Total costs of MS varied widely across countries for which studies have been conducted but are substantial in all countries. The total (prevalence weighted) average annual cost per person with MS in 2007 (based on existing studies from 15 countries) was $41,334. Over a lifetime it is estimated that the average financial cost of MS in high income countries is more than $US 1.2 million per person. Loss of employment, or early retirement, is considered the single largest cost factor contributing to this financial cost.
Costs of MS
Types of costs were divided into three broad categories: direct, indirect and intangible costs, with the view to understand more fully the kinds of costs that MS demands of the individual and society.

Direct costs
Direct costs are those incurred by the individual or society as a direct result of the disease. In the report these costs were divided into medical and non-medical subcategories and cover everything from visits to neurologists to the costs of installing wheelchair ramps at home, and the value of care-giving provided by family, friends or professional carers. The responsibility of caring for the person with MS often falls on those closest to him/her and this can affect the carers’ ability to work. Often carers are forced to work shorter hours in order to care for their loved one, or increase working hours to compensate for their loss of income. For carers it is essential that employers are understanding, supportive, and flexible where possible to enable carers to continue working in order to support those who cannot work themselves. Direct costs accounted for 26% to 87% of the total costs of MS

Indirect costs
Indirect costs, which accounted for 13% to 74% of total MS costs, are those costs which are related to MS but cannot be attributed directly to the disease itself. Loss of work is often the most costly contributor to the overall cost of MS since the average age of onset of MS is 29.2 and can dramatically affect or curtail the working life of the individual. The symptoms of MS, which can include physical disability, fatigue, cognitive impairments, transportation difficulties and speech impairments, can make finding and retaining employment difficult especially where employers do not support the changing needs of the employee.

The costs incurred can include short-term and long-term absence from work during periods of relapse, reduced working hours, changing the type of work to a less physically challenging and stressful nature (often at a lower pay), and early retirement.

Intangible costs
Intangible costs are those costs that are often most difficult to measure and can include changes to the quality of life of both the individual and his/her friends and family. In the 13 studies that were analysed with relation to quality of life, several patterns emerged. Firstly, the impacts on physical functioning are larger than those on social functioning or mental functioning, and secondly that physical quality of life deteriorates as the disease progresses over time. Significant impacts on social and mental functional were also found over time. These studies show that a diagnosis of MS does not necessarily affect the ability of the individual to engage socially or mentally, but that physical engagement may be the biggest barrier to activity that the individual faces – especially in the early stages of the disease. With this in mind, it is important that employers offer a variety of solutions to make work more accessible to those with physical disabilities.

You can read the full article here

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Introduction

Multiple sclerosis presents in various ways and subsequently shows variable disease courses. If we knew early on what the disease course for Multiple Sclerosis would be then we could better target the medication in each individual case. To date it has been unpredictable right from disease onset but, knowing the disease course is of crucial importance in guiding treatment.

Now “The Department of Neurosciences” at Cardiff University has recently been looking into factor H as a biomarker for multiple sclerosis and the findings are promising.

Effective and accessible biomarkers are needed in order to stratify (separate into groups) patients and inform treatment. The team at Cardiff University decided to look into factor H as such a marker. Regulator factor H, has recently been implicated as a biomarker in other chronic inflammatory central nervous system conditions. Could it identify or predict specific pathological processes and outcomes in multiple sclerosis?

Method

They measured factor H in blood serum from 350 patients with multiple sclerosis classified according to disease course and relapse status. Controls were found for variables including disease duration, age, gender, disability and treatment. I have decided not to go into the full method in this document as the details will be somewhat turgid to the average reader. However, the findings are fairly clear and very encouraging.

Results

1) Factor H levels were significantly higher in progressive disease compared to controls and relapsing patients. Thus factor H levels were capable of distinguishing secondary progressive from relapsing remitting disease (excluding patients in clinical relapse)

2) Acute relapse was also associated with temporarily increased factor H levels compared to stable relapsing disease.

