.

In group III (stress exposed group),themean ± S.D of neutrophil countwas 9.9 ± 0.62 mg%. This level showed significant increase in neutrophil count as compared with the control group.

In comparison to group II, neutrophil countssignificantly increased.

In group IV (music exposed group), themean ± S.D of neutrophil countwas 8.4 ± 0.56 mg%. This level showed significant increase in neutrophil countas compared with the control group.

In comparison to group II, neutrophil countinsignificantly increased. 

In comparison to group III, neutrophil countsignificantly decreased.

Differences in lymphocytic counts (Table 3):

In group I (Control group), the mean ± standard deviation (S.D) of lymphocyte countwas 1.812± 0.40mg%.

In group II (Wound group), the mean ± S.D of lymphocytecountwas 1.788± 0.50mg%. This level showed insignificant decrease in lymphocyte count as compared with the control group.

In group III (Stress exposed group), themean ± S.D of lymphocytecountwas 1.401± 0.40mg%.This level showed significant decrease in lymphocyte counts as compared with the control group.

In comparison to group II, lymphocytecountwas significantly decreased.

In group IV (music exposed group), themean ± S.D of lymphocyte countwas 1.732 ± 0.50mg%. This level showed insignificant decrease in lymphocyte counts as compared with the control group. 

In comparison to group II, lymphocyte countwas insignificantly decreased.

In comparison to group III, lymphocyte countwassignificantly increased.

Differences in blood platelets count (Table 4):

In group I (control group), the mean ± standard deviation (S.D) of blood plateletscounts were0.381 ± 0.01(×10³/mm³).

In group II (wound group), the mean ± S.D of blood plateletscountwas0.352 ± 0.03(×10³/mm³). This level showed insignificant decrease in blood plateletscounts as compared with the control group.

In group III (stress exposed group), themean ± S.D of blood plateletscountwas0.283 ± 0.05(×10³/mm³).This level showed significant decrease in blood plateletscounts as compared with the control group .

In comparison to group II, blood plateletscountwassignificantly decreased.

In group IV (music exposed group), themean ± S.D of blood plateletwas0.275 ± 0.02(×10³/mm³).This level showed insignificant decrease in blood platelets countas compared with the control group.

In comparison to group II, blood plateletscountwassignificantly decreased.

In comparison to group III, blood platelets countwas insignificantly decreased.

Table (1): Differences in WBCs count in all studied groups

Test used: One way ANOVA followed by post-hoc tukey

P1: significance relative to G1 (Control)

P2: significance relative to G2 (Wound)  

P3: significance relative to G3 (Noise)

P4: significance relative to G4 (Music)

Table (2): Differences in neutrophil counts in all studied groups

Test used: One way ANOVA followed by post-hoc tukey

P1: significance relative to G1 (Control)

P2: significance relative to G2 (Wound)  

P3: significance relative to G3 (Noise)

P4: significance relative to G4 (Music)

Table (3): Differences in lymphocyte counts in all studied groups

Test used: One way ANOVA followed by post-hoc tukey

P1: significance relative to G1 (Control)

P2: significance relative to G2 (Wound)  

P3: significance relative to G3 (Noise)

P4: significance relative to G4 (Music)

Table (4): Differences in platelets count in all studied groups

Test used: One way ANOVA followed by post-hoc tukey

P1: significance relative to G1 (Control)

P2: significance relative to G2 (Wound)  

P3: significance relative to G3 (Noise)

P4: significance relative to G4 (Music)

Histopathological Results:

(1) Gross findings of wound size (Figures 1&2):

     Visual assessment of wound healing indicated that the wound tissue was in good condition in both group IV (music exposed group), no inflammation or other problems appeared during the healing period. In addition, a large amount of exudate and small amount of bleeding were observed one week after incision; both gradually decreased.

     The wound closure time was lesser, as well as the percentage of wound contraction was more with group IV (music exposed group). The epithelization of wound was found to be significantly earlier as compared to group III(stress exposed group).The wounds were completely healed (epithelization period) in 16 ± 2 days, whereas in the Group III animals took more than 20± 2 days.

     During early wound healing, no significant differences were observed between the two groups. However, wound healing seemed to accelerate at later stages in group IV (music- exposed group). Significant difference in wound contraction rate and scar formation was oblivious in group III (stress-exposed group).

     In the measurements of the percentage of wound healing, music exposure resulted in a statistically significant improvement by the final stages of healing.

     On postoperative day 21, granulation tissue increased in the group III (stress-exposed group). In addition, scar formation in group III (stress-exposed group) significantly increased.

