Thursday, December 12, 2002
By Dana Frisch
A new study suggests stressful incidents may trigger symptom flare-ups in multiple sclerosis (MS) patients, adding to the debate on whether mild to moderate levels of stress are protective or harmful to people with MS.
The study followed 23 women, 18 of whom had relapsing-remitting MS, the most common form of the disease, for a year. In this type of MS, symptoms wax and wane. The remaining 5 had secondary progressive MS, in which symptoms worsen over time. The women completed weekly surveys in which they reported any stressful incidents and their MS symptoms.
The study, in the December issue of the journal Psychosomatic Medicine, found that 85% of symptom exacerbations occurred after a stressful event had happened in the previous six weeks. On average, stressful events occurred two weeks before the symptoms worsened, and women were more than 13 times more likely to suffer symptom exacerbations after an increase in the number of potentially stressful life events. Women in the study had 2.6 exacerbations per year, lasting about a month, consistent with the profile of the disease. The study cannot prove that the stress caused the flare-ups, but does add to research in the field.
In MS, the slow destruction of myelin--the thin, protective coating that insulates nerve fibers in the brain and spine--can lead to numbness, muscle weakness and stiffness, impaired vision and coordination problems. MS, like lupus and rheumatoid arthritis, is believed to be an autoimmune disease, meaning that the immune system turns against the body's own cells.
Lead author Dr. Kurt Ackerman said that stress can influence the immune system and may cause changes that make it even more active, thus worsening damage to nerve cells and producing MS symptoms.
While this study included women only, Ackerman, an assistant professor of psychiatry at the University of Pittsburgh School of Medicine, said that the mechanism is similar in males as well. He noted that this stress-symptom link can be generalized to other autoimmune conditions, such as diabetes, lupus and rheumatoid arthritis.
Ackerman told Reuters Health that there has been controversy on whether mild to moderate levels of stress are protective, as in animals with MS, or harmful. "People have very strong opinions on this," he said. "Many people with MS believe that the disease is triggered by stress and neurologists are split, and so that is why these studies need to be done."
This research should not be construed as blaming MS patients for their disease, said Ackerman. Rather, people should view stress as something that can be controlled by a variety of mechanisms, including relaxation techniques, he said.
According to Ackerman, regardless of whether the association found in this study holds true over the long-term, people "need to handle stressful events as well as possible to keep them healthy." He added that this is important for people without MS as well.
SOURCE: Psychosomatic Medicine 2002;64:916-920.
Copyright 2002 Reuters