3) In clinically stable patients, factor H levels remained constant over 1 year but in patients in transition from relapsing to progressive disease, factor H levels significantly increased over a period of 2 years. This is a crucial point as the transition between relapsing and progressive signals the need for therapy change.

Conclusion

Serum factor H could be an effective indicator of progression and a practical and accessible tool to split patients into groups and to predict disease course, Once we have this information we have objective evidence which can help guide therapeutic decisions. As we have known for some time, the earlier you can pick up a disease pattern the better chance of success you have with the treatment.

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Introduction

Vascular co-morbidity means that as well as MS you have  hypertension, hypercholesterolemia, diabetes, or heart disease too. It has recently been found that whether present at symptom onset, diagnosis, or later in the disease course, it  is associated with a substantially increased risk of disability progression.

Who found this ?

Published in Neurology. 2010 Mar 30;74(13):1041-7. was a study by

Marrie RA, Rudick R, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T.

Health Sciences Center, Winnipeg, Canada.

Background

On October 29 in Neurology, researchers outlined how co-morbidities may contribute to diagnostic delay in multiple sclerosis (MS) and increased disability at diagnosis. But Vascular co-morbidity adversely influences health outcomes in several chronic conditions so it became a question that needed to be answered about MS.( Vascular co-morbidities are common in multiple sclerosis (MS), but their impact on disease severity was unknown).

It could be that these “vascular co-morbidities” may contribute to the poorly understood variability in MS disease severity. So,  A total of 8,983 patients with MS enrolled in the North American Research Committee on Multiple Sclerosis Registry participated in this cohort study.

Method

Time from symptom onset or diagnosis until ambulatory disability was compared in these 8933 patients with or without vascular co-morbidities to determine their impact on MS

Models were adjusted in the analysis for sex, race, age at symptom onset, year of symptom onset, socioeconomic status, and region of residence.

Results

Participants reporting one or more vascular co-morbidities at diagnosis had an increased risk of ambulatory disability, and risk increased with the number of vascular conditions The median time between diagnosis and need for ambulatory assistance was 18.8 years in patients without and 12.8 years in patients with vascular co-morbidities.

CONCLUSIONS

Vascular co-morbidity, whether present at symptom onset, diagnosis, or later in the disease course, is associated with a substantially increased risk of disability progression in multiple sclerosis. The impact of treating vascular co-morbidities on disease progression deserves investigation as treatment of vascular co-morbidities may represent an avenue for treating MS

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Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system. It  is believed to be primarily an autoimmune disorder with an initial trigger suspected among environmental factors (including viral infection and bacterial) impacting a genetic predisposition. The initial trigger facilitates the movement of T-cells and demyelinating antibodies from the blood into the brain through disruption of the blood–brain barrier.

Interestingly, from the time of the first histologic description by Charcot in 1868, MS plaques ( seen now on and MRI scan) were known to be venocentric. Additionally, and in common with several neurodegenerative disorders, the brain and spinal cord of MS-affected patients contain abnormally high levels of some metals, particularly iron. The advanced MRI and histologic studies show the peculiar deposition of the iron stores in MS constantly encircling the venous wall. These iron deposits, curiously, resemble iron stores commonly seen in peripheral venous disease.

It has been recently shown that MS is significantly associated with a condition defined as chronic cerebrospinal venous insufficiency (CCSVI) (Zamboni et al, 2009a, 2009b, 2009c). In CCSVI, put simply, there is a narrowing of the vessels draining blood away from the brain.Blocked venous blood outflow causes a high rate of cerebral venous reflux in MS patients.

This detected reflux, propagated from the chest and neck veins, may have an important function in explaining the mechanism of iron overload in MS. By contrast, venous reflux has not been found in patients affected by other neurodegenerative diseases with increased iron stores, such as Alzheimer’s and Parkinson’s diseases.

More specifically, the rate of venous reflux flow detected in the main cervical veins of MS patients was 70% as opposed to 0%  in the three control populations. It has been shown that extracranial reflux was also transmitted up to the deep cerebral venous system in 50% of MS cases, but was detected neither in healthy controls nor in patients with other neurologic diseases

Despite the strong association found between CCSVI and MS, it has not yet been clarified whether such venous obstructions can be considered a cause or an effect of MS.

