Can Stress Lead to MS Flare-Ups? (2023)

Stress has been linked to a long list of chronic health conditions, includingmultiple sclerosis (MS). Though evidence is mixed, some research suggests stress could increase the risk of MS and triggerrelapses(also called flare-ups ad exacerbations).

While it's known that living with MS can contribute to stress, the specificeffects of stress on MSremain unclear. This article will explore the various connections between stress and MS, and why study results may not align. In addition, you'll learn about strategies to help manage stress when living with MS.

Stress and MS

Results from studies examining whether stress may make a person vulnerable to developing MS are mixed. Different study designs and how stress is defined in each study may help explain the inconsistent findings. Coping strategies, stress perception, and lifestyle habits (e.g., smoking or having a support system in place) might also play a role.

Personality type and how the person responds to stress may be more influential than the stress itself, with those who perceive stress positively having better health outcomes than those who view stress negatively (even if they have less stress).

The relationship between stress and MS can be considered with respect to whether stress contributes to the development of MS, to MS flares, and whether MS causes stress.

Does Stress Cause MS?

MS is a chronic autoimmune disorder that affects the nervous system. While stress is known to interfere with the immune system, it isn't clear what severity or duration of stress ultimately leads to lasting effects, and it likely varies depending on many contributing factors. And there is no explanation for why immune dysfunction would specifically target the nervous system.

The following are two studies suggesting that stress could be a risk factor for MS onset:

• In one study, investigators questioned nearly 3,000 people with MS to see whether stressful life events influenced MS development. Results revealed that major life events (e.g., divorce, conflicts, sickness, and accidents) increased MS risk by 15% to 30%.
• In another study, individuals exposed to any stressful life event during childhood were found to have an 11% increased risk of MS compared to individuals not exposed to childhood stress. On closer look, the death of a parent or sibling during childhood was not associated with MS risk, but parental divorce was.
  

The following are two studies that did not find stress to be a risk factor for MS onset:

• In one study, investigators examined over 500 people with MS to determine whether a person's number of total stressful life events was associated with MS risk. Overall, no significant association was found. That said, there was some evidence that certain individual stressful life events, like divorce and homelessness, could be MS risk factors. Marriage, on the other hand, was found to protect against MS.
  
• In another study of nearly 150 patients withprimary progressive MS (PPMS), stressful life events, including the death of a loved one, jail terms, homelessness, unemployment, divorce, and retirement were not associated with an increased risk of MS. Interestingly, marriage, having a close family member with a serious disease, and being in debt were found to decrease a person's risk of developing PPMS.

Does Stress Increase the Risk of Relapses?

MS relapses are episodes of symptoms that may persist for days or weeks before they improve or go away. Relapses are confirmed by detecting one or moreenhancing lesions(areas of inflammation) on a brain or spinal cord magnetic resonance imaging (MRI) scan.

There is research suggesting that long-term stressors (those lasting more than 48 hours) increase your risk for relapses while acute stressors do not. Other research suggests that a higher number of stressors, as opposed to stress severity, increases relapse risk.

One study even found that while major negative stressful events (e.g., assault or partner affair) increased a person's risk for lesions, positive stressful events decreased their risk.

Can MS Cause Stress?

Evidence suggests stress is more common among people with MS than in the general population.

In addition to the typical day-to-day stress common to everyone, stressors for people with MS include:

• Being newly diagnosed
• The unpredictability of the condition
• Living with and managing symptoms
• Side effects of treatment
• Navigating mobility limitations and disability
• Effects on the ability to perform tasks, including work, parenting, and daily activities like housework
• Effects on personal relationships
• Concerns about health care benefits and coverage
  

Managing Stress

Stress management can be beneficial for people with MS. Some studies even suggest that stress management may be able to slow down the development of new MS lesions and help a person have fewer flare-ups.

There are several different ways to manage stress.

Don't Be Too Hard On Yourself

• Recognize what is within your control and what isn't.
• Keep a journal to better understand what triggers your stress.
• Set realistic goals.
• Plan ahead for expected or unexpected situations.
• Prioritize activities and tasks.
• Simplify where you can.
• Relax standards you place on yourself, such as keeping the house spotless or the lawn perfectly cut.
• Learn to say no.
  

Exercise

• Engage in physical activity that you enjoy, which can help release stress, increase endorphins, gain energy, help with physical health, and improve sleep.
• Activities such as yoga and tai chi can help get you moving.

For people with MS, yoga has been found to have many benefits, such as easing pain, fatigue, anxiety, and depression, and improving balance, mobility, and leg/arm strength. It is also effective for reducing stress.

Practice Relaxation and Mindfulness

Try mindfulness techniques such as:

• Mindful meditation
• Mindfulness exercises such as progressive muscle relaxation
• Guided imagery
• Breathing exercises
• Yoga
  

Sleep and Rest

• Get at least seven or eight hours of sleep per night.
• Evaluate the quality of your sleep and address any sleep issues, such as insomnia or sleep apnea.
• Put rest periods into your schedule.
• Set an alarm to remind you to stop what you are doing and rest.

Talk to Others

• Communicate with friends, family, and other important people in your life.
• Join a support group.
• Seek professional help from a counselor, therapist, or another mental health professional.
• Ask for help and be specific with requests.

Use Daily Coping Strategies

• Get necessary but unpleasant tasks out of the way by doing them earlier in the day.
• Use the "three-fourths rule" (fill up and restock things like medication, gas, and groceries when they are three-fourths gone), so you don't run out of items or scramble to get them last minute.

Practical Tips

• Keep a supply of needed items on hand.
• Make notes.
• Use gadgets or devices that you find helpful.
• Leave earlier when going places if you tend to feel rushed.
• Keep prepared foods in the house for days you aren't up to cooking.
  

MS Symptom Triggers

It isn't always possible to avoid MS triggers. Studies suggest that MS flare-ups may be influenced by factors such as:

• Age
• Sex
• Pregnancy
• Vitamin D serum levels
• Interactions between genetic and environmental factors
• Infectious diseases/serious infections

While they aren't relapses, MS symptoms can fluctuate day-to-day and be temporarily influenced by factors such as:

• Temperature (like a hot, stuffy room)
• Short-term stress (prolonged stress may trigger a full flare-up)
• Minor infections (such as a urinary tract infection, cold, or stomach virus)

Summary

MS can cause stress due to the nature of the condition, its symptoms, and its impact on daily life. Evidence is mixed on whether stress can cause or worsen MS. There is more evidence to support prolonged stress triggering flare-ups in people who already have MS than there is for MS triggering the onset of MS.

Stress management techniques, such as daily coping skills, planning ahead, healthy lifestyle habits, mindfulness, and seeking support, may help prevent MS flare-ups.

A Word From Verywell

Having MS is stressful, and, unfortunately, prolonged stress may exacerbate MS. It may feel like a vicious cycle, but there are ways to break it. If you have MS and are struggling with stress, talk to a healthcare provider or mental health professional. They can offer resources to help.