Complementary and alternative treatments in multiple sclerosis

Abstract

Despite recent therapeutic advances, multiple sclerosis (MS) remains a chronic disabling disease with no cure. National surveys have demonstrated the widespread use of complementary and alternative medicine (CAM) among the general population in the United States. These surveys also indicate that individuals with a variety of chronic illnesses are more likely to use CAM than are the general population1,2. Several surveys have demonstrated the use of CAM treatment options by individuals with MS3-8. While recognizing the use of alternative therapies by MS patients, neurologists generally have taken little interest in these therapies. Individuals with MS and neurologists frequently adopt a ‘don’t ask, don’t tell’ policy regarding alternative therapies. Neurologists are sometimes very negative about patient use of alternative therapies, primarily for two reasons: first, they cite the lack of scientific evidence establishing efficacy for various CAM therapies; second, they focus on highly publicized therapies that are expensive, seemingly bizarre or even dangerous, such as thereplacement of amalgam dental fillings, magnet therapy and bee stings, as being representative of CAM therapies, and want to protect their patients from pointless expenses and risks. However, these negative attitudes are not well founded. First, despite individuals with MS reporting benefit from some alternative therapies, there has been a paucity of scientifically valid research into CAM therapies for MS. The lack of scientific evidence on efficacy does not mean that there is no benefit; we simply do not have the data to allow us to determine what works and what does not. Second, most individuals with MS who use CAM therapies tend to use affordable and low-risk treatments, such as diet therapies, nutritional supplements, herbal therapies and mind-body therapies, such as yoga and prayer4-7. While there certainly are individuals with MS who make poor decisions regarding CAM use, in general, individuals with MS who use CAM seem to be sensible in their approach. Rather than ignoring the issue, or adopting a universally negative attitude about CAM, neurologists should be better informed about CAM use so that they can serve as a resource for these individuals.