How Stress Affects Multiple Sclerosis Symptoms
As part of MS Awareness Month, we want to talk about the role stress plays in multiple sclerosis. Having any chronic illness is likely to increase stress levels and MS is no exception. However, stress is more likely to exacerbate the symptoms of MS and bring about a flare or relapse.
While we know its impossible to go through life without getting stressed out, its important for MS patients to try and avoid triggers as much as possible and to get into good lifestyle habits that can help manage and reduce stress.
If you find yourself feeling unexpectedly sad, angry, anxious or more fatigued than normal, you are probably suffering from stress. Tackling stress and taking positive steps to reduce it will benefit your overall physical and emotional health.
Getting plenty of rest is one way to try and reduce stress. If youre well rested, youll be better prepared to handle difficult situations. If you know you have a potentially stressful situation coming up, planning ahead can help you cope better with the event. Dont be afraid to decline invitations to events that may make you anxious and leave early if youre feeling uncomfortable.
Take time out of your day to unwind by doing something relaxing like listening to music, painting, yoga or going for a walkanything that helps you to forget your worries for a while.
What Are Ms Relapses
A relapse is a relatively sudden episode of either a new symptom or a worsening of an existing symptom that:
- continues for longer than 24 hours
- cannot be explained by other causes
- is separated from the previous attack by at least 30 days.
Relapse symptoms can evolve over one to 7 days. They can then plateau for several weeks. It can then take months for your body to recover. How often you have a relapse, and how severe they are, can be variable and unpredictable.
If you think you are experiencing a relapse, notify your MS healthcare team, neurologist or MS nurse as soon as possible. They will be able to guide you through the relapse and provide you with supportive treatment such as medications and allied health care involvement/rehabilitation, if this is required.
Use a diary to keep a record of your symptoms. Accurate patient information is useful to your doctor in treating and managing your MS. A relapse might indicate that your treatment is no longer suitable.
Due to the episodic nature of MS and relapses, you and your loved ones might experience a range of emotional responses. Specialised MS support servicesare available to support you during this time. These include employment advice and support.
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Lack Of Sleep Can Worsen Ms Symptoms
Getting enough restful sleep can be challenging when you have MS. Pain, restless legs, urinary or bowel symptoms, or temperature dysregulation are some of the top symptoms that can interfere with nightly zs, according to the National MS Society.
While no one likes being sleep deprived, it can be an even bigger issue for people with MS, says Dr. Conway. Most people with MS have a lower reserve of energy, and a lack of sleep can worsen MS symptoms, he says.
A 2018 review of studies published in Current Neurology and Neuroscience Reports found significant associations between sleep disturbance and cognitive dysfunction in MS. Objective sleep measures generally predicted objective impairments in processing speed and attention, according to the analysis.
Other consequences of poor sleep can include increased pain, anxiety, fatigue, and problems with coordination, according to the National MS Society.
In some cases, sleep difficulties for people with multiple sclerosis may be due to an underlying sleep disorder, such as obstructive sleep apnea, says Scott Ireland Otallah, MD, a neurologist who specializes in multiple sclerosis at Atrium Health at Wake Forest Baptist in Winston-Salem, North Carolina.
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Speak With Your Health Care Provider Or A Counselor
Your health care provider can be a great resource for managing stress. They can suggest stress management techniques that are suitable for you and your health status, and they may also provide other resources and referrals for stress management. It is also important to discuss your levels of stress with your doctors because some medications and treatments wont be as effective if you have high levels of stress.
If your stress levels start to feel unmanageable, you might also seek counseling or therapy. Therapists and professional counselors can provide a place to voice your frustrations and also offer you suitable coping tools. The National Multiple Sclerosis Society can work with you and provide referrals to counselors in your area.
Stress And Ms Relapses
Studies have found that continuous emotional stress, rather than short-term stress, can trigger an MS relapse in people with RRMS. 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.