How does this differ from other diseases?

Starting from histology, there is an impressive parallel between the inflammatory process activated in the course of chronic venous disorders (CVDs), and that studied in MS. However, two important things have happened in the past 2 years:

(1) a demonstration of altered venous flow in the cerebral venous system in the course of MS and (2) the development of advanced MRI techniques that have brought about an extraordinary improvement in the capacity to assess iron stores and cerebral veins.

There is thus a hypothesis that iron overload in MS is secondary to disturbed venous flow in the cerebral veins.

So when  does iron accumulate in the brain ?

With advancing age, iron accumulates in the brain and has been associated with senile dementia, many cognitive dysfunctions, and neurodegenerative disorders. The reason may include

• dysregulation of the proteins involved in iron influx and sensing of intracellular iron;
• iron accumulation in ventral motor neurons
• increased mitochondrial iron load .

This finding may pave the way to a better understanding of iron accumulation in the aged brain.

Iron Overload in Multiple Sclerosis

Although investigations into the role of iron in MS are still few, many high-resolution MR techniques have shown stored iron regions inside the brain and spinal cord.

If we look at experimental autoimmune encephalomyelitis (EAE), an animal model of MS, dietary modifications have revealed an incidence of EAE in 70% of mice with a normal iron level or iron overload, but 0% in iron-deficient mice. This is clear evidence that iron deficiency protects against the progress of MS in mice with induced EAE, with obvious clinical implications (Grant et al, 2003).

Authors have speculated that the failure of iron-deficient mice to develop EAE is impressive, but controversial as iron deficiency may lead to much more serious health hazards. However, they conclude that any of the pharmaceutical approaches to inhibiting EAE are less effective than iron deficiency.

At present, despite the intriguing mechanisms of iron deposition in CCSVI  we cannot definitely prove this hypothesis.

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Introduction

As we know Multiple sclerosis is a common neurological disease that affects 1 in 1,000 people, most commonly young women, although men too to a lesser extent. The typical disease progress includes attacks and remissions with slowly progressing disability. Current therapies can prevent the appearance of new events, but they have much less effect on disease progression and serve mainly to moderate the initial relapsing-remitting phase.

May 15th 2009 saw a new review published from Oxford University by Lars Fugger, Manuel A. Friese and John I. Bell. In it they describe the current and new approaches that can be applied to define the functional role of the known genes involved in multiple sclerosis but also point out that environmental factors have a bearing on the function of the genes.

Environmental factors

Unfortunately, these environmental factors have proved to be even more elusive than the genes. Why do different areas of the world have a different prevalence and incidence of MS ? Could this be climate? Diet ? Genetics ? Lifestyle ? Infections ? What could these infections be ? Numerous viral and bacterial infections are potential candidates such as those found in the respiratory airways and gastrointestinal or urinary tracts as they are often associated with relapses, but no single infection has been consistently associated with disease.

We do not know how so many different infections could have a role in MS and how they might interact with genetic risk factors but, it is also important to try to understand how non-infectious risk factors, such as sunlight, may interact with genetic risk factors.

Asking the questions

The biggest challenge will be to use genetic information to ask questions about the environmental factors that interact with gene pathways and contribute to disease development. The identification of the exact disease susceptibility gene does not necessarily define the pathway involved in disease development.

The insights gained from functional studies may help the study of environmental risk factors by using methodology that goes well beyond the conventional approaches of population epidemiology. The improving capacity for modelling and simulation using genetic data may lead to the identification of the additional environmental factors that interact with genetic factors to cause disease.

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In some studies, pet owners reported reduced fear, improved self-esteem and significantly fewer minor health problems and emotional concerns than people who had no pets. But it has also been shown that it is not necessary to actually own the pet in order to receive some benefits from an animal-human “relationship”. The mere presence of a friendly animal can be beneficial as well. “Visiting pets” or “therapy pets”, are just two of the names given to describe programmes in which animals help people just by visiting them. This may be an interesting possibility for people with MS who would have significant difficulties taking on the responsibility of their own pet due to problems with balance, mobility and co-ordination, fatigue and other MS symptoms.

