Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review

Palliative Care Interventions for Persons With Neurodegenerative Disease: A Scoping Review of Clinical Trial Study Design Features

Background: Within palliative care research, best practice guidelines to conduct scientifically rigorous clinical trials for neurodegenerative diseases are underexplored. This patient population experiences unique challenges, including fluctuations in cognitive capacity, care partner (CP) and proxy involvement, and high adverse events (AEs), that necessitate special consideration when designing clinical trials. Objective: The objective of this study was to describe and identify clinical trial design features that have been documented in studies involving a neuropalliative intervention for persons with neurodegenerative diseases, highlighting features that have been adapted for this unique patient population. Design: We conducted a scoping review of clinical trials with a neuropalliative intervention for persons with neurodegenerative disease. We searched Cochrane, Web of Science, EMBASE, Scopus, and PubMed (MEDLINE) databases for articles published in English between 1950 and 2023. Two reviewers screened, extracted, and synthesized data from the included articles. A third reviewer adjudicated instances of conflict. The data were analyzed using a thematic framework approach. Results: Of 1025 texts, 44 articles were included. Seven study design features were analyzed: (1) consent, (2) proxies and CPs, (3) recruitment strategies, (4) retention strategies, (5) choice of comparator, (6) AEs, and (7) internal validity. This scoping review found disparities in study design features around structured consent, proxies and CPs, comparators, and AEs. Conclusions: To date, neuropalliative care clinical trials have had varied study designs and the majority of research has focused on dementia. Research guideline development for high-quality neuropalliative care clinical trials is greatly needed across the range of neurodegenerative diseases. To increase the scientific rigor of clinical trials and neuropalliative care, we recommend a standardized capacity assessment for consent, defining conditions for the CP, proxy, and AEs, systematizing appropriate comparators, and outlining preemptive recruitment and retention strategies to address the broader unpredictable challenges of palliative care research.

Use of Complementary and Alternative Medicine in Patients With Idiopathic Inflammatory Demyelinating Diseases of the Central Nervous System: A Cross-Sectional Study in Thailand

Background

Complementary and alternative medications (CAM) are common among patients with multiple sclerosis (MS) for physical and psychological support. However, there is insufficient data regarding the application of CAM in the different cultures and beliefs of each community as well as patient's status.

Objective

To evaluate the prevalence and modalities of the use of CAM among patients with central nervous system idiopathic inflammatory demyelinating diseases (CNS-IIDD) in a tertiary care hospital.

Methods

A cross-sectional study was conducted at Siriraj Hospital from June to December 2021 involving patients with MS, neuromyelitis optic spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), idiopathic transverse myelitis (iTM), and optic neuritis (ON) to examine the prevalence and mode of CAM use and its correlation with patient characteristics.

Results

There were 107 patients. The diagnoses were MS (38), NMOSD (55), MOGAD (5), iTM (7), and ON (2). Most of the patients were female (89.7%), and 61.7% were diagnosed over 5 years. The mean Expanded Disability Status Scale was 2.63 (S.D., 2.38), and the median ambulation index was 0 (range 0-8.5). There were 68 patients (63.6%) with a history of CAM use for at least 3 months, while those with current use decreased to 62 (58.5%). Vitamins and minerals were the most commonly used, particularly vitamin D (97.1%) and calcium (47.7%). Both treatments were primarily prescribed (95.3%) rather than self-administered (24.3%). The main reasons for the use of CAM were to strengthen their health (48.6%) and relieve existing symptoms (28.0%).

Conclusions

The use of CAM is common among patients with Thai CNS-IIDD. Further exploration of patient perspectives and preferences regarding CAM usage may contribute to a more comprehensive management approach for patients with CNS-IIDD.

