Naturopathy | 11 min read | 2024-08-19 | 107 Views
The Connection Between Stress, Inflammation, and Surgical Outcomes
Explores how stress and inflammation affect recovery and results from surgical procedures.
The Connection Between Stress, Inflammation, and Surgical Outcomes
In the realm of medicine, the relationship between a patient's mental state and their physical health has been increasingly acknowledged. Among the various factors that influence surgical outcomes, stress stands out as a significant determinant. Research has shown that decreased stress levels lead to better surgical outcomes, primarily by reducing inflammation. This blog post delves into the intricate connection between stress, inflammation, and the success of surgical procedures.
The Physiology of Stress
Stress occurs when our body elicits a specific response to an external or internal stimulus, such as a threat, pain, or fear, that disrupts physiological homeostasis (Lanini et al., 2022). Homeostasis is the internal regulation of physiological states despite changes in external conditions to ensure survival. This involves regulating factors like temperature, pH, and other vital conditions to keep them within a narrow, optimal range (O'Connor et al., 2021). Stress threatens homeostasis, so our bodies release various hormones to try and return to equilibrium. An individual's body is constantly adjusting to their needs based on environmental challenges; however, if these challenges are prolonged or a stressor is present and the physiological response is maintained over time, this can be harmful to a person's health (O'Connor et al., 2021).
When we experience stress, we often encounter a feeling commonly known as the "fight or flight response" in reaction to a real or perceived threat (Jones & Gwenin, 2020). This response is caused by the activation of the sympathetic-adrenal-medullary (SAM) system and the hypothalamic-pituitary-adrenal (HPA) axis. The SAM system induces the "fight-or-flight" feeling because our adrenal glands secrete adrenaline into our bloodstream. Adrenaline causes quick and intense reactions such as faster breathing, dilated pupils, increased heart rate, and redirected blood flow to the muscles, preparing the body to face the “threat” (O'Connor et al., 2021).
The hypothalamic-pituitary-adrenal (HPA) axis releases various hormones, the most important being the glucocorticoid cortisol, known as the stress hormone. Cortisol's main functions include fat mobilization, decreasing inflammation, increasing protein synthesis, and enhancing access to energy storage (O'Connor et al., 2021).
Overall, when we are stressed and enter "fight-or-flight" mode, the two main hormones released are adrenaline and cortisol. The body redirects resources away from functions such as the immune and digestive systems, which aren't crucial for immediate survival. It is important to note that this mode is usually short-lived because these functions are temporarily reduced. However, if a person is chronically in this state, it can lead to serious health issues and impact their well-being.
The Connection Between Stress and Inflammation
Inflammation typically occurs in response to infection or tissue injury as a way to protect homeostasis (Kim et al., 2022). However, research has shown that stress has a strong effect on inflammatory responses (Rohleder, 2019). Cortisol is a major hormone that plays a significant role in the metabolic reactions that occur when someone is stressed (Jones & Gwenin, 2020). Most cells in our bodies have cortisol receptors, as it regulates many bodily functions. The specific stress hormone released by the HPA axis is glucocorticoid, and the cells with receptors for this hormone have anti-inflammatory and immunosuppressive properties (Jones & Gwenin, 2020).
If cortisol is supposed to decrease inflammation, how can it have a strong effect on inflammatory responses? When an individual experiences acute stress, glucocorticoid cortisol plays an important role by reducing inflammation as well as having metabolic and immunological effects. The stress reaction in the body is temporary until the perceived threat is gone and the body returns to homeostasis. However, individuals dealing with persistent or chronic stress experience high cortisol levels and HPA axis dysfunction for prolonged periods, causing the opposite effect. High cortisol levels cause cortisol receptors on cells to bind, producing pro-inflammatory cytokines. This results in immune deficiencies, inflammation, and other metabolic issues (Jones & Gwenin, 2020). Additionally, due to the increase in cortisol throughout the circulatory system, glucocorticoid cortisol may become less effective. The extensive exposure to tissues and various systems desensitizes tissues and cells to cortisol's regulatory effect on inflammation (Kim et al., 2022).
Overall, while cortisol is beneficial during acute stress by promoting survival as part of the "fight or flight" response, it can harm an individual's well-being and health if they deal with chronic stress. While inflammation is a natural defense mechanism that the body uses to protect itself from harm, chronic inflammation can cause many issues and significantly impact surgical outcomes.
Inflammations and Stress Effects on Surgical Outcomes
Inflammation significantly affects surgical outcomes by influencing the body's healing process and susceptibility to complications. Postoperative inflammation is a natural response that aids in healing; however, excessive or prolonged inflammation can impair tissue repair, increase pain, and heighten the risk of infections and other complications. Chronic inflammation can lead to delayed wound healing and may contribute to adverse effects. Stress can also significantly influence or trigger various medical conditions, including depression, anxiety, and adverse operation outcomes (Lanini et al., 2022).
Several studies suggest that psychological factors, like stress, in preoperative patients can affect wound healing, immunity, inflammation, pain perception, and mood, thereby slowing down or worsening recovery. Research has also shown that individuals experiencing high or chronic levels of stress, particularly those with anxiety, catastrophizing attitudes, and depression, are strongly correlated with impaired postoperative recovery, postoperative complications, and increased re-hospitalization rates (Villa et al., 2020).
