Coping strategies for managing multiple sclerosis symptoms and stress

Multiple Sclerosis

(Coping Strategies)

Multiple sclerosis is caused by the self triggered allergic reaction that scrubs away the myelin sheath that protects the nerve cells, creating plagues and fissures that cause problems with the normal functioning of the central nervous system. As with any chronic illness, being diagnosed with Multiple Sclerosis has a devastating effect on the lives of people. This degenerative nervous disorder alters the self-perception and self-identity of the individual and seriously compromises his/her relationship with the external world. Disease management is further complicated by the wide array of symptoms and their varying intensity. Symptoms may range from postural imbalance, tremor, weakness, incontinence, visual impairment to progressive decline in cognitive ability and serious disability. The diagnosis creates a stressful experience and coping with the disease particularly during the initial stages can be really frustrating. Let us discuss some important coping strategies for this debilitating disease.

Coping with Cognitive Decline (Psychotherapy)

Decline in cognitive ability is an observed symptom in around 40% to 70% of patients who have multiple sclerosis. Though cognitive decline is a serious problem available data indicate that only 10% of the people manifest acute cognitive degeneration and hence in majority of the people near normal functioning can be maintained. It is important for the patient and the families to realize the possibility of cognitive decline and prepare themselves to handle the situation. Patients may exhibit poor memory and indifferent attitude and the family members have to anticipate, understand and be supportive under the strange circumstances where the interactions and relationship with the person may be not be normal. Since in Multiple Sclerosis flaring up of cognitive symptoms is mainly temporary it would also be helpful from the patient perspective to understand, anticipate it and avoid being overly alarmed. Cognitive behavioral therapy is very effective in arresting cognitive decline and enabling maximum functionality. Cognitive therapy exercises such as visualization, concentration and retention are excellent for improving cognitive function and must be done in conjunction with pharmacological treatment. Cognitive therapy is particularly effective in treating fatigue and memory loss due to MS. [Stark, Sharon]

Coping with Disability

In most of the cases of multiple sclerosis restricted mobility is an attendant condition. This is because the fissures and plagues in the neurons cause motor impairment and spasticity which severely affect mobility. Some patients are not able to perform the activities of daily living (ADL) by themselves and are dependant on the care and support of their family members. Feelings of despondency and depression are common and it is important to be sensitive to the patient's mindset during this period. The acute psychological distress further dampens the motivation of the individual to actively participate at the social level and hence the patients manifest withdrawal symptoms. Some patients may have difficulty in adapting to the changes and may even refrain from using mobility gadgets (walking stick, wheelchair) which worsens the problem. [Chan A]

We see that mobility difficulty when combined with depression and cognitive impairment can seriously undermine the overall functioning of the individual. As Kay Toombs, a multiple sclerosis researcher and a patient says, "To live with multiple sclerosis is to experience a global sense of disorder -- a disorder which incorporates a changed relation with one's body, a transformation in the surrounding world, a threat to the self, and a change in one's relation to others" [Toombs, 1995, p. 12]. Learning to adapt and adjust to the new situation is a big problem for most of the patients and hence caregivers must provide psychological counseling sessions to help the patients adapt to change.

While drugs may help in alleviating symptoms their long-term effects are doubtful and not without serious side effects. In particular the use of corticosteroids in multiple sclerosis to contain the inflammatory response of the immune system has the effect of compromising the immune system leaving the person open for opportunistic infections. In a latest research release from the Mayo clinic Dr. Sean Pittock, M.D. says, "Our study demonstrates that the longer the duration of MS and the lower the disability, the more likely a patient is to remain stable and not progress to a greater level of disability," "This isn't a small issue; it's a big issue." [Mayo Clinic]. So physicians can consider delaying or even avoiding imunomodulatory drug treatment for patients with benign form of multiple sclerosis.

Conclusion

There has been a tremendous change in the treatment methods that are available for multiple sclerosis over the last few years. Favorable outcome for patients depends a lot on early diagnosis followed by appropriate medical intervention. Behavioral and psychological coping strategies are also important for delaying the onset of disability and containing the ill effects of the disease. Effective management of the disease would involve a combination of pharmacological, psychological, as well as experimental therapy based on clinical trials. Management of a chronic illness like multiple sclerosis can be a very challenging task however proper understanding, acceptance and a positive attitude would definitely go a long way in effective handling of the disease condition.