Effects of Dietary Modification Based on Complementary and Alternative Iranian Medicine in Patients with Secondary-Progressive Multiple Sclerosis: A Randomized Controlled Clinical Trial

Objectives: To evaluate the efficacy of dietary modifications based on complementary and alternative Iranian medicine (CAIM) in patients with secondary-progressive multiple sclerosis (SPMS). Design: In this randomized controlled trial, 70 SPMS patients were randomized to receive either a moderate-nature diet based on Persian medicine (as intervention) or usual diet plus health-related diet recommendations (as control) for 2 months. Serum high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), Expanded Disability Status Scale (EDSS), Modified Fatigue Impact Scale (MFIS), State-Trait Anxiety Inventory (STAI), Global Pain Scale (GPS), Gastrointestinal Symptom Rating Scale (GSRS), anthropometric measurements, and quality of life (QOL) were assessed at baseline and end of trial. Analysis of covariance was performed, and the results were adjusted for potential confounders using SPSS v.14. Results: All participants completed the study for 2 months. There were significant improvements across the mean changes of hs-CRP (-0.1 ± 0.2 mg/L for intervention vs. -0.01 ± 0.13 mg/L for control; padjusted = 0.012), MFIS (-11.0 ± 11.8 vs. -0.7 ± 9.9; padjusted <0.001), GSRS (-19.9 ± 16.3 to 1.2 ± 17.5; padjusted <0.001), GPS (padjusted = 0.032), and QOL (padjusted <0.05). No significant difference was observed across the ESR, EDSS, STAI, and anthropometric measurements. Conclusion: Dietary modifications based on CAIM may improve inflammation and clinical manifestations in SPMS patients. Nonetheless, further trials are required to confirm these findings. Clinical Trial Registration: IRCT20181113041641N2.

The Efficacy and Safety of Manual Therapy for Symptoms Associated with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background:

Multiple sclerosis (MS) is a chronic neurological autoimmune disease, affecting the psychological and physical health of patients. Manual therapies have been proven to relieve pain, strengthen muscles, and improve bladder and bowel problems with a high safety and low adverse event profile. Previous studies have reported the results of manual therapy in alleviating symptoms associated with MS, but the conclusions were controversial.

Objective:

The purpose of this meta-analysis is to comprehensively analyze and determine the efficacy and safety of manual therapy in relieving symptoms associated with MS.

Methods:

Eight electronic databases were searched from inception of the database to April 30, 2021. Randomized controlled trials (RCTs) using manual therapy in patients to relieve symptoms associated with MS were considered eligible for this study. Two reviewers independently extracted data using pre-established standards.

Results:

Finally, 10 eligible RCTs with 631 subjects were included in this meta-analysis. These data establish that massage therapy can significantly ameliorate fatigue, pain, and spasms, while reflexology was only effective in relieving pain in MS patients. No adverse events were reported in eligible RCTs.

Conclusions:

The present study provides strong evidence that massage therapy could alleviate fatigue, pain, and spasms in MS patients, while reflexology plays a positive role in relieving pain. Physicians could consider massage therapy or reflexology as a safe and effective complementary and alternative treatment. Larger RCTs with higher methodological quality are needed in the future, which aim to provide more meaningful evidence for further proof of efficacy.

Complementary and alternative therapies in multiple sclerosis: a systematic literature classification and analysis

INTRODUCTION AND AIM

Multiple Sclerosis (MS) is a disease determined by inflammatory demyelination and neurodegeneration in the Central Nervous System (CNS). Despite the extensive utilization of Complementary and Alternative Medicine (CAM) in MS, there is a need to have comprehensive evidence regarding their application in the management of MS symptoms. This manuscript is a Systematic Literature Review and classification (SLR) of CAM therapies for the management of MS symptoms based on the International Classification of Functioning Disability and Health (ICF) model.

METHOD

Studies published between 1990 and 2020 IN PubMed, Science Direct, Scopus, Pro-Quest, and Google Scholar using CAM therapies for the management of MS symptoms were analyzed.

RESULTS

Thirty-one papers on the subject were analyzed and classified. The findings of this review clearly show that mindfulness, yoga, and reflexology were frequently used for managing MS symptoms. Moreover, most of the papers used mindfulness and yoga as a CAM therapy for the management of MS symptoms, which mostly devoted to mental functions such as fatigue, depression, cognition, neuromuscular functions such as gait, muscle strength, and spasticity, and sensory function such as balance, in addition to, reflexology is vastly used to management of mental functions of MS patients.

CONCLUSION

Evidence suggested that CAM therapies in patients with MS have the potential to target and enhancement numerous elements outlined in the ICF model. Although the use of CAM therapies in MS symptom management is promising, there is a need for strict clinical trials. Future research direction should concentrate on methodologically powerful studies to find out the potential efficacy of CAM intervention.

