Editorial Message: Laugh Away Your Venous Ulcer?

Dear Readers,   Venous ulcers are common and, many times, difficult problems with which to deal. We use a combination of compression and other therapies to treat these ulcers with less than stellar results. I will bet that there is one treatment you have not tried yet — laughter therapy! Yes, laughter therapy. Professor Andrea Nelson from the University of Leeds School of Healthcare in the United Kingdom said treatment of venous ulcers with weekly, low-dose ultrasound therapy is not effective,¹ and “having a really hearty chuckle can help … This is because laughing gets the diaphragm moving and this plays a vital part in moving blood around the body.”² We all know that the treatment of ambulatory venous hypertension by getting the blood “to move” toward the heart is a very desirable goal of therapy for venous ulcers. This is an interesting concept.   It appears that laughter has other beneficial effects that could stimulate healing of venous ulcers and other types of chronic wounds. Michael Miller, MD, FACC, FAHA, professor at the University of Maryland School of Medicine in Baltimore, reported that laughter results in vasodilatation of arteries. He showed that arterial vasodilatation was significantly higher in patients who had seen a funny movie and experienced laughter compared to patients in a control group and those who had seen an anxiety-producing movie.³ He proposed that laughter stimulates the hypothalamus and pituitary gland in the brain causing release of ß-endorphins. These activate the µ-3 receptor in the vascular endothelium, resulting in nitric oxide production. Nitric oxide causes vessel dilatation, reduced platelet aggregation, and decreased inflammation.⁴ All of these end results would be beneficial for anyone with a chronic wound, especially a venous ulcer.   Another side benefit of the production of endorphins by laughter is the relief of pain. One patient reported that 10 minutes of laughter would relieve his pain from ankylosing spondylitis for up to 2 hours!⁵ Laughter therapy has been beneficial in the treatment of pain patients in long-term care facilities, thus reducing the amount of pain medication required.⁶ Pain relief without the use of narcotics or other pain medications would be a great benefit to our venous ulcer patients.   Laughter has been shown to enhance the body’s immune system. It does this by stimulating neuropeptide production and release. Among those peptides released are epinephrine, cortisol, and growth hormone. These simulate the increased production of immunoglobulins A, G, and M. Increased release of B-cells and T-cells is also noted after laughter with the effects lasting up to 12 hours in some cases.⁷ This immune system boost would be very beneficial for our venous ulcer patients and especially for our diabetic foot ulcer patients who are known to have suppressed immune systems.   Maybe we should be actively prescribing a “course of laughter” as additional therapy for our patients with venous ulcers and other chronic wounds. There is early evidence that it may improve their healing, but if nothing else, it will make them feel better. We may start showing cartoons on our televisions in the waiting room at the wound center! Mark Twain may have had it right when he said, “Against the assault of laughter, nothing can stand.”

References

1. Watson JM, Kang’ombe AR, Soares MO, et al. Use of weekly, low dose, high frequency ultrasound for hard to heal venous leg ulcers: the VenUS III randomised controlled trial. BMJ 2012;342:d1092 2. Laughter really is the best medicine (for leg ulcers) [news release]. University of Leeds, UK. https://www.eurekalert.org/pub_releases/2011-03/uol-lri030811.php. Accessed December 28, 2012. 3. Miller M. Don’t Worry, Be Happy: Is Laughter Indeed the Best Medicine? Paper presented at: European Society of Cardiology 2011 Congress, Paris, France, August 27-31, 2011. https://spo.escardio.org/eslides/view.aspx?eevtid=48&fp=351. Accessed December 27, 2012. 4. Miller M, Fry WF. Proposed Signaling Pathway Underlying Laughter and Vascular Function. Med Hypotheses. 2009;73:636-639 5. Cousins N. Head First: The Biology of Hope and the Healing Power of the Human Spirit. New York, NY: E.P. Dutton; 1990. 6. McCaffery M. Nursing approaches to nonpharmacological pain control. Int J Nurs Stud. 1990;27(1):1-5 7. Pert C. The Molecules of Emotion: The Science Behind Mind-Body Medicine, New York, NY: Touchstone; 1999.