Complementary and alternative medicine and MS

Complementary and alternative medicine (CAM) is an umbrella term for many diagnostic and therapeutic methods that lie outside orthodox medicine. It's often described by what it is not, rather than by what it is – not taught in medical schools, not scientifically proven, not on the NHS, not plausible, not orthodox.

The Cochrane Collaboration (an international organisation that produces reviews of published evidence of drugs and health interventions) has adopted the definition of CAM as:
"Diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine".

It's important to differentiate between therapies that complement orthodox treatment, for instance aromatherapy being used alongside drugs for pain relief, and those sought as an alternative.

People with MS are one of the biggest user groups of CAMs. This is due to a number of factors.

• People with MS are more likely to tackle their condition in an active and problem focused way. They are more likely to be enquiring risk takers who seek information and strategies in the defence of threat.
• People with MS and doctors may view orthodox medicine differently. Treatment which is 30-40% effective may be viewed as a plus by a doctor but 60-70% away from the cure by the person with the condition.
• There may be an association with dissatisfaction with outcomes of previous interventions.
• Use may be part of the coping process and adjustment – a process of experimentation and exploration of all possible coping strategies.
• Use may relate to regaining control, reducing the sense of helplessness, hopelessness and engendering hope and control.
• CAMs holds a prospect of real hope whilst the scientific process is slow (although powerful) and very 'black and white'.

There can be a variety of reasons.

• There's sometimes the mistaken assumption that as CAMS are 'natural' they're safe and harmless, and therefore there is no need to seek advice on using them or adding them to your existing regime of treatments.
• People perceive a lack of time to talk and that the doctor is too busy to discuss issues outside the orthodox topics of consultation.
• Sometimes there's a feeling that the doctor would not be interested in, or bothered by, the use of CAMS and may be negative or even derisory about their use.
• A perceived lack of knowledge about CAMs in the doctor can be off-putting.
• Sometimes the possibility that use of CAMS may jeopardise the prescribing of orthodox medicine that might also be a hopeful treatment. There is also the fear that this may make the MS worse. Uncertain hope is better than hopeless certainty.
• Sometimes the influence or attitude of the alternative practitioner can lead the individual to conceal treatments from their doctor. The alternative medicine industry is not regulated and has its own licensing laws.

It's important for the doctor to be aware of potential interactions between orthodox and alternative treatments, as in some circumstances the treatments can act against each other, sometimes with serious implications.

There is evidence to suggest that many European GPs feel it's safe to support the use of CAMS but there is a need to remain open minded and clinically cautious. There is little evidence of the efficacy and tolerability of CAMs for treating some aspects of MS. The effectiveness and safety of many therapies remains largely unproven.

There are hundreds of therapies used across the world. What is considered as orthodox in one culture may be viewed as radical and outside mainstream medicine in another. Much is to be learned and understood about the concept of illness and wellness from each other.

The categories can be broadly placed as:

Whole (alternative) medical systems

Such as traditional Chinese medicine (which includes acupuncture, diet, and exercise), Ayurvedic medicine (an Indian system that includes meditation, diet and exercise), and homeopathy.

Mind-body medicine

This focuses on the interaction between mind and body. It includes relaxation techniques, biofeedback, yoga, Tai Chi, prayer and spirituality, and some behavioural therapies such as cognitive behavioural therapy (CBT).

Manipulative and body-based systems

This includes chiropractic and osteopathic manipulation, massage, reflexology, and many others.

Biologically-based therapies

Such as whole diets and dietary supplements including vitamins and minerals.

Energy-based therapies (bio-field and bio-electromagnetic)

This includes therapies using both measurable (veritable) energy sources, such as magnet therapy or sound energy, and perceived (putative) sources of energy, such as acupuncture and distant healing therapies such as Reiki.

There is growing interest in CAMS in western conventional medicine, but the dilemmas remain the lack of evidence, the quality of the little evidence available and the measurement outcomes used. Multiple sclerosis has been documented since the 19th century and yet conventional medicine has yet to find consensus, or the answers on what it is. Is it time serious consideration be given to possible alternatives that may have a powerful role to play in the outcomes for people with MS? The subjective effectiveness reported by two thirds of those who use CAMS needs to be investigated by rigorous methods and questioned by scientific minds.

Written by Vicki Gutteridge, MS specialist nurse, for Open Door - November 2012