     At the bottom of wounds, newly created granulation tissue (GT) was observed. The GT consisted from fibroblasts, endothelial cells, and newly synthesized non-organized collagen.

(2) Microscopic findings (Figures 3 &4):

     Group II (wound group) showed that the epidermis was thickened at its cut edges. The dermis near the excision was rich in inflammatory cells (PMNL). Thus, the demarcation line was formed and separated the necrosis from vital tissue. The number of fibroblasts slightly increased in the dermis near the wounded area. Beneath the dermis, it was possible to observe the beginning of neoangiogenesis, but presence of new collagen was not recorded.

     Group III (stress-exposed group) showed that the exposure to stress resulted in significantly slowed inflammatory process. This effect was demonstrated by increased infiltration of wounds with PMNL.

     Moreover, the epidermis regeneration significantly inhibited. In addition, the proliferation and migration of fibroblasts decelerated as well. The GT included a fewer amount of collagen as well as a significantly lower number of new vessels.

     As compared to the Group IV (music- exposed group) the process of epidermis regeneration significantly decelerated and the inflammatory phase prolonged. Nevertheless, the general picture of healing delayed due to a slightly inhibited both fibroblast and endothelial cells proliferation which resulted in an altered formation of the GT.

     Group IV (music-exposed group) exhibited significant wound healing activity as compared to group II. The wound closure time was lesser, as well as the percentage of wound contraction was more with music exposure than wound and stress groups. The epithelization of wound was found to be earlier as compared to III (stress-exposed group).

Figure (1): Gross representation of wound contraction rate on different days in group II (control group) and group III (stress-exposed group).

Figure (2): Gross representation of wound contraction   rate on different days in group II (control group) and group IV (music-exposed group).

Figure (3): Histological appearance of skin of rats in group II (Hx&E x 100).The inflammatory cell infiltrate consisted of mononuclear cells, including lymphocytes, histiocytes, and, to lesser extent, neutrophils. The inflammatory response was associated with marked fibrosis, edema (B), and fibrin deposition (D). The epidermal layer was absent in the infected lesions. Numbered arrows indicated the following: 1, epidermis; 2, dermis; 3, muscular layer; 4, collagenfibers;5, fibrin deposition; 6, inflammatory cell infiltrate.

Figure (4):Microscopic sections at day 30 showed: (a) Normal skin architecture (control group), (b) normal healing process with vascular proliferation and fibroblasts(wound-group), (c) Dermal edema with poor collaged infiltration after noise exposure and scar formation(stress-exposed group)and (d) Accelerated healing with dense collagenation on after music exposure with minimal scar(music-exposed group).(Hx&E x 100).

DISCUSSION

     Several drugs such as thiazolidinediones, analogues of GLP-1, sulfonylurea and insulin are available to control diabetes mellitus (Jeong et al., 2018). It is mandatory to deal with DM by polytherapy regimens which include diet control, regular physical activity and new line of drugs to improve symptoms, reduce complications and decrease side effects of ordinary drugs (Pearson, 2016). Much attention has focused on thiazolidinediones and glucagon-like peptide-1 agonists (Weiss et al., 2014).

     Music is one of a small set of human cultural universals evoking a wide range of emotions from exhilaration to relaxation, joy to sadness, fear to comfort and even combinations of these. Many people use music to regulate mood and arousal, much as they use caffeine or alcohol. Neurosurgeons use it to enhance concentration, Armies to coordinate movements and increase cooperation, workers to improve attention and vigilance and athletes to increase stamina and motivation (Soto et al., 2009).

     Careful selection of music that incorporates patient’s own preferences may yield positive results, whereas contrary effects may result from use of the wrong type of music. Selection of “wrong” music can intensify depressive syndromes, aggressiveness and anxiety. In addition, feelings toward music may change during different phases of life and may lead to different effects (Brotons and Marti, 2008).

     In recent years, music no doubt plays a pivotal role in the lives of human beings as a therapeutic tool in the treatment of different diseases. It has been shown that music therapy not only reduced blood pressure, heart rate and patient anxiety but had a significant effect on future events, including re-infarction and death, in acute coronary syndrome patients who underwent revascularization. More recently, several reports have indicated the usefulness of music therapy in managing psychiatric disorders as psychosis and neurosis and now is being used in addressing organic disorders such as dementia (Sarkamo et al., 2008).

     Music may not only be an important mood inducing factor as a successful marketing tool for restaurants but also a possible influencing factor on meal duration and meal size (Nanette et al., 2010).

     Humans may be needs both relaxed and sad music in some times for satisfaction of pleasure and unpleased centers in limbic system. So we noticed in restaurants relaxed music always played while in bad situations sad music could be required.