Massage therapy as a complementary and alternative approach for people with multiple sclerosis: a systematic review

PURPOSE

Multiple sclerosis (MS) causes a range of different symptoms. Patients with MS (PwMS) have looked for alternative therapies to control their MS progress and treat their symptoms. Non-invasive therapeutic approaches such as massage can have benefits to mitigate some of these symptoms. However, there is no rigorous review of massage effectiveness for PwMS. The present systematic review aims to examine the effectiveness of different massage approaches on common MS symptoms, including fatigue, pain, anxiety, depression, and spasticity.

MATERIALS AND METHODS

A systematic search of related trials was conducted in electronic databases including Cochrane Library, PubMed, Scopus, Web of Science, and Google Scholar, using search terms related to Multiple Sclerosis and massage therapy. The PEDro scale was used to evaluate the methodological quality of reviewed studies.

RESULTS

A total of 12 studies met the inclusion criteria. We rated 5 studies as fair and 7 studies as good. Fatigue was improved by different massage styles, such as reflexology, nonspecific therapeutic massage, and Swedish massage. Pain, anxiety, and depression were effectively improved by reflexology techniques. Spasticity was reduced by Swedish massage and reflexology techniques.

CONCLUSIONS

Different massage approaches effectively improved MS symptoms such as fatigue, pain, anxiety, depression, and spasticity.Implications for rehabilitationThe present review results indicate that massage may have beneficial effects on motor and non-motor symptoms in MS.Massage could be considered a complementary and alternative treatment combined with conventional medicine in people with MS.Pain and fatigue are best improved by Swedish massage, while anxiety and depression are effectively improved by reflexology.

Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

Fatigue and pain are prevalent symptoms of multiple sclerosis (MS) and frequent complaint in MS patients, which reduce their quality of life. This study aimed to assess the effect of massage therapy on pain and fatigue in MS Patients.

METHOD

The original and Persian databases were searched included PubMed, web of science, embase, ovid, scopus, and the Cochrane Library, SID, and Iranedex from inception to November 2020. Studies that reported the effect of massage on fatigue and pain were included. Two investigators extracted all relevant data, independently. For deriving analysis, mean difference (MD) and standardized mean difference (SMD) were used.

RESULT

Ten studies were eligible acoording criteria. The effect of massage on fatigue showed significant improvement (-1.62; 95% CL -2.40, -0.83; p < .00001), also results of the systematic review showed a significant reduction in pain severity.

CONCLUSION

Massage as a complementary and non-pharmacological therapy might have been associated with alleviating fatigue and pain in M.S. patients. Based on the current study, massage intervention for MS patients could have possible clinical value for palliating pain and fatigue and improving quality of life; however, this matter needs further and more significant trial studies.

Patterns and Outcomes of Complementary and Alternative Medicine Use Among Adult Patients With Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease that causes demyelination of the central nervous system. No treatment has been shown to be curative; thus, we assume that the tendency for patients with MS to use unconventional therapies, such as complementary and alternative medicine (CAM), might increase. The aim of this study was to explore the pattern of CAM use among patients with MS at a tertiary health care center in Saudi Arabia (SA). This was a questionnaire-based observational cross-sectional study that targeted adult patients diagnosed with MS at King Abdulaziz Medical City in Riyadh, SA, from 2018 to 2019. The sample size included 176 patients, and a consecutive non-probability sampling technique was used to engage them during their appointments. An Arabic questionnaire was used to evaluate patients' use of CAM. The mean age of participants was 34.6 ± 10.9 years, females represented the majority 125 (71%) of participants, and 89% of the participants reported using CAM at least once, with one or more modalities being used. Prayer, Salat, was the most frequent modality (60%) followed by supplication, Dua'a (59%), Ruqia, reciting Holy Quran (52%), and vitamins (44%). Symptomatic improvement was reported by 49 (27.8%) of dietary supplement users and 81 (46%) of non-dietary supplement medicine users. The study found a high prevalence of CAM utilization among Saudi adult patients with MS, which exceeded internationally reported rates. Although some patients described some improvement in their symptoms, further research is needed to evaluate the effectiveness of CAM.

