The latest view on trauma and stress.

Since MS was first identified and named by the pioneering 19th century neurologist Jean Charcot, people have suspected a connection between injury or stress and the onset of attacks of MS. But like so many other aspects of MS, this is complicated. Virtually everyone on earth experiences stress or traumatic injury sometime in life. What would it take to prove a cause-and-effect relationship between stress or injury and this unpredictable disease?

In the 20th century, scientific evidence has been classified. The most weight goes to Class I evidence--data from a randomized, controlled clinical trial, where bias can be minimized. Anecdotal evidence--a credible report about something that happened--is Class III. An anecdote might provide important research clues, but it must be backed up to support a scientific conclusion.

Class II evidence, which requires a study to have a carefully defined control group for comparison, is the most feasible source of back-up data when the questions involve injury or stress in human beings.

The Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology undertook a review of the medical literature on injury, stress, and MS--and sifted the data against these standards. The results were published in the June 1999 issue of Neurology.

The AAN reviewers concluded that there is no association between recent physical injury and the onset or exacerbation of MS.

The relationship between MS and stress is not quite as clear. The reviewers said "the relationship ... is considered possible, on the basis of several Class II studies." However, they concluded that these studies "have important limitations," meaning that the evidence isn't strong enough to answer the question either way.

This much is clear: controlling stress in everyday life is a good wellness strategy for everyone. The National MS Society will try to help. Call your chapter at 1-800-FIGHT MS, option #1, for information on programs--and ask for a copy of our booklet "Taming Stress in Multiple Sclerosis" by Dr. Fred Foley and Jane Sarnoff.