March 18, 2004 -- People with MS -- multiple sclerosis -- believe stress makes their symptoms worse. Their doctors should believe it, too, a new study suggests.
Despite MS patients' widely held belief that stressful events bring on sudden worsening of symptoms, the idea has been controversial among doctors. But a look at published research shows that in this case, the patients know best.
David C. Mohr, PhD, director of the Behavioral Medicine Research Center at the University of California, San Francisco, and colleagues looked at every major published study of MS and stress. Their analysis shows that stressful events worsen MS at least as much, if not more, than an effective MS drug -- beta interferon -- makes it better.
"The negative effects of stress on exacerbation of multiple sclerosis are at least as great as the positive effects of a class of drugs widely considered to produce clinically meaningful results," Mohr and colleagues write in the March 20 issue of the British Medical Journal.
MS is a disease of the brain, spinal cord, and optic nerves that can cause problems with muscle control and strength, vision, balance, sensation, and mental functions. The cause is unknown. Most people with the disease suffer the relapsing form. This means that they are stable for what may be a long time -- then, they get a barrage of symptoms that subside over the following weeks or month. Very often, these "exacerbations" leave long-lasting impairment in their wake.
Not all kinds of stress are equal, however. Mohr and colleagues point to a famous study of MS patients who underwent the terrible stress of rocket attacks during the first Gulf War. These patients actually did better during this month of mortal danger. The researchers suggest that a short period of intense stress has different effects on the immune system.
"These findings should in no way be misconstrued to suggest that patients with multiple sclerosis bear any responsibility for exacerbations," Mohr and colleagues note. "Rather, we hope these findings will open investigation into new avenues of managing multiple sclerosis, either through stress management or through pharmacological management of potential [hormonal] or immune responses to stress."