     On the other hand, stress is states of threatened balance induced by external stressor and appear as the display of somatic and psychic reactions, struggling to regain homeostasis. Among stressful stimuli, noise which is the most prevalent and insidious natural pollutant causing hearing impairment, behavioral, mental and widespread disturbances at several levels in human organs and apparatus due to chemical and physiological modifications of endocrine, cardiovascular and nervous systems Also, noise is partially responsible for reduced reproductively and decrease in the number of fetuses of pregnant rats and had a lethal effect in mice embryos that were exposed to high frequencies of noise (Cyr, 2009 and Enk et al., 2010).

     Noise exposure has long been used as a stressor to investigate its effect on biological and biochemical responses.

     This study was investigated the effect of listening to music and noise on wound healing. It was considered as a pilot study and as such certainly raises more questions than answers.

     The results of this study showed that group III (stress-exposed group), show significant increase in WBCs count in comparison to all studied groups but in (music-exposed group) showed insignificant increase in WBCs count in comparison to group I and II.

     This result may be explained by Agbagwa (2009) who reported that WBCs countsand differential leukocyte counts (DLC) reflect the systemic status of an animal in relation to its response and adjustment to stress; the indices are of value in confirming or eliminating a tentative diagnosis, in making a prognosis and guiding therapy.

     Group III (Stress-exposed group), showed significant increase in neutrophil count in comparison to group I and II but in group IV (music-exposed group), there was significant increase in neutrophil count in comparison to group I and significant decrease in comparison to group III .

      Group III (Stress-exposed group), showed significant decrease in lymphocyte count in comparison to groupI and II but in group IV (music-exposed group), there was insignificant decrease in lymphocyte count in comparison to group I, II. There was significant decrease in comparison to group III.

     Doreen et al. (2016) showed significant difference on lymphocyte and neutrophil count was shown between the experimental rats and to the rats in the control cages. Such findings confirmed previous related physiological findings on the effect of various stressors on the WBCs of rats.

     Taylor et al. (2008) first proposed the idea of a unique female stress response which they termed "tend-and-befriend." The tend-and-befriend response is characterized as an oxytocin mediated stress response cascade. Estrogen has been found to increase the effects of oxytocin already in excess in females as compared with males. Testosterone and vasopressin, the counterparts of estrogen and oxytocin, present during the male stress response, "fight-or-flight," have been found to exhibit the opposite effects of oxytocin.

     Hence, despite the difference in mechanism, comparable results were controlled on the basis of hormonal secretions for both male and female mice as to the differential WBC count is concerned.

     Group III (Stress-exposed group), showed significant decrease in blood platelets count in comparison to group I and II.

     Group IV (Music-exposed group), showed significant decrease in blood platelets count in comparison to group II only.

     Qureshi et al. (2009) reported that stress produces changes in blood cell parameters and reported increased Blood Platelets counts. Noise exposure has long been used as a stressor to investigate its effect on biological and biochemical responses.

     Rohiniet al. (2017) showed that stress induced changes in hematological parameters clearly decrease in platelet count. The treatment of fusidic acid decreased the stress induced effect on hematological values and also showed a protective role in thrombocytopenia.

     One of the limitations of the present study was the lack of bacteriological data to possibly correlate biochemical findings with those involved in the histopathologic process of tissue repair. Nevertheless, the method of wound contraction is a good reference in the study of factors that influence tissue repair, and other authors have used very similar methods (Semenoff-Segundo et al., 2008). Calculation of the contraction of the wound based on the initial area, which avoids a bias of the wound due to the mobility of the tissues in the area treated. Considering the importance of treating the skin wounds, finding more beneficial agents to enhance and improve the wound healing process have always been a concern for the researchers.

     Group II (wound-group) showed that the epidermis was thickened at its cut edges .The dermis near the excision was rich on inflammatory cells (PMNL), thus the demarcation line was formed and separated the necrosis from vital tissue. The number of fibroblasts slightly increased in the dermis near the wounded area. Beneath the dermis was possible to observe the beginning of neoangiogenesis, but presence of new collagen was not recorded.

     Group III (Stress-exposed group) demonstrated that the exposure to stress resulted in significantly slowed inflammatory process. This effect was demonstrated by increased infiltration of wounds with PMNL.

     Moreover, the epidermis regeneration was significantly inhibited. In addition, the proliferation and migration of fibroblasts was decelerated as well. The GT included a fewer amount of collagen as well as a significantly lower number of new vessels.