Lipoic Acid and Other Antioxidants as Therapies for Multiple Sclerosis

Oxidative stress (OS), when oxidative forces outweigh endogenous and nutritional antioxidant defenses, contributes to the pathophysiology of multiple sclerosis (MS). Evidence of OS is found during acute relapses, in active inflammatory lesions, and in chronic, longstanding plaques. OS results in both ongoing inflammation and neurodegeneration. Antioxidant therapies are a rational strategy for people with MS with all phenotypes and disease durations. PURPOSE OF REVIEW: To understand the function of OS in health and disease, to examine the contributions of OS to MS pathophysiology, and to review current evidence for the effects of selected antioxidant therapies in people with MS (PwMS) with a focus on lipoic acid (LA). RECENT FINDINGS: Studies of antioxidant interventions in both animal and in vivo models result in reductions in serum markers of OS and increases in levels and activity of antioxidant enzymes. Antioxidant trials in PwMS, while generally underpowered, detect short-term improvements in markers of OS and antioxidant defenses, and to a lesser extent, in clinical symptoms (fatigue, depression). The best evidence to date is a 2-year trial of LA in secondary progressive MS which demonstrated a significant reduction of whole-brain atrophy and trend toward improvement in walking speed. Antioxidant therapy is a promising approach to treat MS across the spectrum and duration of disease. Rigorous and well-powered trials are needed to determine their therapeutic benefits.

Complementary and Alternative Medicine Usage by Multiple Sclerosis Patients: Results from a Prospective Clinical Study

OBJECTIVES

To investigate the factors associated with complementary and alternative medicine (CAM) usage by multiple sclerosis (MS) patients. Design, Setting/Location: Single-center, prospective clinical study at an academic MS center in the northeastern United States.

METHODS

This study included CAM data from 524 MS patients and 304 healthy controls (HC) enrolled in a prospective study of clinical, neuroimaging, and environmental risk factors in MS at an academic MS Center. Clinical, neuroimaging, and disease-modifying treatment data were obtained. In addition, data on usage of CAM modalities, including acupuncture, aromatherapy, Ayurveda, Chinese herbal medicine, chiropractor, electromagnetic therapy, homeopathy, hypnosis, massage, naturopathy, Qi gong, Reiki, therapeutic touch, and bee stings were collected in an in-person interview.

RESULTS

The percentages of HC reporting usage of any CAM (32%) was similar to that in MS patients after diagnosis (30.5%). The usage of any CAM was higher in MS patients after MS diagnosis compared to before MS diagnosis (p < 0.001). The three most frequently used CAM for MS patients after MS diagnosis and HC were chiropractor, massage, and acupuncture. The most frequent reasons for CAM use were MS symptom relief, back problems, and pain. In multivariate analysis, female gender, higher education level, MS disease course, and not currently on disease-modifying therapies (DMT) treatment status were associated with CAM usage.

CONCLUSIONS

Gender, education level, DMT treatment status, and MS disease course are associated with CAM usage in MS patients. Ever-CAM usage patterns in MS patients are similar to those in HC.

Evaluation of anti α-d-Glcp-(1→4)-α-d-Glcp (GAGA4) IgM antibodies as a biomarker for multiple sclerosis

The correct diagnosis of multiple sclerosis (MS) remains challenging due to the complex pathophysiological and clinical characteristics of the disease. Consequently, there has been immense interest in finding a non-invasive diagnostic test for MS. Recent studies found that serum anti-α-d-Glcp-(1→4)-α-d-Glcp (GAGA4) IgM antibodies were upregulated in MS patients, and this finding led to the development of a commercial diagnostic test (gMS® Dx test), although the test has poor selectivity and has not been independently validated. Herein, we developed an enzyme-linked immunosorbent assay (ELISA) to evaluate the use and reliability of several anti-glucose IgM antibodies, including those against GAGA4, as diagnostic biomarkers for MS. In contrast to previous studies, our results show that serum anti-GAGA4 IgM antibody levels are not significantly higher in MS patients, which could potentially explain the poor selectivity of the commercial test.

Anti-glucose IgM antibodies are not upregulated in RRMS patients and thus are not a suitable biomarker for MS.