To learn more about pet therapy visit:

http://www.deltasociety.org

http://www.petsastherapy.org

But what else can a dog do for you ?

Did you know that (in th UK at least and in may other countries) nearly all form forms of transport have facilities in place to carry assistance dogs with their owners. They have a duty under the Disability Discrimination Act (DDA) to provide services to enable assistance dog’s owners to travel.

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For some people with MS, medicines can provide complete relief from pain,but many pain sufferers do not achieve adequate pain relief by pharmacological means. Fortunately, a number of non-pharmacological approaches can be used that have been proven to be effective in other groups of people with chronic pain.

The biopsychosocial model of pain

The experience of pain is very complex, involving not only the body but also the mind. Current thinking is that chronic pain is best understood from a biopsychosocial perspective, which recognises the importance of the underlying biological basis of pain (for example, nerve damage due to MS), but  also acknowledges that psychosocial factors may have a significant impact on the experience of pain and its effects on life.

Some of these factors include one’s emotional reactions to pain and how one thinks about or deals with pain. The biopsychosocial model has led to treatments that are effective for decreasing pain severity and the negative impact of pain.

People with pain sometimes worry that others think that their pain is “not real”, exaggerated, or a sign of mental illness. On the contrary, chronic pain is a serious condition that is “in one’s head” only because pain signals are processed in the brain. Advances in brain science have confirmed that psychological factors such as one’s emotions or stress can affect physical health, including pain. Living with MS and pain can also cause chronic stress. The brain (mind) and body influence one another in ways that science is just beginning to understand.

Relaxation training

Pain and other stressors often result in a natural response of repeated and prolonged tensing of muscles, which tends to worsen pain. Research has shown that one of the best ways to counteract the tensing effects of pain and stress is to practice various forms of relaxation. There are many methods to achieve relaxation – deep breathing, baths, music, meditation or prayer for example.

Some relaxation strategies can be tried without instruction, whereas others may need to be learned under the guidance of a professional.

People vary in their ability to relax, so trying a variety of relaxation techniques may be necessary to find what works best. Relaxation exercises may also work best when paired with other coping strategies.

Deep breathing is the basis for many relaxation techniques, so it is often a good skill to learn first.

It is generally done lying down or sitting in a comfortable chair. The basic method involves taking a deep breath through the nose, trying to cause a rise in the abdomen, followed by a brief pause, and then exhaling through the mouth. To heighten the sense of relaxation, some people say calming words to themselves, such as “relax” or “peace” on each exhalation. To achieve maximum benefit, deep breathing should be practiced for at least five minutes, several times per day.

One technique that has been used for some time iscalled Binaural Beats.

Two tones at slightly different frequencies are presented separately, one to each of a subject’s ears, using stereo headphones. A beating tone will be perceived, as if the two tones mixed naturally, out of the brain.

These two frequencies, when mixed together, result in a different frequency which aligns your brain waves into a different way of thinking. This is often called brainwave entrainment.

I have used this myself to get a better night’s sleep with amazing results

12 Amazing Binaural Beats Audios

Self-hypnosis training

Research published over the past decade supports the benefits of self-hypnosis training for helping individuals better manage both acute and chronic pain. Like relaxation training, self-hypnosis is a way to use the power of the mind to manage pain by altering the experience of pain.

This may include distracting from pain, focusing on more pleasant sensations, or even experiencing pain as decreasing or going away. Contrary to how hypnosis is portrayed in the media, people using self-hypnosis always remain in control of themselves. Training in self-hypnosis should be done with a professional experienced in its use for pain. It can often be learned in only a few sessions and should be practiced regularly to maintain benefits.

Like medications, self-hypnosis training rarely, if ever, eliminates pain completely; nor does it benefit everyone who tries it. However, there appears to be a subgroup of individuals, including those with MS, who report substantial decreases in pain severity following self-hypnosis treatment and who are able to maintain this improvement over time. In addition, unlike some medications, the “side-effects” of self-hypnosis training are positive. For example, in a study that included people with MS, 40 different benefits of self-hypnosis were identified in addition to pain relief and no negative effects were reported.

