Three articles on PainSci cite Bjornevik 2022: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. 38 Surprising Causes of Pain 3. A Rational Guide to Fibromyalgia
PainSci commentary on Bjornevik 2022: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This study strongly links the endemic Epstein-Barr to multiple sclerosis. Unlike countless other “links” in medical science, there is so much correlation smoke here that there is almost certainly a causality fire. EBV probably causes multiple sclerosis — an extremely important discovery. For instance:
Would a vaccine against EBV protect against MS? Can the B cells that dwell in the CSF be killed or inactivated with therapeutics? Would antivirals that target EBV provide effective therapy, especially when given early in the course of disease? Now that the initial trigger for MS has been identified, perhaps MS could be eradicated.
This experiment was a triumph of modern data wrangling. Thanks to military records, researchers studied literally millions of subjects over twenty years, identifying a risk of developing multiple sclerosis thirty-two times greater after EBV infection.
And yet, even with that kind of statistical power, they still couldn’t “prove” causality. The link could be explained by some common denominator, by “systematic differences between individuals,” and the authors were well aware of it; the whole enterprise was devoted to the causality question. As impressive as their number crunching was, the real artistry here was their careful ruling out of all possible ways for the signal to be due to something else. The result is technically still not proof of causality… but it’s as close as you can possibly get.
Many of medicine’s greatest mysteries are probably going to be explained by fallout from the forever war between animals and microorganisms. The long-term consequences of infections, basically. There are many good examples, but this is probably the best one so far.
The Science editorial about this paper is worthwhile, and here’s a more accessible explanation from Scientific American. Or you can listen to a detailed discussion about it between virologists, which is easier to follow in some ways, and harder in others.
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system of unknown etiology. We tested the hypothesis that MS is caused by Epstein-Barr virus (EBV) in a cohort comprising more than 10 million young adults on active duty in the US military, 955 of whom were diagnosed with MS during their period of service. Risk of MS increased 32-fold after infection with EBV but was not increased after infection with other viruses, including the similarly transmitted cytomegalovirus. Serum levels of neurofilament light chain, a biomarker of neuroaxonal degeneration, increased only after EBV seroconversion. These findings cannot be explained by any known risk factor for MS and suggest EBV as the leading cause of MS.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.