A review of stress-relapse interactions in multiple sclerosis: important features and stress-mediating and -moderating variables

Abstract

Studies do not provide a consensus opinion of the relationship between stress and relapse in relapsing-remitting multiple sclerosis (RRMS). Few studies have defined the critical features of these stressful situations, or examined the role of stress-mediating and -moderating variables. Available evidence indicates that the relationship between life stress and relapse is complex, and is likely to depend on factors such as stressor chronicity, frequency, severity and type, and individual patient characteristics such as depression, health locus of control and coping strategy use. Little is known about how these factors, individually or in combination, are related to MS disease activity. Viral infections are also likely to precipitate relapse in MS, and significant life-stress may further enhance this relationship. The nature and strength of these interrelationships have strong clinical implications. MS patients are particularly vulnerable to a deteriorating cycle of stressful life events, illness episodes and disability. Timely multidisciplinary care interventions aimed at both minimizing psychological distress and physical symptoms may halt this downward reciprocal cycle. Little is known of the pathogenesis of these putative stress-induced changes in disease activity, and almost all stressor studies suffer from some biases or limitations.

Relationship between Psychosocial Factors and Onset of Multiple Sclerosis

“…All of these studies have been associated with the relationship between psychological factors and MS, and the overwhelming majority of authors believe that psychological disorders coexist with MS, or one of the MS symptoms. In addition, there is evidence to show that the relationship between MS relapse and life stress is complex and may rely on one or more factors such as long-term stress, severity, frequency and the type of the patient’s personality and coping strategies [21, 22]. According to Folkman’s stress model, characteristics of the stress source and personality of MS patients were only among the many intermediary factors affecting stress consequences.…”

Palliative Care in Amyotrophic Lateral Sclerosis, Parkinson's Disease, and Multiple Sclerosis

“…Specific therapies include pharmacologic and non-pharmacologic approaches. 192 Stress reduction 193 and transcutaneous electrical nerve stimulation (TENS) unit therapy, 194 for example, are complimentary to numerous pharmacologic options. These include the tricyclic and SSRI antidepressants 192 ; anticonvulsants such as gabapentin, 195,196 carbamazepine, 197 and now pregabalin 198 ; as well as opioids.…”

Stress as a Risk Factor for Multiple Sclerosis Onset or Relapse: A Systematic Review

“…So far, published reviews have dealt with studies fragmentarily, except for the meta-analysis mentioned, focusing mainly on results and theoretical conceptualizations [12][13][14][15] . To our knowledge, there is a lack of systematic approach in observational studies.…”