Self Hypnosis Questions, Answers, and MP3s

Cognitive behavioural therapy

Numerous studies indicate that the way people think can have a big impact on how much pain they experience, how they deal with pain, and how much pain interferes with their lives and functioning. Things people do to cope with their pain can also be helpful (for example, using relaxation techniques) or unhelpful (for example, using alcohol excessively to relieve pain).

Cognitive behavioural therapy (CBT) involves teaching people how to change their pain-related thoughts and behaviours in order to reduce pain and its associated suffering. In CBT, individuals are taught to examine the thoughts they have about pain, determine whether these thoughts are helpful or unhelpful, and replace any unhelpful thoughts with helpful, reassuring ones.

CBT often also includes teaching other pain management techniques such as relaxation training, distraction techniques, or activity scheduling. It typically involves either group or individual treatment by a professional with expertise in CBT, and optimally, pain.

Other psychological interventions

Other psychological treatments may be useful in addressing pain and its impact, including support groups, pain education, and psychotherapy. Treating depression, when present, is recommended, given that depression and pain often impact one another. Physical exercise (for example, walking, swimming, or yoga) often has beneficial effects not only on a person’s physical condition but also on pain and stress.

How to find help

Unfortunately, many people with MS pain are offered these treatments only after all medical treatments have been tried and failed. Psychological interventions should be considered early, soon after the development of pain, along with other appropriate and effective treatments such as medications or rehabilitation. The sooner these treatments are used, the more likely they are tobe of benefit. For those who do not have access to specialists in the psychological treatment of pain, text and web-based resources may be available from your national MS society, or via your nurse or doctor

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A lot of the pain in MS is due to immobility or poor posture, rather than directly related to damage to the nervous system. In particular, using the same posture repeatedly with mobility aids (e.g. a frame or wheelchair) will put stress on your body, which can cause pain. A physiotherapist can provide useful guidance in this area.

Non-medical approaches to pain management include massage, hydrotherapy, acupuncture and reflexology. However, these activities should be discussed with your doctor beforehand.

Then there are relaxation techniques, meditation, prayer, breathing techniques, self hypnosis and psychological interventions such as psychotherapy.

The most important thing is to get pain treated. You should discuss where and how much pain you have with your healthcare provider. Your own description of the pain is the most important aspect of pain assessment.

Unfortunately, knowing how something feels does not mean it is easy to describe. Health professionals often talk about pain being ‘acute’ (short-term) or ‘chronic’ (long-term). But describing how it affects you will be an individual thing. When you do describe it, use whatever words seem to best sum up what you experience, however odd they may seem at first. Here are just some of the words people use to describe pain:

• squeezing or crushing

• cold

• hot or burning

• sharp

• dull

• like ants under my skin or ‘creepy crawlies’

• like a build up of pressure

• stabbing

• creeping

• like an electric shock

Being able to explain your pain also helps family, friends and carers understand this ‘invisible symptom.’

So let’s look at some of the types of secondary pain in MS

Musculoskeletal Pain

Description

Stiff joints and muscle contractures, caused by the physical stress of immobility. It can affect the neck, the back or limb joints.

Non medical treatments

Stretching exercises, posture & gait examination, orthotics, exercise

(Especially swimming), position changes, support and cushioning, application of heat and cold.

Usual medications

Ibuprofen, diclofenac  and naproxen.

Nerve Pressure Pain

Description

Pain caused by pressure on the nerves from immobility or poor posture.

This can include sciatic nerve pain from pressure on the back of the leg and ulnar nerve pain from pressure on the elbow.

Usual treatment

Correct seating is important, but elevation of the legs will usually relieve pressure pain.