The Experience of Complementary Alternative Medicine Use among People with Multiple Sclerosis

People with multiple sclerosis (MS) are increasingly using complementary and alternative medicine (CAM) for symptom management, despite the absence of an evidence base. This exploratory qualitative study ( n = 10) examined the experiences of CAM use among people with MS. Results suggest disillusionment with current medical treatments and a desperate search for something to relieve symptoms. Participants had an open attitude toward various approaches to health care, liked to be actively involved in their care, and viewed CAM as a “healthier” choice. Further research is needed to develop the preliminary findings, using more heterogeneous samples embracing the complexities of gender, ethnicity, and socioeconomic status.

Predictors of alternative medicine use by multiple sclerosis patients

Objective: To determine the frequency of alternative medicine use among multiple sclerosis (MS) patients, and the factors which predict such use. Methods: We examined 20778 MS patients enrolled in the North A merican Research C onsortium on Multiple Sclerosis (NARC O MS) Patient Registry, residing in the USA. We used demographic and clinical data to create multivariate logistic regression models for i) lifetime use of any alternative medicine, ii) lifetime use of any alternative provider (A P), and iii) lifetime use of each of the three most common A P. Results: 20387 patients provided data regarding alternative medicine use. Lifetime use of any alternative medicine was 54% and current use was 30%. C hiropractors (51%), massage therapists (34%), and nutritionists (24%) were the most commonly used A P. In all five models, use of alternative medicine was most strongly predicted by use of a conventional provider, and more modestly by disease factors indicating more severe or prolonged disease. Predictive power of the models was poor (c-index =0.62-0.68), despite good fits for the data. Conclusions: Demographic factors play only a minimal role in predicting the use of alternative medicine in this MS population while disease factors play a slightly stronger role. There must be other factors involved that may include accessibility, social acceptability and cultural factors. G iven the frequency of alternative medicine use by this patient population, further characterization of these factors is important.

Uses of complementary and alternative medicine in multiple sclerosis

Multiple sclerosis (MS) is a chronic, disabling, recurrent demyelination of the central nervous system (CNS). It could affect different regions in the brain and spinal cord, and according to the domain which is affected, it could cause different symptoms such as motor, sensory, or visual impairment; fatigue; bowel, bladder, and sexual dysfunction; cognitive impairment; and depression. MS patients also face reduced quality of life. Drugs that are used in MS are not fully efficient and patients suffer from many symptoms and adverse effects. Today there is an increasing trend of using complementary and alternative medicine (CAM). People are more likely to use this type of treatment. Using appropriate lifestyle and CAM therapy can subside some of the symptoms and could improve the quality of life in these patients. Many people with MS explore CAM therapies for their symptoms. This review is aimed to introduce CAM therapies that could be used in MS patients.

Comparison of the Effect of 8 weeks Aerobic and Yoga Training on Ambulatory Function, Fatigue and Mood Status in MS Patients

Background

Multiple Sclerosis (MS) is a disease of the central nervous system that results in many symptoms including mobility limitation and fatigue.

Patients and Methods

Thirty-one MS patients, all female with mean of age of 36.75 years and Expanded Disability Status Scale scores (EDSS) of 1.0 to 4.0 were recruited. Subjects were randomly assigned to one of the three groups: treadmill training, yoga or control groups. Treadmill training and yoga practice consisted of 8 weeks (24 sessions, thrice weekly). The control group followed their own routine treatment program. Balance, speed and endurance of walking, fatigue, depression and anxiety were measured by Berg Balance scores, time for 10m walk and distance for a two minute walk, Fatigue Severity Scale (FFS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively.

Results

Comparison of results have shown that pre- and post-interventions produced significant improvements in the balance score, walking endurance, FFS score, BDI score and BAI score in the treadmill training group and yoga group. However, 10m walk time decreased in the treadmill training group but did not show any clear change in the yoga group. Moreover, the analysis showed significant differences between the treadmill training group and yoga group for BAI score.

Conclusions

These results suggest that treadmill training and yoga practice improved ambulatory function, fatigue and mood status in the individuals with mild to moderate MS.

