Different types of evidence may be available to determine the safety and effectiveness of unconventional as well as conventional therapies. When considering a therapy, it is extremely important to understand these different levels of evidence and how they apply specifically to MS. Information about a therapy may be based on theoretical arguments, experimental studies, or clinical trials of people with MS. (Chapter 1 includes a detailed review of the different types of evidence that may be available for a particular therapy.)

When reviewing information about a therapy, it is important to determine the strength of the evidence that is available. Some CAM literature does not distinguish between the various levels of evidence or makes very strong recommendations on the basis of weak evidence. For example, a CAM therapy such as a dietary supplement might be highly recommended for MS because it suppresses the immune system, produces therapeutic effects in the animal model of MS, and has minimal side-effects. Although this sounds promising, there is no clinical trial evidence. As a result, it is quite likely that this therapy would not be an effective treatment for MS.

It is important to recognise that among all of the conventional and unconventional therapies that are claimed to alter the disease course in MS the best evidence that is currently available is that which has been obtained for the conventional medications that are in widespread use, including interferon beta-1a (Avonex®, Rebif®), interferon beta-1b (Betaseron®, Betaferon®), glatiramer acetate (Copaxone®), and mitoxantrone (Novantrone ®). There are no CAM therapies that have a similar level of evidence to support their use as these disease-modifying medications.

Ideally, there should be high quality clinical evidence for well-tolerated therapies that could cure MS and completely eliminate all MS symptoms. Unfortunately this is not the case. As has been described in other chapters of this book, there have been remarkable advances recently in conventional medicine in treating MS. However, there is no cure for the disease, and the disease-modifying and symptomatic conventional therapies that are available are often only partially effective or may produce side-effects. Due to this situation and in an effort “to do the best we can,” there are circumstances in which conventional medicine uses approaches that are not entirely proven. These approaches must be used thoughtfully and with recognition of the limited evidence. There must be careful weighing of possible risks and benefits. Examples of these unconventional approaches include assessing the effectiveness of disease-modifying therapies by subjective clinical and MRI criteria, using unproven “combination therapies” to try to modify disease course, and using symptomatic therapies for which there is limited clinical evidence (“off-label” use).

These limitations of conventional medicine are part of the reason that some people with MS are interested in CAM. For people with MS who are interested in CAM, there should be a careful and thoughtful approach that is similar to that used for conventional therapies for which the information is limited. It is important to obtain unbiased MS-relevant information, determine the safety and effectiveness of the therapy, and discuss the therapy with a physician or other conventional healthcare provider. If the therapy is pursued, there should be a plan for monitoring for a response. If that response does not occur, then the therapy should be discontinued and other approaches should be considered. It is important to use caution, realise that the safety and effectiveness information about most CAM therapies is limited, and recognise that there is a certain degree of risk that an individual takes in pursuing CAM.