Overall, stress can cause many issues with post-surgical recovery not only through inflammation but also through severe pain, wound healing, and poor immunity. While inflammation is a normal part of recovery, excessive amounts can cause numerous complications. So how do you reduce stress in patients to improve surgical outcomes?
How To Decrease Stress To Improve Surgical Outcomes?
Many psychological therapy approaches aim to increase endorphin and serotonin levels while decreasing cortisol levels (Villa et al., 2020). Research has suggested that psychological therapy before surgery can successfully modify inflammatory states. A randomized clinical trial conducted on 45 patients recently diagnosed with breast cancer found a significant decrease in fatigue, pain, depressive symptoms, and inflammation when they received psychological therapy (Lanini et al., 2022).
Cognitive behavioral therapy (CBT) aims to change feelings of helplessness, fear-avoidance beliefs, lack of control, and catastrophic thinking into positive thoughts and behaviors. This was demonstrated in a study where obese patients underwent knee arthroplasty in a randomized controlled trial. These patients underwent 24 weeks of CBT and experienced a reduction in osteoarthritis-related inflammation (Lanini et al., 2022). This form of therapy helps patients reduce stress from catastrophizing and fear avoidance behaviors before surgery, which has been shown to improve surgical outcomes by reducing inflammation.
Another strategy that helps reduce stress in patients is relaxation techniques. A controlled study was conducted on 51 patients undergoing general abdominal surgery. Some of these patients participated in guided imagery and relaxation techniques leading up to their surgery to learn how to cope with the associated stress. The results showed that those who participated in these techniques experienced fewer postoperative complications and less severe pain. It was also noted that those who completed the techniques had lower cortisol levels before and after the procedure compared to those in the control group (Villa et al., 2020). It can be inferred that lower cortisol levels led to lower inflammation rates, contributing to positive surgical outcomes.
Research has found that written emotional disclosure can be very beneficial in reducing stress, enhancing health before surgery, reducing hospitalization, and improving surgical outcomes. This technique involves patients writing about stressful or traumatic events in detail, specifically outlining their emotions and feelings. A study investigated the correlation between wound healing after a punch biopsy and this technique. Individuals in the experimental group wrote about a traumatic experience, while the control group wrote an objective, non-emotional piece on time management. The study found that those in the experimental group had faster wound healing and reduced postoperative complications (Lanini et al., 2022). As previously mentioned, stress can negatively affect wound healing, so it is possible that lower stress levels resulted in less inflammation in the experimental group, leading to better wound healing compared to the control group. While this was not directly assessed in the study, it is a potential area for future research.
Mindfulness is a form of meditation and mental training practice that allows you to slow down, be calm, and be present in your mind, body, and soul while releasing any negativity. A study took 95 individuals between the ages of 18 and 67 and split them into an experimental group that went on a 3-day mindfulness retreat and a control group. Their cortisol and inflammatory markers were assessed before and after the 3 days. The results showed that those in the experimental group had decreased stress and anxiety levels, decreased inflammation, and increased anti-inflammatory markers (Gardi et al., 2021). While most people do not have time to go on mindfulness retreats, mindfulness can be practiced daily for 5-10 minutes to help decrease stress. This can be very beneficial for individuals who are going to have surgery, and it is a useful practice that everyone can implement into their daily lives.
Conclusion
The link between decreased stress levels and improved surgical outcomes underscores the importance of holistic patient care. By actively managing stress, we can reduce inflammation, bolster immune function, and enhance overall recovery. As our understanding of the mind-body connection grows, integrating stress-reduction strategies into preoperative and postoperative care will likely become a standard practice, ultimately leading to better surgical outcomes and healthier, happier patients.
References
Gardi, C., Fazia, T., Stringa, B., & Giommi, F. (2021, November 6). A short mindfulness retreat can improve biological markers of stress and inflammation. Psychoneuroendocrinology. https://www.sciencedirect.com/science/article/abs/pii/S0306453021004534
Jones, C., & Gwenin, C. (2020). Cortisol level dysregulation and its prevalence—is it nature’s alarm clock? Physiological Reports, 8(24). https://doi.org/10.14814/phy2.14644
Kim, I.-B., Lee, J.-H., & Park, S.-C. (2022). The relationship between stress, inflammation, and depression. Biomedicines, 10(8), 1929. https://doi.org/10.3390/biomedicines10081929
Lanini, I., Amass, T., Calabrisotto, C. S., Fabbri, S., Falsini, S., Adembri, C., Di Filippo, A., Romagnoli, S., & Villa, G. (2022). The influence of psychological interventions on surgical outcomes: A systematic review. Journal of Anesthesia, Analgesia and Critical Care, 2(1). https://doi.org/10.1186/s44158-022-00057-4
O’Connor, D. B., Thayer, J. F., & Vedhara, K. (2021). Stress and health: A review of Psychobiological Processes. Annual Review of Psychology, 72(1), 663–688. https://doi.org/10.1146/annurev-psych-062520-122331
Rohleder, N. (2019). Stress and inflammation – the need to address the gap in the transition between acute and chronic stress effects. Psychoneuroendocrinology, 105, 164–171. https://doi.org/10.1016/j.psyneuen.2019.02.021
Villa, G., Lanini, I., Amass, T., Bocciero, V., Scirè Calabrisotto, C., Chelazzi, C., Romagnoli, S., De Gaudio, A. R., & Lauro Grotto, R. (2020). Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: A systematic review. Perioperative Medicine, 9(1). https://doi.org/10.1186/s13741-020-00169-x
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