Qi Gong exercises and Feldenkrais method from the perspective of Gestalt concept and humanistic psychology

This study describes two similar approaches to human movement: Qi Gong exercises and the Feldenkrais method. These systems are investigated in terms of Gestalt concepts and humanistic psychology. Moshe Feldenkrais created the concept known as Awareness Through Movement. This concept assumes that by becoming more aware of one's movements, one functions at a higher level. In similar ways to those using the Feldenkrais method, individuals may become more aware of their own movements by performing Qi Gong exercises: A therapeutic modality that facilitates mind-body integration. Qi Gong exercises commonly lead to increased personal awareness accompained by enhanced quality, fluency and smoothness of movement. These two methods of movement therapies are explored in terms of their relations with Gestalt concept and humanistic psychology.

Effectiveness of applying progressive muscle relaxation technique on quality of life of patients with multiple sclerosis

AIMS AND OBJECTIVES

To identify the effects of applying Progressive Muscle Relaxation Technique on Quality of Life of patients with multiple Sclerosis.

BACKGROUND

In view of the growing caring options in Multiple Sclerosis, improvement of quality of life has become increasingly relevant as a caring intervention. Complementary therapies are widely used by multiple sclerosis patients and Progressive Muscle Relaxation Technique is a form of complementary therapies.

DESIGN

Quasi-experimental study.

METHOD

Multiple Sclerosis patients (n = 66) were selected with no probability sampling then assigned to experimental and control groups (33 patients in each group). Means of data collection included: Individual Information Questionnaire, SF-8 Health Survey, Self-reported checklist. PMRT performed for 63 sessions by experimental group during two months but no intervention was done for control group. Statistical analysis was done by SPSS software.

RESULTS

Student t-test showed that there was no significant difference between two groups in mean scores of health-related quality of life before the study but this test showed a significant difference between two groups, one and two months after intervention (p < 0.05). anova test with repeated measurements showed that there is a significant difference in mean score of whole and dimensions of health-related quality of life between two groups in three times (p < 0.05).

CONCLUSIONS

Although this study provides modest support for the effectiveness of Progressive Muscle Relaxation Technique on quality of life of multiple sclerosis patients, further research is required to determine better methods to promote quality of life of patients suffer multiple sclerosis and other chronic disease.

RELEVANCE TO CLINICAL PRACTICE

Progressive Muscle Relaxation Technique is practically feasible and is associated with increase of life quality of multiple sclerosis patients; so that health professionals need to update their knowledge about complementary therapies.

Reflexology for the treatment of pain in people with multiple sclerosis: a double-blind randomised sham-controlled clinical trial

Multiple sclerosis (MS) results in pain and other symptoms which may be modified by conventional treatment, however, MS is still not curable. Several studies have reported positive effects of reflexology in the treatment of pain, however, no randomised controlled clinical trials for the treatment of pain have been conducted within this population. The objective of this study was to investigate the effectiveness of reflexology on pain in and MS population. We randomly allocated 73 participants to receive either precision or sham reflexology weekly for 10 weeks. Outcome measures were taken pre-and post-treatment with follow-up at 6 and 12 weeks by a researcher blinded to group allocation. The primary outcome measure recorded pain using a Visual Analogue Scale (VAS). A significant (p < 0.0001) and clinically important decrease in pain intensity was observed in both groups compared with baseline. Median VAS scores were reduced by 50% following treatment, and maintained for up to 12 weeks. Significant decreases were also observed for fatigue, depression, disability, spasm and quality of life. In conclusion, precision reflexology was not superior to sham, however, both treatments offer clinically significant improvements for MS symptoms via a possible placebo effect or stimulation of reflex points in the feet using non-specific massage.

A review of complementary and alternative medicine (CAM) by people with multiple sclerosis

Multiple sclerosis (MS) is a chronic, unpredictable disease of the central nervous system without a known cure. Because of this, people with MS often seek complementary and alternative medicines (CAM) to manage their disease symptoms. The goal of this review article was to describe the use of CAM by individuals diagnosed with MS. Evidence was obtained by searching Medline (1950-2007), EBSCOhost and PubMed for studies relating CAM to MS. Results from the literature showed that people with MS reported that they used CAM from 27 to 100%. The major reasons for choosing CAM were as follows: conventional treatment was not effective, anecdotal reports of CAM's help, and doctor referral. The types of CAM reported by people with MS included exercise, vitamins, herbal and mineral supplements, relaxation techniques, acupuncture, cannabis and massage. The major symptoms treated by CAM as noted in the literature were pain, fatigue and stress. There is a need for further research to evaluate the effectiveness of CAM with MS patients and their application by occupational therapists. The limitation of this literature review was the low response rate in many of the surveys reported.

