April 2, 2004
The National Multiple Sclerosis Society
A new study that combined results of previously published research findings suggests that acute attacks of multiple sclerosis may be associated with stressful life events. The study, appearing in the British Medical Journal (published online March 19, 2004 at this link) and funded in part through National MS Society postdoctoral fellowships, is a “meta-analysis” (which statistically combines findings) of previously published studies of the topic of stress and MS.
Multiple sclerosis is thought to be an autoimmune disease that targets the brain and spinal cord. In its most common form (“relapsing-remitting MS”), neurological symptoms of the disease come and go in the form of acute attacks followed by periods of partial or complete recovery. It is still not known what causes MS, or what triggers relapses, although upper respiratory infections have been linked to relapses in some individuals. Although there have been many studies examining a possible link between stress and MS, conclusions have been controversial. This is because stress has many different meanings and has been defined and studied in many different ways that are hard to compare. Moreover, studies of stress and the long-term course of MS are lacking.
David Mohr, PhD, and colleagues (University of California at San Francisco) searched the medical literature for studies from 1965 to February 2003 that contained the terms “stress,” “trauma,” and “multiple sclerosis.” The investigators independently reviewed the papers, analyzing methods, statistics, and outcomes. They excluded studies that focused solely on physical trauma or medical conditions, and also excluded studies that did not provide adequate details of methods and outcomes. National MS Society-funded postdoctoral fellows Laura Julian, PhD, and Darcy Cox, PsyD, contributed to the analysis.
The authors included 14 studies that met their screening criteria, including studies that looked at MS relapses after diagnosis as well as initial MS attacks. In 13 out of 14 studies, the authors noted a significant increase in the likelihood of MS relapse following stressful life events, such as marital problems or financial difficulties. In one study however, stress was followed by a reduction in relapses.
The authors conclude that these studies indicate a modest association between stressful events and MS relapses, but also note the limitations of their study. The quality of the studies they reviewed varied, and the authors of those studies did not always consider or report other factors (such as upper respiratory infections) that might have triggered relapses. Furthermore, the association between stress and relapse was not consistent among patients, or even in one individual over time.
Dr. Mohr and colleagues do not claim that the data demonstrate a “causal” relationship between stressful events and MS onset or relapses, but instead suggest that these results encourage further research to define which stressful events may likely be associated with changes in MS, what biologic processes may be at work, and how people’s individual reactions to stress may come into play. They emphasize that these data should not be used to infer that persons with MS are responsible for their exacerbations, but rather should encourage further investigations into the potential link between stress and relapse.
This study contributes new insights into the existing literature concerning the possible link between stress and MS attacks, but it does not resolve the issue. Many of the studies cited had significant limitations, such as reliance on subjects’ recall of stressful events over long periods of time. This was particularly true of those studies that examined first MS attacks, where in some cases, participants had to recall stressful events that had occurred several years prior to the interview. It is possible that stress may affect the timing of exacerbations without affecting the long-term course of the disease. Moreover, very little research has addressed the biological mechanisms that might underlie a link between stress and MS. Research focusing on how stress interacts with the immune system in persons with MS may provide useful information about the disease and the role that stress may play in MS attacks.
Learning to manage stress is important for people in general but especially
important for persons with MS since the disease adds additional stressors
to those already present in daily life. However, there is currently no
evidence that managing stress would alter disease course. The National
MS Society is funding research that investigates whether teaching stress
management techniques can help individuals with MS and their caregivers
both physically and psychologically. The National MS Society provides suggestions
Stress in Multiple Sclerosis,” a brochure that is available on its
Copyright © 2004, The National Multiple Sclerosis Society