Article of interest: stressful life events trigger MS relapses. #MSBlog #MSResearch
“I must get asked ‘does stress trigger relapses’ once a month by someone with MS. I usually say possibly and quote this meta-analysis below. If stressful life events trigger relapses what can be done about it? I am not sure. May be MSers could go a pre-emptive stress management course to give them the skills to counteract and manage stressful events? Studying this will be difficult; the power calculations for doing a randomised study to prove stress management would be staggering. Despite this there are compelling other reasons to manage stress to improve your mental well-being and health. Have any of you any experience with this? If you do can you let us know? Thanks.”
Mohr et al. Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. BMJ. 2004 Mar 27;328(7442):731.
OBJECTIVE: To quantify the association between stressful life events and exacerbations of multiple sclerosis.
DATA SOURCES: PubMed, PsychInfo, and Psychological Abstracts searched for empirical papers from 1965 to February 2003 with terms “stress”, “trauma”, and “multiple sclerosis”.
REVIEW METHODS: Three investigators independently reviewed papers for inclusion/exclusion criteria and extracted the relevant data, including methods, sample statistics, and outcomes.
RESULTS: Of 20 studies identified, 14 were included. The meta-analysis showed a significant increase in risk of exacerbation in multiple sclerosis after stressful life events, with a weighted average effect size of d = 0.53 (95% confidence interval 0.40 to 0.65), P < 0.0001. The studies were homogenous, Q = 16.62, P = 0.22, I2 = 21.8%. Neither sampling nor study methods had any effect on study outcomes.
“None of these studies on their own are very positive; it is only when you add them together in the meta-analysis do get a relatively strong effect.”
CONCLUSIONS: There is a consistent association between stressful life events and subsequent exacerbation in multiple sclerosis. However these data do not allow the linking of specific stressors to exacerbations nor should they be used to infer that MSer are responsible for their exacerbations. Investigation of the psychological, neuroendocrine, and immune mediators of stressful life events on exacerbation may lead to new behavioural and pharmacological strategies targeting potential links between stress and exacerbation.