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Wound Healing with Pain Management: Perspective or Utopian

Research Article Open Access
Yesim Senayli*
Anaesthesiology and Reanimation, T.C. Health Ministry Health Services General Directorate, Atadan Cad.Bahar.Apt. 17/16 06010 Etlik, Ankara, Turkey
*Corresponding authors: Yesim Senayli
M.D, Assistant Professor, Anaesthesiology and Reanimation
T.C. Health Ministry Health Services General Directorate
Ankara, Turkey
Tel: 905066917970
Fax: 903122872693
E-mail: ysenayli@gmail.com
 
Received March 05, 2012; Published August 20, 2012
 
Citation: Senayli Y (2012) Wound Healing with Pain Management: Perspective or Utopian. 1: 296. doi:10.4172/scientificreports.296
 
Copyright: © 2012 Senayli Y. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 
Abstract
 
Performing the treatment process of wound healing in the treatment of pain could be an attractive concept for medical practitioners. Wound healing potentials of opiates and local anaesthetics have been investigated for this purpose. It was demonstrated that the drugs used to treat pain are insufficiently effective on wound healing. Although wound healing seems to be hard via pain management instruments, there are evidences to continue the investigations. I support the coexistence of the wound healing treatment and pain management in the light of the literature by this review.
 
Keywords
 
Wound; Pain; Opiates; Local Anaesthetics; Acupuncture
 
Introduction
 
Healing periods of the wounds are very important for operations. Successful wound healing and pain management will provide better post surgical stress control [1]. In addition, organ dysfunctions will be prevented [1]. If a drug or a method that may be useful in pain management and wound healing can be found, it will be a turning point in terms of scientific advances. Due to the complex nature of wound healing, progressing the pain management and wound healing in a drug or method is difficult, for now [2]. Nevertheless, mammalian wound healing cascade is well known and this is important to handle the scientific studies [1,3].
 
Wound healing process has 4 main stages: haemostasis, inflammation, proliferation and remodelling [4,5]. Factors like suture material, radiation, surgical technique, poor nutrition, diabetes mellitus, uraemia and advanced age can affect these stages and this can cause risks for surgical expectations [4-6]. Unsuitable drug or treatment usage may cause poor wound healing and weak pain management and, because of this, therapy may result with failure [4]. In addition, due to prolonged inflammatory phase retardation as a result of drug treatment, especially for morphine treatment, angiogenesis has been shown to delay in animals [3].
 
In practice, there have been some studies for the collaboration of pain management and wound healing. These studies mainly aimed to stop the destructive inflammation [9]. In literature, morphine and endogenous opiates were proved to be suppressive on lymphocyte proliferation [10]. Opioids inhibit neuronal actions [7]. Therefore, sensory nerve terminals can’t secrete pro-inflammatory neuropeptides [7]. Consequently, the failure of the sensory nerve terminals becomes the main reason of the disconnection of nervous and immune systems [7]. In practice, when the patients are treated with morphine, the macrophages are influenced and especially monocyte chemotactic protein-1 is not generated [3]. Therefore, wound bacterial clearance is delayed [3]. Neuropeptides might be added into morphine infusion to stimulate monocytes against the side effects of morphine and to stabilize the wound-healing period [7].
 
Effect of tramadol on immune functions was also studied [10]. Tramadol keeps immune system active in its process by altering interleukin-2 (IL-2) production [10]. Therefore, in cancer treatment, pain management and immune regulation can be achieved by tramadol [10]. This drug may be the one of practical development of the concept.
 
Local anaesthetics, which have anti-inflammatory activity, have been evaluated for wound healing and pain management [11].Pederson et al also reported that local anaesthetics had insignificant inflammatory effect [9]. Opposed to this, Carvalho et al. reported that local anaesthetics displayed significant anti-inflammatory effect via systemic administration and pro-inflammatory mediators altered [8]. Local anaesthetic drugs provide anti–inflammatory effect by neutrophil reduction and help for the reduction of free oxygen radicals [11]. By this mechanism, finally, oedema reduction occurs [11]. Although pain formation was not the expected, hyperalgesia was revealed in the same study [11]. In this situation, someone may conclude that the local anaesthetic drugs are undetermined and imbalanced on pain management and wound healing. Development activities must be continued because other drugs do not have as the potential for the development properties as local anaesthetic drugs have.
 
Treatments like acupuncture can be useful for healing of chronic wounds and pain management simultaneously [4]. Acupuncture is used for pain management mainly and the acupuncture is stimulating neural fibers Aδ and C in order to liberate vasoactive neuropeptides [4]. Substance P, vasoactive intestinal peptides are some of the proinflammatory agents secreted during acupuncture.
 
In my opinion, acupuncture is an inspiring method to configure cranial and spinal stimulations of specific or nonspecific neurons to form analgesia with wound healing. In addition, some suitable and new drugs may be added in these manipulations.
 
For nearly thirty years, effects of analgesic drugs on wound healing have been evaluated but enhancement of wound healing with simultaneous pain management has not been enough. Nowadays, unfortunately, very little published information regarding conceptual pain management and wound healing is present. I advocate that there is cooperation between pain management and wound healing and I strongly believe that theory will be more useful after the pharmacologic and technical improvements. Nevertheless, a treatment containing both pain management and wound-healing stimulation seems to be horizon.
 
 
References