Complementary therapy use by persons with multiple sclerosis: benefits and research priorities

People with multiple sclerosis (MS) are commonly actively involved in self-care, with many accessing complementary and alternative medicine (CAM) to help in symptom management. To provide increased insight into benefits from CAM use and service user ideas over research priorities, a two-part study, involving a questionnaire and interactive workshop, was undertaken with attendees at a national Congress of the MS Trust in the UK. The six most used therapies were reflexology, massage, yoga, relaxation and meditation, acupuncture and aromatherapy. Each was rated by a quarter to two-fifths as 'extremely helpful'. Insight into the nature of the therapeutic benefit was provided in user comments. Despite the self-selected nature of the sample, the findings point to potential benefits of a set of CAM therapies in helping people with MS. More research on potential benefits of therapies was called for by participants and on the dynamics of the therapeutic effect.

Preliminary Initiatives in a Bridge Building Project between Conventional and Alternative Practitioners in Denmark

BACKGROUND

A growing number of the approximately 7,400 persons with multiple sclerosis (MS) in Denmark use alternative treatments. The Danish Multiple Sclerosis Society has been experiencing an increasing demand for research on the effects of combined conventional and alternative treatments. For this reason, the Society has initiated a bridge building project to be implemented from 2004-2011 at a specialized MS hospital. In that project, a team of five conventional and five alternative practitioners works together and offers integrative treatments to a total of 400 MS patients.

OBJECTIVE

The overall purpose of the project is to examine if integrative treatments may optimize treatment results for people suffering from MS, and to develop a model for a bridge building cooperation of conventional and alternative practitioners in the future.

MATERIAL AND METHODS

In this article we give an overview of the steps taken before establishing the hospital- based team of practitioners: (1) a public hearing attended by conventional and alternative practitioners experienced in treating MS patients; (2) qualitative interviews among conventional practitioners at a specialized MS hospital; (3) a literature study on the use and effects of alternative treatments and integrative treatments related to MS.

RESULTS

The knowledge gained in the preliminary steps of the project showed that we had to add a preparatory phase to the project focusing on the development of the team before it would start treating MS patients.

Music therapy in the treatment of multiple sclerosis: a comprehensive literature review

Coping with multiple sclerosis symptoms still remains a challenge for each patient suffering from this chronic inflammatory disease. Therefore, patients often turn to using complementary and alternative medicine (CAM). In this review, the authors aimed to investigate the current state of literature of music therapy in the treatment of multiple sclerosis (MS). Medline, PubMed, Embase, AMED, CAMbase and the Music Therapy World Journal Index were searched for the terms MS and 'music therapy'. In addition, an internet search using Google Scholar was performed. The authors found seven case-reports/series and seven studies on music therapy for MS-patients. Both the case reports and studies presented here are pioneer work. Most of the studies are naturally predominated by the use of qualitative and uncontrolled research designs. Nevertheless, the results of the studies as well as the case reports demonstrate patients' improvement in the domains of self-acceptance, anxiety and depression. The results of the studies as well as the case reports define a sufficient basis for further music therapeutical work as they show a variety of psychosocial and emotional benefits for MS patients.

Does trust in health care influence the use of complementary and alternative medicine by chronically ill people?

BACKGROUND

People's trust in health care and health care professionals is essential for the effectiveness of health care, especially for chronically ill people, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that chronically ill people turn to complementary and alternative medicine (CAM), often in addition to regular care. Chronically ill people use CAM two to five times more often than non-chronically ill people. The trust of chronically ill people in health care and health care professionals and the relationship of this with CAM use have not been reported until now. In this study, we examine the influence of chronically ill people's trust in health care and health care professionals on CAM use.

METHODS

The present sample comprises respondents of the 'Panel of Patients with Chronic Diseases' (PPCD). Patients (>or=25 years) were selected by GPs. A total of 1,625 chronically ill people were included. Trust and CAM use was measured by a written questionnaire. Statistical analyses were t tests for independent samples, Chi-square and one-way analysis of variance, and logistic regression analysis.