Back Pain

Description

This can be caused by muscle weakness, abnormal posture, spasticity and spasm. It may also occur as a result of osteoporosis or MS lesions in the spinal cord. If the osteoporosis was steroid induced changing treatment options often eliminates the pain

Usual treatment

Evaluation to pinpoint the source of the pain is essential, as treatments differ widely. It is also important to note that back pain is not always related to MS even though we all think that all of our symptoms must stem from it.

Pain from MS symptoms and treatments

Description

It is worth remembering that certain drug treatments can have painful side effects. Some people taking beta interferon, for example, experience headaches and flu-like symptoms such as aching muscles, particularly in the first few months of taking the drug. Ibuprofen and paracetamol can both help control these side effects.

Some people taking Copaxone (glatiramer acetate) notice an uncomfortable feeling of tightness or pain around the chest.

Some MS symptoms can cause pain as well as the symptom itself, such as pressure sores, urinary retention and infections. A particular example is pain due to Optic Neuritis—an MS symptom that occurs when the optic nerve is stretched or inflamed (with pain occurring behind the eyes which is intensified with eye movement). Painful optic neuritis is probably a unique kind of pain. In addition to pain, optic neuritis can be accompanied by blurred vision, visual acuity loss, impaired colour vision and complete or partial loss of vision. This was one of my first symptoms although I have fortunately never lost total sight. The painful eye movement did however make it almost impossible to reverse the car wherein I had to look over my shoulder. I also did not seek help to have this treated but Corticosteroids (oral prednisone and intravenous methylprednisolone) can significantly increase the rate of recovery from optic neuritis.

It is also treated with painkillers like ibuprofen, diclofenac or naproxen.

People with MS can also experience pain as a result of treatment

for the condition. Two examples include injection-site reactions and steroid-induced osteoporosis.

Usual treatment

It is very important to discuss each particular problem with your healthcare provider. Fortunately, fixing the initial problem or changing treatment options often eliminates the pain.

For injections site reactions there are a number of things you can do.

If you get lumps post-injection then try a warming (not hot) pad pre-injection to loosen the sub-coetaneous fat. If the lumps persist then gently massage the area but if the lump develops a discharge contact your doctor as it is possible it has become infected.

If you experience itching or stinging then try using an ice pack for a short period of time before and after the injection. If this does not work, discuss it with your doctor as you may need an antihistamine.

For simple redness and inflammation that lasts more than 24hours you could try using a a cream or gel such as Aloe Vera, Witch Hazel or Arnica but do noit try any other opver the counter cream without discussing with your doctor.

Always let the medication warm up to room temperature before injecting and if you’re using an Autoject the setting should be adjusted based on the depth of subcutaneous tissue in the area you plan to use.

Generally these reactions diminish as you become accustomed to injecting and remember to do it at the prescribed interval without missing a dose.

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Interestingly the most common areas for this type of pain are the face, neck

and torso so let’s start at the top with TGN

Trigeminal Neuralgia

TGN is an excruciating, sharp, shock-like pain in one side of the face, lasting seconds to minutes and often repeated; may be triggered by speaking or a touch. It usually settles spontaneously by itself over several weeks. Unfortunately many of the side effects of the usual drugs mimic the symptoms experienced in MS anyway so it is difficult to tell the cause and it may lead to alarm that the disease is getting worse. To allay these fears I have outlined the usual side effects of each drug,

Usual medications

Carbamazepine (anticonvulsant): Side effects Drowsiness, Dizziness, Coordination difficulties

Phenytoin (anticonvulsant): Side effects Dizziness, Nausea, Insomnia, Uncontrollable eye movements, Coordination difficulties, Slurred speech, Confusion

Baclofen (muscle relaxant): Side effects Weakness, Drowsiness, Dizziness

Gabapentin (anticonvulsant) may also help: Side effects Dizziness, Coordination difficulties, Fatigue

Lhermite’s Sign/Symptom

This is a  brief, stabbing, shock-like sensation that runs from the back of the head down the spine, (like an electric shock) brought on by bending the neck forward. It is not always painful.

Usual medications

Carbamazepine or Phenytoin (see above)

Other treatments

A soft collar may limit neck movement. Most often Lhermite’s symptom disappears spontaneously and medical treatment is not necessary.

