Complementary and alternative medicine (CAM) includes a wide variety of interventions — from diets and supplements to meditation and T’ai Chi — which come from many different disciplines and traditions. Most are considered to be outside the realm of conventional medicine, although others, including vitamin D, exercise, acupuncture and cooling strategies, for example, are establishing their role in comprehensive care through scientific study and clinical trials.
When used in combination with conventional medicine, these interventions are referred to as "complementary;" when used instead of conventional medicine, they are referred to as "alternative." In the United States today, the vast majority of people incorporate one form or another of CAM as part of their MS management, most often in combination with their prescribed MS treatments.
Many people use CAM because they believe that anything sold online or over-the-counter at a pharmacy or health food store is healthy and harmless. But many products that claim to be safe and beneficial may not be. Unlike conventional medical treatments that are thoroughly tested and carefully regulated by the U.S. Food and Drug Administration (FDA), most CAM therapies have undergone very little — if any — scientific study to evaluate their safety and effectiveness. So some forms of CAM may be completely safe for a person with MS while others may actually pose significant risks — by producing significant side effects, over-stimulating the person’s immune system or interacting negatively with other medications a person is taking. Some may provide some benefit for a person with MS while others offer no benefit at all.
The American Academy of Neurology recently released a guideline on the use of complementary and alternative medicine (CAM) in MS. The guideline was developed to address the following questions:
- Do CAM therapies reduce specific symptoms and prevent relapses or disability?
- Can CAM use worsen MS or cause serious adverse effects?
- Can CAM use interfere with MS disease-modifying therapies?
Although these are all very important questions, the authors found very few published studies of sufficient quality to provide helpful answers about most of the CAM therapies that are being used by people with MS.
The importance of clinical trials
Carefully-designed clinical trials are the best way to determine the safety and effectiveness of a particular treatment. Here’s why:
- Because the course of MS is variable, and each person’s symptoms tend to come and go in an unpredictable way, the only way to determine the effectiveness of a treatment is to test it on a large number of people.
- Because most people — regardless of the disease they have — will have a positive response to any new treatment they receive (even if it’s an inactive substance or placebo). The effectiveness of a new treatment can only be proven by comparing it to a placebo or to another treatment that has already been shown to be effective.
- Because every treatment carries with it the risk of anticipated and unanticipated side effects, the only way to evaluate a treatment’s safety is to evaluate it in a large number of people over a sufficient period of time.
Guidelines for considering or using CAM
Questions to ask when considering CAM:
- What does the treatment involve?
- How and why is it supposed to work?
- How effective is it?
- What are the risks associated with its use?
- How much does it cost?
Keep your physician informed about everything you are taking. Not sharing this important information is like asking your physician to treat you blindfolded — and knowing everything you are taking will allow your doctor to alert you to possible side effects or drug interactions.
Don't abandon conventional therapy. The treatments your physician prescribes for you are the ones that have been evaluated in controlled clinical trials or accepted by the MS medical community as safe and effective therapies. So stay with your prescribed treatments even if you decide to add CAM to your comprehensive treatment plan.
Document the experience. Keep a detailed log of what you take or what is done and any changes you experience. Use this form to track your prescription and over-the-counter treatments (.pdf).
Complementary approaches to taking care of yourself
Food and diet — Although various diets have been promoted to cure or control MS, no diet has been proven to modify the course of MS. MS specialists recommend that people follow the same high fiber, low fat diet that is recommended for all adults.
Exercise — Exercise offers many benefits for people with MS. In addition to improving your overall health, aerobic exercise reduces fatigue and improves bladder and bowel function, strength, and mood. Stretching exercises reduce stiffness and increase mobility. The physical therapist can recommend an exercise plan to fit your abilities and limitations.
Stress management (.pdf) — The relationship between stress and the onset or worsening of MS is far from clear — and different types of stress appear to affect different people in different ways. But none of us feel our best when we’re stressed, so it’s important to find the stress management strategies that work best for you.
Acupuncture — Acupuncture is finding its way into Western medicine, with studies suggesting possible benefits for a wide range of problems.