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Dr. Sechrest: Hello, I’m Dr. Sechrest, your host for Real Pain Care. I’m back with Dr. Patrick Johnson, a clinical psychologist in Seattle, Washington. Last visit we discussed several things but the major focus of our discussion at the last visit was on the psychological evaluation and what role the psychologist plays in the evaluation of chronic pain. Dr. Johnson explained very nicely what the goals of the evaluation were, what’s done during the evaluation, and, in the end, what information is provided back to you as a patient and also back to the medical physician who may have sent you to see a psychologist. Good afternoon, Dr. Johnson.

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Psychology Evaluation in Chronic Pain

Real Pain versus Not Real Pain

Acne is made worse by mental/emotional stress

Lots of people describe stress as a factor that increases their acne, and recent research to supports this claim. Scientists found that college students with acne were vulnerable to a worsening of their condition during examination periods.

Acne vulgaris is the most common skin disease treated by dermatologists – affecting an estimated 85% of the population at some time in their lives.

Researchers led by Dr Alexa Kimball from Stanford University, studied 22 university students with varying degrees of acne.

The students’ acne was rated for severity during a non-exam period (approximately one month before an examination) and again during an exam period (three days before an exam to seven days after an exam).

The students also filled out questionnaires during the two acne assessments, in which they rated their stress levels.

The researchers found the students had worse acne during exam periods, when they also rated their stress as higher.

The link remained even after other factors such as changes in sleep hours, sleep quality, diet, and number of meals per day were taken into account.

Writing in the journal Archives of Dermatology, the researchers say the finding does not prove that stress directly causes acne.

Various ideas have been proposed for why stress may aggravate acne.

Some investigators believe that stress stimulates the release of hormones known to worsen acne by increasing production of oily substances from sebaceous glands found in the skin.

There is also research suggesting that stress increases production of chemicals which can trigger an inflammation.

In addition, stress is known to slow down the wound healing process by up to 60%.

Research has also found that stress can worsen the symptoms of other skin diseases, such as psoriasis and atopic dermatitis.

Mental/emotional stress slows the healing process

Research shows that cutting stress could shorten hospital stays by speeding up the healing process. One study showed that stress caused by a 30-minute argument with a spouse is enough to slow wound healing by a day.

A Ohio State University team focused on 42 married couples and found that blisters on hostile couples healed at a rate 60% slower than the healing rate for non-hostile couples.

The team told the journal Archives of General Psychiatry the findings showed that hospitals should try to minimize stress for patients ahead of surgery.

The researchers focused on a group of 42 couples. Each couple was admitted into the University’s General Clinical Research Center for two, 24-hour-long visits, separated by a two-month interval.

During each visit, both the husband and wife were fitted with a small suction device that created eight identical tiny blisters on their arms.

The skin was removed from each blister and another device placed directly over each small wound, forming a protective bubble, from which researchers could sample the fluids that normally fill such blisters.

The couples also completed questionnaires intended to measure their level of stress at the beginning of the experiment.

During the first visit, each person was asked to talk to his or her spouse for several minutes about some characteristic or behavior that he or she would like to change. This was a supportive, positive discussion.

During the second visit, they were asked to talk about an area of disagreement something that provoked strong feelings.

Analysis showed wounds took a day longer to heal after the arguments than they did after the supportive discussion.

Wounds on the hostile couples healed at only 60% of the rate of couples considered to have low levels of hostility.

Levels of a key immune system chemicals that control wound healing, were also particularly elevated in the hostile couples.

High levels of something called interleukin 6 levels are linked to long-term inflammation, which in turn is implicated in a range of age-related illnesses, including cardiovascular disease and arthritis.

Researcher Professor Jan Kiecolt-Glaser said: “In our past wound-healing experiments, we looked at more severe stressful events.

“This was just a marital discussion that lasted only a half-hour. The fact that even this can bump the healing back an entire day for minor wounds says that wound-healing is a really sensitive process.”

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