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Research Updates from CMSC 2019: Empowering People to Solve Everyday Challenges

June 7, 2019

More than 2,100 MS healthcare providers, researchers, people living with MS, industry personnel and others gathered at the 33nd Annual Meeting of the Consortium of MS Centers (CMSC) in Seattle in May 2019 to share findings and learn the latest about diagnosing and treating MS, and to hear MS research updates. The meeting also focused on solutions that help people with MS to live their best lives.
Many studies showed continued benefits of available therapies and longer-term safety information, as well as advances in basic laboratory studies. Below are highlights that focus on presentations related to understanding and managing symptoms to improve quality of life. Studies presented are considered preliminary until they are published in peer-reviewed journals. Where available, links are provided to the presentations, or to the abstracts.  
Novel paths to reduce MS pain: “Pain is connected to the body,” said Dr. Brett Stacey (University of Washington). “But pain is an experience of the brain.” Effectively treating pain, he said, is tied to improving mood, coping, sleep and function while reducing stress. (View the slides) Options for reducing pain that were discussed:
  • Multiple studies show that behavioral interventions – such as cognitive behavior therapy or meditation – can reduce pain severity or improve mood and function, said University of Washington’s Dr. Dawn Ehde. But too few people with MS and pain are accessing these options. She suggests that providers reinforce strategies that their patients already use, and take advantage of telehealth (remotely accessible) options and community-based behavioral health programs that may help to reduce pain. (View the slides)
  • Opioids can be used to reduce nerve pain in MS, but other pain medications and non-pharmacological interventions should be tried first, said nurse practitioner Pamela Davies (University of Washington). She advised that providers use the guidelines provided by the Centers for Disease Control for prescribing opioids, which include re-evaluating use every three months. (View the slides)
Diet and damage to myelin:  Dr. Lucinda Black (Curtin University, Perth, Australia) looked at dietary factors in people enrolled in the Ausimmune study, which examined risk factors in people who experienced one demyelinating event (symptoms indicating damage to nerve fiber-insulating myelin) and were thus at high risk for developing MS. The results suggest that, among 282 people at risk for MS and 558 controls, the highest intake level of unprocessed red meat, as part of a Mediterranean diet, was associated with a reduced risk of the demyelinating event. This finding adds to increasing knowledge of how diet may impact MS. (Abstract #EP102)  
Meditation improves processing speed: Doctoral student Heena Manglani (Ohio State University) and colleagues compared the effects of meditation, computerized “brain games,” and a wait list (i.e., no intervention) on information processing speed and working memory in 61 people with MS. The meditation group showed a significant improvement in processing speed not seen in the other two groups during the four-week program. For reasons that are unclear, working memory improved in all three groups. View the slides or view the abstract
Respiratory therapy for advanced MS: Complications from breathing problems, such as pneumonia, are a frequent reason for critical illness in people with MS, particularly as the disease progresses. Dr. Min Huang (University of Michigan-Flint) and her team examined the effects of a 10-week respiratory muscle exercise program on muscle strength in 36 people with advanced MS. The training program led to significant improvements in muscle strength and the effect lasted up to eight weeks after training ended. (Abstract #REH04)
Transition to adult MS: Maria C. Bryant (Brigham & Women’s Hospital, Boston) and colleagues surveyed people aged 22 to 35 who had developed MS as children for information on current disease management. More than half of the 83 respondents wrestled with treatment issues (which medicine to take and/or remembering to take medications), employment issues and family planning.(Abstract QOL23) Clinical nurse specialist Jennifer Boyd (Hospital for Sick Children, Toronto) shared tips for parents in easing the transition from pediatric to adult MS, including: encouraging your teen to communicate directly with healthcare providers, and to write down questions before appointments. View the slides
GI disorders and MS: Dr. Ruth Ann Marrie (University of Manitoba, Winnipeg) and colleagues surveyed participants in the NARCOMS registry about their gastrointestinal disorders. These are disorders that impact digestive function, including irritable bowel syndrome (IBS). Of 6,312 respondents, 41% reported having these disorders, including 28% with IBS. Depression and anxiety were associated with the increased risk of having IBS. The authors suggest that addressing psychosocial issues may help to reduce the prevalence of GI disorders in MS. (Abstract #QOL13)
Hoarding disorder: Esti Chapman (Yeshiva University) and colleagues queried nearly 140 people with MS about hoarding/cluttering disorder (persistent difficulty discarding or parting with possessions), and found that 11.5% met the criteria for this disorder. This is more than twice the prevalence of 5% in the general population. The presence of hoarding/cluttering disorder was associated with an increased difficulty in performing daily activities. Psychotherapy can help people who hoard live safer, more enjoyable lives, so identifying this disorder is important. (Abstract #PSF01)
Employment issues: “Patients and family often experience fear, uncertainty and numerous concerns about the impact of MS on employment,” said rehab counselor Joe Stuckey (University of Washington). He suggested practical guidelines for dealing with workplace concerns: put all accommodation requests in writing, and be specific – do not describe all symptoms. He also suggested that healthcare providers ask questions related to employment, such as, have you received negative feedback on your job performance? ­­ Are you behind in your work or putting in extra hours to keep up? He also advised that volunteering can provide a social connection and a sense of purpose, and it can serve as a transition into or out of the workforce. View the slides
Addressing sleep disorders: Doctoral student Stacy Coffin (University of Kansas) and colleagues asked whether a cognitive behavior intervention (involving sleep education, meditation, and cognitive therapy for negative sleep beliefs) compared to a brief sleep education program, would reduce insomnia and fatigue in 20 people with MS. Both groups had significant reductions of insomnia and fatigue, but the magnitude of the reduction with cognitive therapy was larger. This study was funded by a pilot award to Dr. Catherine Siengsukon, who is now funded by the National Institutes of Health to determine whether a web-based cognitive behavior intervention can affect insomnia in people with MS. View the slides
Mood and MS:  In a session on depression and other mood disorders, Dr. Scott Patten (from the University of Calgary) noted that depression is two or more times more prevalent in people with MS than in the general population. It’s crucial to distinguish it from other MS symptoms, though. Dr. Anthony Feinstein (University of Toronto) discussed treatment options. There are several antidepressants that have shown promise for treating MS-related depression.  Which of these you might be prescribed can depend on your other symptoms. Cognitive behavioral therapy works, he said, whether it’s given individually, in groups, or even via telephone. Read more in a blog
Browse the meeting’s presentations and abstracts

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