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Relationship between stress and relapse in multiple sclerosis: Part I. Important features.
Brown RF, Tennant CC, Sharrock M, Hodgkinson S, Dunn SM, Pollard JD.
Department of Psychology, University of New England, Armidale, NSW 2351, Australia. firstname.lastname@example.org
OBJECTIVE: The aim of this two-year prospective study was to examine the relationship between multiple aspects of life-event stress and relapse in multiple sclerosis (MS) patients. BACKGROUND: Few studies have defined the critical features of this life-event stress; for example, stressor duration, frequency, severity, disease-dependency, valency, or stressor constructs, such as the propensity to cause emotional distress/threat or the frustration of life goals. METHODS: 101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life events were assessed at study-entry and at three-monthly intervals for two years. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria. RESULTS: Acute events, but not chronic difficulties (CDs), predicted relapse occurrence: acute stressor frequency counts predicted greater relapse risk, along with low disability score (EDSS) and being male. We also confirmed the bi-directional stress-illness hypothesis: stressors predicted relapse, and relapse separately predicted stressors. CONCLUSIONS: Life-event stress impacts to a small degree on MS relapse. The number and not the severity of acute stressors are most important; chronic stressors do not predict later relapse. Males and those with early stage disease are also at greater risk of relapse. MS patients should be encouraged to reduce acute stressors during times of high stress, and feel reassured that disease-related chronic stressors do not increase their relapse risk.
PMID: 16900759 [PubMed - in process]
Stress is definitely a big part of my ms, and things like meditation and yoga and lifestyle changes and relaxation and psychotherapy has helped me a lot. Here are a few more studies linking stress and exacerbation in multiple sclerosis:
The relationship between acute stress and aggravation of quiet or asymptomatic MS is well established by medical literature especially that which has come out since the year 2000.
1. The study published in the distinguished Journal of Neurology in 2000 by Mohr et al entitled "Psychological Stress and the Subsequent Appearance of New Brain MRI Lesions in MS" examine the relationship between stressful life events and the subsequent development of brain lesions on MRI. The results state "for a total sample of patients, increase conflict and disruption in routine was followed by increased odds of developing new Gd + brain lesions eight weeks later."
2. An article (Esposito, et al) in the "Journal of Pharmacology and Experimental Therapeutics" looked at the cellular mechanism involved in stress on a microscopic level. Their findings, published December 2002, state "these results demonstrate that CRH and the mast cells are involved in regulating BBB permeability and possibly, brain inflammatory disorders exacerbated by acute stress."
3. An article from a distinguished British Medical Journal(BMJ) was published in 2003. The paper entitled "Self Reported Stressful Life Events and Exacerbations in Multiple Sclerosis: Prospective Study" (Buljevac D. et al, 2003) sought to study the relationship between stressful life events not related to MS and the occurrence of exacerbations in relapsing remitting MS. Patients used in the study were ones with the ability to walk, such as the Plaintiff. It noted in the introduction into the paper that "psychological stress is an additional factor that has been implicated repeatedly as a determinate of disease activity ever since Charcot first described the disease." In the conclusion to the study it was noted "stressful events were associated with increased exacerbations in relapsing-remitting multiple sclerosis. This association was independent of the triggering effect of infections on exacerbations of multiple sclerosis." They noted that this study fulfilled an earlier need by the American Academy of Neurology to obtain tightly defined prospective study on stress and aggravation of MS. They noted that their study adds "that patients with multiple sclerosis who experience a stressful event are subsequently at increased risk of an exacerbation of their disease."
4. A Harvard Medical School (2002) study "The Role of Stress in Neuro - degeneration Diseases and Mental Disorders" noted the relationship between stress and disease like MS.
5. A 2002 University of California study (Mohr D.C. et al) entitled "Moderating Effects of Coping on the Relationship Between Stress and the Development of New Brain Lesions in Multiple Sclerosis" stated "considerable research has supported a relationship between stress and both clinical exacerbation and the development of new brain lesions".
6. The Journal "Neuroendocrinology Letters" in 2004 published a supportive article.
7. The Journal of Neuroimmunology in 2004 confirmed again that stress can affect the mast cells leading to worsening of inflammatory diseases.
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