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The Ebb And Flow Of Symptoms
Symptoms during an MS attack may gradually worsen over time, and then decrease and level off. Over time, the symptoms will subside, and youll start to recover. In some cases, symptoms go away completely. In other cases, they may not fully disappear but will be less intense than they were during the flare.
Can Stress Cause Ms
There is no definitive evidence to say that stress is a cause for MS. Stress can, however, make it difficult for a person to manage MS symptoms. Many patients also report that stress triggered their MS symptoms or caused a relapse. In the absence of scientific evidence, stress cannot be considered as a specific cause of developing MS.
For a better quality of life, however, keeping stress under control is advisable. This will improve overall wellbeing and would also help the physician and the patient judge the response to treatment in a better way.
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Who Diagnoses Multiple Sclerosis
Many conditions could cause similar neurological symptoms. Getting an accurate diagnosis is sometimes difficult. Some people see multiple providers over years before receiving a diagnosis. While the search can be frustrating, its important to keep looking for answers. Identifying and treating MS as soon as possible can help slow the diseases progression.
If your primary care provider suspects you may have MS, you will need to see a neurologist. A neurologist is a doctor who specializes in treating conditions that affect the nervous system, which includes your brain and spinal cord.
The Danger Of Anxiety: Avoidance Behaviors
If youve ever experienced anxiety, you know it can make daily life difficult. One way some people deal with anxiety is by avoiding its source. When you get anxious about getting dizzy while driving, your instinct may be to avoid getting in the car. Or if you are afraid of having a bowel accident in public, not leaving the house may seem like a good solution. These avoidance behaviors could make you skip a doctors appointment, reduce your time with friends or stop you from doing what you enjoy.
People who have both MS and anxiety are more likely to have suicidal thoughts, adds Beier. Although data varies, it is estimated that up to 15 percent of people with MS die of suicide. If you notice avoidance behaviors, or anxiety that is impacting daily life, its important to start a conversation with a doctor.
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Ms Inflammation And Stress
Autoimmunity, in which the body’s immune system attacks the myelin around the nerves on the brain and spinal cord, is a component of MS.
Some research suggests that early stages of this inflammation may cause changes in the brain’s function that produce a state of anxiety. Put another way, physiological changes that result from MS can give birth to feelings of stress all on their own, which can compound stress experienced because of external factors, like daily challenges.
Stress has long been associated with MS exacerbations. It isn’t completely clear whether stress actually causes exacerbations, or whether you may become more anxious than usual because of the physical changes that occur before an exacerbation has its peak impact.
What Questions Should I Ask My Doctor
You may want to ask your healthcare provider:
- How do we know for sure that I have multiple sclerosis and not another neurological condition?
- Do I need to start taking disease-modifying therapy medication?
- What are the benefits and risks of various DMTs?
- Will I need to stay on medication for the rest of my life?
- What lifestyle changes can I make to help manage MS?
A note from Cleveland Clinic
Multiple sclerosis is a disease that affects the central nervous system . It is an autoimmune disease that causes your immune cells to mistakenly attack your healthy nerve cells. These attacks lead to inflammation and damage to the myelin sheath that covers and protects your nerve cells. This damage causes neurological symptoms such as loss of balance, vision problems and muscle weakness. Several effective treatments exist for MS. These medications reduce relapses and help slow the progression of the disease. Most people with MS are able to manage their symptoms and lead full, active lives.
Last reviewed by a Cleveland Clinic medical professional on 02/10/2021.
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How The Program Can Help
Good news: although its 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:
The OMS program combines all of these factors with the added support of a community.
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
How Is Multiple Sclerosis Managed Or Treated
There is currently no cure for MS. Treatment focuses on managing symptoms, reducing relapses and slowing the diseases progression. Your comprehensive treatment plan may include:
- Disease-modifying therapies : Several medications have FDA approval for long-term MS treatment. These drugs help reduce relapses . They slow down the diseases progression. And they can prevent new lesions from forming on the brain and spinal cord.
- Relapse management medications: If you have a severe attack, your neurologist may recommend a high dose of corticosteroids. The medication can quickly reduce inflammation. They slow damage to the myelin sheath surrounding your nerve cells.
