Stress and MS

Stress is an inevitable part of modern life. It has been shown to contribute to a long list of health problems such as chest pain, headaches, insomnia, stomach problems and a lowered immune system with more frequent infections.

However, if you have MS, you have an additional incentive to make sure that you try to manage your stress  — studies show that negatively experiencing stress can affect MS relapses and worsen MS symptoms

Can stress cause MS?

People with MS often describe their personal experiences on forums and you will find that stress and MS is a relationship that comes up time and time again, with many seeing the link within their own lives. Some people with MS feel that their MS was triggered as a direct result of a specific trauma or going through an exceptionally stressful period of time.

But studies which have investigated whether stress causes MS have been mixed. Although the person with MS knows from their experience that their MS symptoms started after or alongside a stressful period of time, there is no direct evidence that stress causes MS — although it might trigger it. However, the connection between long periods of stress and MS exacerbation within people who already have an MS diagnosis has been realised through scientific research and studies. Stress management has also been seen to slow down new areas of MS lesions on an MRI scan.

What is an MS relapse?

An MS relapse is caused by acute inflammation in the central nervous system (CNS) damaging the protective myelin. As a result, new MS symptoms occur or old symptoms worsen, but to be defined as a relapse they must be separated from the previous flare-up by at least 30 days and last for at least 24 hours. There must also be no other explanation for the symptoms for example fever, acute infection or acute stress – in such cases the new symptoms would be classified as a pseudo-relapse.

Symptoms will vary from person to person and can range from mild sensory disturbance to severe new disability. For example, in some cases it can be just one symptom while others may experience several new symptoms at the same time. 

MS relapses can last from several days, to weeks or even months.  In relapsing-remitting MS, exacerbations are followed by remissions. Some people will find that they go back to how they were feeling before the exacerbation — but going into remission doesn’t mean that symptoms always disappear. 

Stress and MS relapses

Studies have found that continuous emotional stress, rather than short-term stress, can trigger an MS relapse. Long-term, continuous stress keeps the immune system on hyper-alert, is very pro-inflammatory and creates a lot of wear and tear in the body, otherwise known as allostatic load.  

There is so much evidence to back this up, just take a look at the list of studies below. One study at the University of Pittsburgh found that stressful events like a death in the family or divorce were often followed by an MS relapse within six weeks, while the study in the Netherlands found that stressful life events more than doubled the rate of relapse. 

However even stress caused by positive events like a new baby or organising a wedding can increase the chance of an MS relapse. 

But it is not stress itself that necessarily causes the problem, rather our response to it. In fact, people who perceive stress as a positive have better health outcomes than those with less stress, but who perceive it negatively.

Fortunately, there are lifestyle changes that you can make, that have been clearly shown to reduce stress, including meditation, exercise and diet to help you manage stress and strengthen your mind-body connection.

What is the link between multiple sclerosis and stress?

A number of published papers have shown that stress affects MS. Here are a few:

At UCLA, studies showed stress can precipitate MS relapses and worsening disability through a variety of mechanisms – including excessive inflammatory response and worsening degeneration. The immune system balance of Th1 (exciting inflammation) versus Th2 (reducing inflammation) cytokines is intimately involved in the development of relapses in people with MS.

In Switzerland, researchers studied 14 healthy medical students to see whether a psychologically stressful event (their final exam) could modify Th1 cytokine’s levels. The students showed a significant increase of an inflammatory cytokine (tumor necrosis factor alpha) starting the next day; this cytokine has been shown to be elevated in MS relapses.

In Pittsburgh, a study by the Department of Psychiatry at the University of Pittsburgh followed 50 women with MS to see how major life events affected their MS disease activity. Nearly half of all major life events were followed within six weeks by a relapse.

US researchers have studied the development of new MRI lesions in 36 people with MS and correlated these with stressful life events. After major life stresses, people were roughly 1.6 times more likely to develop a new lesion in the next eight weeks. This study also noted that those with coping mechanisms could reduce this risk. 

In 2006, the same research group summarized the effects of stress on MS: “A growing literature reports that stressful life events are associated with exacerbation and the subsequent development of brain lesions in patients with multiple sclerosis.” Acute short-term stressors generally caused no problems, but bigger stressors such as conflicts, loss, bereavement, poor social support, anxiety and depression were shown to be risk factors for MS exacerbations.

In the Netherlands, researchers examined 73 patients with relapsing-remitting MS at an MS clinic. During the study, 70 had major stressful events. Stress more than doubled the exacerbation rate during the following four weeks. The researchers also noted a 3-fold increase in relapses following infections during the study, but this was independent of the stress associated with the infection.

How the program can help

Good news: although it’s simply not possible to avoid stressful life events, there are ways that you can learn to deal with stress so that you can prevent MS relapses. Scientists have discovered that stress management techniques can significantly reduce lesions and MS relapses. MS symptoms can also be stressful in themselves and symptoms can naturally feel worse if you are feeling stressed and anxious, so stress management will also help you day-to-day.

Some of the ways in which you can manage stress effectively include: 

  • Meditation strong scientific evidence shows that meditation affects areas in the brain that can help you to respond to stress more effectively.

  • Exerciseexercise can directly reduce stress by increasing your endorphins, but it also improves your overall sense of wellbeing, especially if you are enjoying the physical activity and socialising with friends at the same time. 

  • Dietchronic stress releases cortisol and studies have shown this increases the desire for calorie-laden, sweet, fatty, processed foods. A bad diet can lead to inflammation of the gut which leads to an MS relapse. So what's the best diet to help reduce stress and improve MS symptoms? We have made it easy with an OMS diet which includes reducing saturated fats, increasing omega-3 intake and a wide range of colourful fruit and vegetables. Take a look at all our delicious recipes for inspiration and read about OMSers diet/stress experiences

  • Sleep — Good quality sleep is vital to reduce stress as a good night’s sleep will help you to better manage any stress which comes your way. You need at least seven or eight hours of sleep per night.

  • Identify what is making you anxious — counselling can be beneficial in helping you to identify your source of stress, make life changes and develop coping mechanisms.

The OMS 7 step recovery program combines all of these factors with the added support of a community.


References:

 

1. Gold SM, Mohr DC, Huitinga I, et al. The role of stress-response systems for the pathogenesis and progression of MS. Trends Immunol 2005

2. Lalive PH, Burkhard PR, Chofflon M. TNF-alpha and psychologically stressful events in healthy subjects: potential relevance for multiple sclerosis relapse. Behav Neurosci 2002; 116:1093-1097

3. Ackerman KD, Stover A, Heyman R, et al. Relationship of cardiovascular reactivity, stressful life events, and multiple sclerosis disease activity. Brain Behav Immun 2003; 17:141-151

4. Mohr DC, Goodkin DE, Bacchetti P, et al. Psychological stress and the subsequent appearance of new brain MRI lesions in MS. Neurology 2000; 55:55-61

5. Mohr DC, Goodkin DE, Nelson S, et al. Moderating effects of coping on the relationship between stress and the development of new brain lesions in multiple sclerosis. Psychosom Med 2002; 64:803-809

6. Mohr DC, Pelletier D. A temporal framework for understanding the effects of stressful life events on inflammation in patients with multiple sclerosis. Brain Behav Immun 2006; 20:27-36

7. Strenge H. [The relationship between psychological stress and the clinical course of multiple sclerosis. An update]. Psychother Psychosom Med Psychol 2001; 51:166-175

8. Buljevac D, Hop WC, Reedeker W, et al. Self reported stressful life events and exacerbations in multiple sclerosis: prospective study. Bmj 2003; 327:646