     These results were explained by that stress can lead to raised levels of the hormone cortisol which, if prolonged, affects immunity and inflammatory responses in the body. Sustained cortisol release can lead to myopathy, weakness, fatigue and a suppressed immune system. A reduction in the levels of inflammatory cytokines and enzymes involved in tissue repair will inhibit the regeneration of endothelial cells, resulting in delayed wound healing. Furthermore, prolonged immune suppression might progressively decrease, giving way to the opposite effect: an excessive immune response in which the immune system attacks its own body, which could potentially result in further damage to the healing process.

     Similarly, in a study by Broadbent et al. (2008), wound fluid was collected over the first 20-hour postoperative period. Wound healing was assessed by levels of interleukin-1, interleukin-6 and matrix metalloproteinase-9 in the fluid. It was found that greater preoperative stress significantly predicted lower levels of interleukin-1 in the wound fluid.

     As compared to the Group IV (Music exposed group) the process of epidermis regeneration was significantly decelerated and the inflammatory phase was prolonged. Nevertheless, the general picture of healing was delayed due to a slightly inhibited both fibroblast and endothelial cells proliferation which resulted in an altered formation of the GT.

    Rafi et al. (2009) showed that loud noise stress affects the cells (macrophages) involved in the healing of the wound. Therefore it is expected to have impact on the stages of wound healing. This study was also compatible with Alex Semenoff et al. (2014) who conclude that rats subjected to chronic stress have delayed wound contraction.

     The present study also matched with (Jean-Phillibe et al., 2012) who showed that acute and chronic stressors can disrupt the healing process. Furthermore, the impact of stress on wound repair has been observed across different methodologies and with different healing outcomes and most results have replicated in at least two independent laboratories.

     Group IV (music-exposed group) exhibited significant wound healing activity as compared to Group II.

     This study has shown that stress can delay the healing of an experimentally created wound. Another study looked into the influence of natural stressful emotional conditions such as anxiety and conditions like depression, which can also impact the inflammatory system and wound healing. Delayed healing of a punch biopsy wound was correlated with a higher score on the hospital anxiety and depression Scale.

     An association between psychological stress and delayed wound healing has been demonstrated in studies of biopsy wounds. For example, a study by Kiecolt-Glaser et al. (2008) looked at the impact of hostile marital interactions on pro-inflammatory cytokine production and the healing of experimentally induced blister wounds.

     A study by Juslinand Lukka. (2010) found that, after being given a blister wound, rats who had report‌ed higher levels of stress produced sig-nificantly lower cytokine levels and a higher number of adverse life events compared with rats who had high cytokine levels. Furthermore, rats with low cytokine levels also had higher levels of salivary cortisol than those with high cytokine levels. These findings suggest that stress can delay the appearance of pro-inflammatory cytokines early in the wound-healing process, which could have a detrimental effect on wound repair.

     In contrast to previous biopsy wound healing studies, Kiecolt-Glaser et al. (2008) investigated the effect of long-term, naturally occurring, psychological stress caused by caring for a relative with Alzheimer’s disease on healing. Thirteen women caring for relatives with Alzheimer’s disease and a control group were given a punch biopsy wound on the non-dominant forearm. Wounds were assessed using photography and hydrogen peroxide, and were defined as completely healed when the site no longer foamed after peroxide application. Caregivers reported significantly more stress than the controls, and wound healing took an average of nine days longer in the caregivers than controls.

     Cole-King and Harding (2008) also examined the relationship between the healing of chronic wounds and anxiety and depression. A sample of 53 male and female participants was included in the study. Psychological and clinical wound assessments were conducted, with the investigators and participants blinded to the results of the other assessments. The relationship between the healing of chronic wounds and anxiety and depression was statistically significant delayed healing demonstrating that symptoms of both depression and anxiety were associated with chronic wound heal-ing. It should be acknowledged, however, that a causal relationship between stress and delayed wound healing cannot be inferred from these findings as other factors, such as physical or social limi-tations resulting from the wound, may play a role in this relationship.

     The findings of these studies showed that methods of assessing stress during wound treatment would benefit the healing process by enabling the practitioner to understand the patient’s individual needs for minimizing stress.

     Practitioners should pay particular attention to both physiological and psychological aspects when delivering wound care. For some patients, psychological treatments, such as emo-tional disclosure, in addition to wound treatment, may help improve quality of life, relieve subjective distress and potentially also promote wound healing. It would be beneficial for patients if practitioners were to take account of the role that stress plays in wound healing, particularly in leg ulceration, where stress may increase the incidence of wound recurrence.

CONCLUSION

     Listening to light music has some antistressor effect and may accelerate wound healing. The music exhibited significant wound healing activity as compared to noise. The wound closure time was lesser, as well as the percentage of wound contraction was more. The epithelization of wound was found to be earlier as compared to noise.

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