Tonic Spasms

These, known as spasticity are sudden and painful muscle contractions, producing stiffness of the whole limb, which can last up to two minutes.

Usual medications

Carbamazepine, phenytoin, and baclofen (see above) and

Clonazepam (anticonvulsant): side effects Sedation, Dizziness

Dysaesthetic Pain in Limbs and Trunk

Dysaesthetic means any impairment of the senses especially the sense of touch

This is a condition in which light physical contact of the skin causes pain; Such as the weight of sheets in bed.  It involves a persistent burning, tingling, tightness, or aching which may be worse at night and after exercise It may be aggravated by temperature and weather.

Patients frequently state that dysaesthetic burning corresponds with what they imagine a hell might be like. Some of the descriptions given by patients include:

- “Like Hell’s hottest knives tearing at my flesh”
- “Like my flesh is being consumed in a fire”
- “Like my flesh is being torn from my body”
- “Like my flesh has been burned off”
- “A pain worse than pain”
- “Indescribable burning”
- “Like an alien pain monster has taken over my body and has ignited my flesh”

Usual medications

Nortriptyline and amitriptyline.(anti-depressants): side effects Dry mouth, Blurred vision, Sedation, Urinary retention

Gabapentin, (see above)

Tegretol (Carbamazepine – see above) and Epilim (sodium valproate – anti epileptic) may also be useful.

Side effects of Epilim nausea, diarrhoea, increased appetite and weight gain, shaky movements, tremor, drowsiness, confusion, temporary hair loss

Other treatments

• Application of cold, pressure stockings
• Capsaicin ointment/cream. Capsaicin is the active ingredient in chilli peppers. It’s what gives chilli peppers their kick. When it is applied to the skin, capsaicin cream has been found to deplete substance P— a neurochemical that transmits pain—which desensitizes a person to pain. Capsaicin cream produces a temporary reduction in pain, so it must be used regularly to provide prolonged pain relief.

Capsaicin can cause an intense burning feeling when it is applied, particularly if it is used less than 3-4 times a day, or if it is applied just after taking a hot bath or shower. However, this side-effect tends to ease off with regular use. Capsaicin cream should not be applied to broken or inflamed skin. Wash your hands immediately after applying capsaicin cream.

In my next article I will be discussing secondary pain in MS.

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Introduction

As we know Multiple sclerosis is a common neurological disease that affects 1 in 1,000 people, most commonly young women, although men too to a lesser extent. The typical disease progress includes attacks and remissions with slowly progressing disability. Current therapies can prevent the appearance of new events, but they have much less effect on disease progression and serve mainly to moderate the initial relapsing-remitting phase.

May 15th 2009 saw a new review published from Oxford University by Lars Fugger, Manuel A. Friese and John I. Bell. In it they describe the current and new approaches that can be applied to define the functional role of the known genes involved in multiple sclerosis but also point out that environmental factors have a bearing on the function of the genes.

Environmental factors

Unfortunately, these environmental factors have proved to be even more elusive than the genes. Why do different areas of the world have a different prevalence and incidence of MS ? Could this be climate? Diet ? Genetics ? Lifestyle ? Infections ? What could these infections be ? Numerous viral and bacterial infections are potential candidates such as those found in the respiratory airways and gastrointestinal or urinary tracts as they are often associated with relapses, but no single infection has been consistently associated with disease.

We do not know how so many different infections could have a role in MS and how they might interact with genetic risk factors but, it is also important to try to understand how non-infectious risk factors, such as sunlight, may interact with genetic risk factors.

Asking the questions

The biggest challenge will be to use genetic information to ask questions about the environmental factors that interact with gene pathways and contribute to disease development. The identification of the exact disease susceptibility gene does not necessarily define the pathway involved in disease development.

The insights gained from functional studies may help the study of environmental risk factors by using methodology that goes well beyond the conventional approaches of population epidemiology. The improving capacity for modelling and simulation using genetic data may lead to the identification of the additional environmental factors that interact with genetic factors to cause disease.

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