- Physical rehabilitation: Multiple sclerosis can affect your physical function. Staying physically fit and strong will help you maintain your mobility.
- Mental health counseling: Coping with a chronic condition can be emotionally challenging. And MS can sometimes affect your mood and memory. Working with a neuropsychologist or getting other emotional support is an essential part of managing the disease.
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Dont Be Afraid To Talk To Your Doctor
If you have MS and think you may have depression, anxiety or pseudobulbar affect, talk to your primary care physician about your symptoms. They can refer you to a rehabilitation psychologist specializing in MS or another specialist who can help.
If you are a support partner of someone with MS, watch for signs of depression and anxiety both in your loved one and in yourself. They may not always be obvious and can often look like irritability, anger or a growing detachment from social life.
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Common Triggers Of An Ms Flare
MS symptoms are different for everyone and may change from one flare to another, but there are triggers everyone with multiple sclerosis should be aware of. “Although a flare or relapse can occur without any warning, certain triggers are common,” says Matthew McCoyd, MD, a neurologist, assistant professor, and associate neurology residency program director with the Loyola University Health System in Illinois.
Here, the most common triggers of an MS flare-up:
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Is This Ms Or Anxiety Awaiting Mri
I am a 22 year old female and a couple of months ago I started getting a pins and needles sensation in my toes. Although I had it in both feet, it was predominantly worse for my left side. I also found that bending or crossing my legs would make it worse. After speaking to my doctor he presumed it was just a pinched nerve.
Shortly after the pins and needles in my toes recovered . But then went on to develop in my arms. It started as the aims in my elbows and wrists and would then occasionally cause tingling in my pinky and ring finger. After speaking to my doctor again he has scheduled me for an mri in two months time and ever since I have been getting anxiety over not knowing what is wrong with me!
Again the tingling and pain in my arms subsided but I still often get electric shock type feelings in different locations on my body and slight twitching in areas.
I also feel as though my memory has been terrible as I often forget what I am about to do but my boyfriend thinks it’s all in my head as I have convinced myself that I have ms. Any opinions would be kindly appreciated!
0 likes, 20 replies
Sexual Function And Ms
Sexual dysfunction is common in MS. It can be directly related to MS from brain or spinal cord lesions, or more indirectly related due to other MS symptoms such as depression and fatigue, or from wider relationship and social issues stemming from MS.
Although a difficult area to talk to your health professional about, it is an important area to maintain your quality of life and self-confidence. There are many avenues of help available from physical to psychological and your GP, MS nurse or neurologist can point you in the right direction for the most appropriate assessment and assistance.
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Implement Daily Coping Strategies
There are many strategies for stress management that could be incorporated into your daily life with MS. The following are some of the techniques recommended by the National Multiple Sclerosis Society:
- Plan ahead for daily situations that may cause stress.
- Do unpleasant tasks earlier in the day to get them out of the way.
- Make a three-fourths rule. For example, refill medication when three-fourths is gone, fill your cars gas tank when its three-fourths empty, and restock groceries when they are three-fourths gone. This will help you avoid a situation where you are out of important items.
- Try to do something you enjoy every day.
Perceived Stress In Multiple Sclerosis Patients: Relationship With Mood States And Pain Experience
Increased stress is a very common symptom among persons with multiple sclerosis .
In a cohort of MS patients, a considerable proportion had from moderate to high levels of perceived stress.
More than half of the studied patients had high score in overall mood states disturbance.
Disturbed mood states and pain experience were significantly associated with the patients level of increased perceived stress.
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What Causes Multiple Sclerosis
MS is an autoimmune condition. This is when something goes wrong with the immune system and it mistakenly attacks a healthy part of the body in this case, the brain or spinal cord of the nervous system.
In MS, the immune system attacks the layer that surrounds and protects the nerves called the myelin sheath.
This damages and scars the sheath, and potentially the underlying nerves, meaning that messages travelling along the nerves become slowed or disrupted.
Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors is involved.