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| MS in focus Issue
15
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2010
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Allen Bowling, Medical Director, Multiple Sclerosis Service and Director, Complementary and Alternative Medicine Service, Colorado Neurological Institute; Clinical Associate Professor of Neurology, University of Colorado-Denver and Health Sciences Center, US |
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Many different terms are used in the area of complementary and alternative medicine (CAM). A broad term is unconventional medicine, which refers to therapies that are not typically taught in medical school or generally available in hospitals.
The terms complementary and alternative indicate the way in which these unconventional therapies are used – complementary therapies are used in conjunction with conventional medicine, while alternative therapies are used instead of conventional medicine.
Since CAM is defined in relation to conventional medicine, the definition is relative and highly dependent on when and where one lives. This concept is made clear in a definition of CAM used by the US National Institutes of Health: “… healing resources…other than those intrinsic to the politically dominant health system of a particular society…in a given historical period”. | 
(Lou-Foto/Alamy)
Medical traditions and cultural attitudes may
shape the way in which diseases are diagnosed
and treated. |
This definition highlights the international relevance of this subject and raises important issues about how medical traditions and cultural attitudes may, sometimes in a manner that may not be readily apparent to health professionals or people with MS, shape the way in which diseases are diagnosed and treated within conventional medicine.
CAM use in MS
Studies in many different countries have documented that CAM use is common in MS. In the United States, about one half to three quarters of people with MS use some form of CAM. One quarter to three quarters of people with MS have been reported to use CAM in studies conducted in Europe, Canada, and Australia. A consistent finding in these studies is that most people with MS use unconventional medicine in combination with conventional medicine. In other words, most people with MS appear to be using unconventional medicine in a complementary manner.
Sources of information on CAM
There is significant concern about the quality of some CAM information. Specifically, people who provide CAM information may have biases, financial incentives, or limitations in their knowledge base that lead them to provide inaccurate, and sometimes dangerous, information. For example, people who are only knowledgeable about a few CAM therapies may, without evidence, make those therapies relevant to an excessively wide range of diseases, including MS. Also, people with financial interests in specific CAM products or services may provide information that is excessively supportive of those therapies. Finally, people with little or no specific knowledge of MS and MS medications may apply CAM therapies to this complex disease in a way that is incorrect or overly simplistic. The article on page 20 provides practical guidelines for evaluating CAM therapies.
Potentially beneficial therapies
In MS, there are two major types of therapeutic effects that may be produced by conventional as well as unconventional therapies. One type of effect, known as “disease-modifying”, acts to slow down the disease course, while the other type, known as “symptomatic”, decreases the severity of MS symptoms, such as fatigue or muscle stiffness.
Several CAM therapies that may provide symptomatic effects in MS are reviewed in this publication. Yoga may relieve MS fatigue, while various mind/body approaches may be beneficial for several symptoms, including anxiety, depression and pain. Acupuncture and traditional Chinese medicine may also provide symptomatic effects, as may music therapy.
There are some CAM therapies that may have both symptomatic and disease-modifying effects. Vitamin D, which is an effective treatment for an MS-associated condition, osteoporosis, may also slow down the disease course of MS. Cannabis may have a disease-modifying effect and may alleviate multiple MS symptoms, including muscle stiffness and pain. Low dose naltrexone has been suggested as potentially useful in MS.
All these therapies are discussed in this issue of MS in focus.
Ineffective or potentially harmful therapies
There are some dietary supplements that raise safety concerns for people with MS. Several supplements are sometimes recommended for MS despite the fact that they have no known benefit in MS and may actually produce serious side effects. Supplements in this category include skullcap, germanium, chaparral and comfrey, all of which may produce serious kidney or liver toxicity. Serious liver toxicity is also associated with kava kava, a herb that may alleviate anxiety.
Specific MS concerns are raised by dietary supplements that stimulate the immune system. MS is characterised by excessive immune system activity, and MS disease-modifying medications typically produce their therapeutic effects by inhibiting the immune system. Thus, dietary supplements that stimulate the immune system could worsen MS or interfere with the therapeutic effects of MS medications. Echinacea is one of the most widely known “immune-stimulating” supplements. Another is an Ayurvedic herb, ashwagandha, which, for unclear reasons and with no supporting evidence, is sometimes recommended for MS. Other common immunestimulating supplements include alfalfa, astragalus, cat’s claw, garlic and Asian and Siberian ginseng.
There are some CAM therapies that have undergone clinical testing in MS and have been found to be ineffective. Nevertheless, these therapies are still sometimes claimed to be helpful for MS and marketed to people with MS. CAM therapies that have been found to be ineffective in MS are hyperbaric oxygen (HBO) and bee venom therapy.
 (Italian MS Society)
If you decide to try a CAM, discuss it with your neurologist or MS nurse.
A new medicine?
Exploring conventional and unconventional therapies highlights how diagnosing and treating disease is often shaped by the medical and cultural attitudes of a particular country. This shaping process may lead to medical practices that are accepted within a country because they are suited to the prevailing attitudes and traditions. However, those practices may not be ideally suited for all individuals living within that country.
These practices may be restricted in scope, thus limiting the range of therapies that are offered and potentially impacting the quality of care that is provided. It is possible that treatment for many people with chronic diseases, including MS, could be improved by taking a more holistic or “global” approach that broadens the range of therapies beyond those that, within a particular country, are traditionally viewed as conventional and appropriate.
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