Stress is not an inherently bad thing, however if you have MS, you know that it can have negative effects. For years, the connection between stress and MS has been accepted by neurologists, neuropsychologists, and patients alike. I agree that acute stress seems to aggravate my MS symptoms.
Saturday morning, I attended an MS Women’s Breakfast sponsored by the local chapter of the National MS Society. The guest speaker was Mary Elizabeth Quig, Ph.D., clinical neuropsychologist at Georgetown University MS Center and founding partner at Neuropsychology Associates of Fairfax. The title of her presentation was "Dames who Reframe."
Dr. Quig began her presentation discussing neuropsychology, stress, and psychoneuroimmunology (PNI). Psychoneuroimmunology takes an interdisciplinary approach to the study of the interaction between mental processes, the nervous system, and the immune system. It offers a scientific study of the Mind-Body connection.
What is stress?
Stress is the body’s unconscious response to a demand – any kind of demand whether good or bad. When the demand is perceived as excessive, the resulting "stress" can help us or hurt us. When a dangerous situation puts you under acute stress, the body’s reaction is to release hormones, including adrenaline and cortisol, as part of the fight-or-flight response. According to the Mayo Clinic, adrenaline helps to increase your heart rate, elevate blood pressure and boost energy supplies. Cortisol alters the normal immune system response and suppresses the digestive and reproductive systems, functions which are "nonessential or detrimental in a fight-or-flight situation."
Although we no longer have to flee from a saber tooth tiger or wooly mammoth in our daily lives, our bodies continue to be wired to respond to this complex alert system. Still helpful when faced with physical dangers, but detrimental if the stress is in response to something emotional or cognitive and there is no need for the extra energy and strength created by an increased surge of hormones.
Stress and MS
Dr. Quig shared one study in the PNI literature that demonstrated individuals with high stress levels (in this case caregivers) have an increased number of respiratory tract infections, a poorer response to the flu vaccine, and slower wound healing as compared to well-matched controls (Kiecolt-Glaser, 1995). Several studies have demonstrated a connection between stressful events and MS relapses (Mohr, 2004).
A study in the Netherlands found that stressful events more than doubled the risk exacerbation in patients with relapsing-remitting multiple sclerosis in the month following the stressful event. Infections were associated with a threefold increase of MS relapse (Buljevac, 2003). Examples of reported stressful events include illness or problems with a close family member, job stress, events related to house or car, sudden personal discomfort (unrelated to MS), death of a friend, relative, or pet, problems in a relationship, stress related to a holiday, or financial problems.
In a study of 101 MS patients in Sydney, Australia, MS relapse was predicted by the number and frequency of acute stressors, but not by chronic stressors. Since it was the number rather the severity of stressors which were most important in relation to MS relapse risk, authors suggest that MS patients should avoid situations that are likely to generate multiple stressors while utilizing their social support network (Brown, 2006).
In a recent meta-analysis of 17 publications investigating the possible connection between psychological stress and MS onset and/or MS relapse, all but two studies reached conclusions in favor of the stress-MS relationship. However due to the wide variety of measurements used between studies, authors could not draw any concrete conclusions (Artemiadis, 2011).
What can be done about stress?
The next post explores methods to develop effective coping skills to combat stress.
Artemiadis AK, Anagnostouli MC, Alexopoulos EC. Stress as a Risk Factor for Multiple Sclerosis Onset or Relapse: A Systematic Review. Neuroepidemiology 2011;36:109-120. DOI: 10.1159/000323953
Brown RF, Tennant CC, et al. Relationship between stress and relapse in multiple sclerosis: Part II. Direct and indirect relationships. Mult Scler 2006 Aug;12(4):465-75.
Buljevac D, Hop WC, Reedeker W, et al. Self reported stressful life events and exacerbations in multiple sclerosis: prospective study. BMJ 2003;327:646. doi: 10.1136/bmj.327.7416.646 (Published 18 September 2003)
Hajhashemi A. Recognition of the Kind of Stress Coping in Patients of Multiple Sclerosis. Indian J Psychol Med. 2010 Jul-Dec; 32(2): 108-111. doi: 10.4103/0253-7176.78507
Kiecolt-Glaser JK, Marucha PT, et al. Slowing of wound healing by psychological stress. The Lancet 1995 Nov 4;346(8984):1194-6. doi:10.1016/S0140-6736(95)92899-5
Lorentz MM. Stress and Psychoneuroimmunology Revisited: Using mind-body interventions to reduce stress. Alternative Journal of Nursing July 2006, Volume 11.
Mohr DC, et al. Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. BMJ 2004;328:731. doi: 10.1136/bmj.38041.724421.55 (Published 25 March 2004)
"Stress: Constant stress puts your health at risk" - Mayo Clinic. Accessed September 15, 2012.