RESULTS

Chronically ill people have a relatively low level of trust in future health care. They trust certified alternative practitioners less than regular health care professionals, and non-certified alternative practitioners less still. The less trust patients have in future health care, the more they will be inclined to use CAM, when controlling for socio-demographic and disease characteristics.

CONCLUSION

Trust in future health care is a significant predictor of CAM use. Chronically ill people's use of CAM may increase in the near future. Health policy makers should, therefore, be alert to the quality of practising alternative practitioners, for example by insisting on professional certification. Equally, good quality may increase people's trust in public health care.

Controlled pilot study of the effects of neuromuscular therapy in patients with Parkinson's disease

The objectives of this study is to examine the effects of neuromuscular therapy (NMT) on motor and nonmotor symptoms in Parkinson's disease (PD). Thirty-six subjects with PD were randomly assigned to NMT or music relaxation (MR, or active control). Subjects received treatment twice a week for 4 weeks. Testing was conducted at baseline, after final treatment, and 8 days after final treatment. Primary outcome measures were the Motor subscale of the United Parkinson Disease Rating Scale (UPDRS) and the Clinical Global Impression scale (CGI-Change). Secondary outcome measures included a PD-specific quality of life scale (PDQ-39), quantitative measures of motor function, and severity scales for anxiety and depression symptoms. NMT resulted in a significant and sustained improvement in the Motor subscale of the UPDRS (P < or = 0.0001), most notable in the tremor scores. Also improved 1 week after the last treatment were the CGI scores (P = 0.007) and the finger-tapping speed (P = 0.001). The MR active control group had a slight improvement in tremor but evidenced no other change in motor function. Both groups exhibited a modest improvement in quality of life immediately after the last treatment. This effect was sustained for 8 days only in the MR group. In the nonmotor domains, the MR group evidenced improvements in mood (P = 0.001) and anxiety (P = 0.002), whereas NMT had no effect on mood (P = 0.09), and its initial effect on anxiety (P = 0.0009) dissipated after 8 days (P = 0.40). Group differences for UPDRS motor score and patient CGI-Change were superior in the NMT compared to the MR group. There was no group difference in PDQ-39 scores or in nonmotor measures. The findings suggest that NMT can improve motor and selected nonmotor symptoms in PD and that this effect is more durable for the motor symptoms. The results of this pilot study warrant larger controlled studies to examine dose range, durability, and mechanisms of NMT in PD function.

Using a novel exercise programme for patients with muscular dystrophy. Part I: a qualitative study

Muscular dystrophy patients have often experimented with different alternative or complementary methods since there is at present no curative medical treatment.

PURPOSE

To evaluate, through qualitative analysis of interview data, the subjective experiences of twenty-eight patients with muscular dystrophy practising a complementary method, qigong.

METHODS

Semi-structured qualitative interviews were performed and data were analysed by a method inspired by Grounded Theory. The material was first coded into 119 categories, thereafter condensed to 59 categories through a constant comparison analysis. In the final analysis, six broad categories were formed out of these 59 categories.

RESULTS

These broad categories were: (1) experience of health care and alternative methods; (2) expectations, acceptance and compliance; (3) qigong as an adaptable form of exercise; (4) stress reduction and mental effects; (5) increased body awareness and physical effects; (6) psychosocial effects of group training.

CONCLUSION

Qigong was accepted as a novel exercise regimen and there was a wide variation of experience regarding it among the participants. Depending upon factors such as expectation of benefits, time available to do qigong and perceived effects doing it, compliance varied. One major advantage of qigong is the ability to adapt the different exercises to the physical capability of the person practising qigong. There were reports of mental, physical and psychosocial effects of the qigong, which reduced the feeling of stress and improved well-being.

Why physicians need to look more closely at the use of complementary and alternative medicine by multiple sclerosis patients

With the aim of contributing to the knowledge of attitudes, patterns and motivations for the use of complementary and alternative medicine (CAM) for multiple sclerosis (MS), 109 MS outpatients, or their close relative in cases of mental status impairment, were interviewed using a semi-structured questionnaire. The main results are: (i). 35.7% used at least one CAM at least once; (ii). homeopathy and diets were the most common; (iii). 39.4% showed a positive attitude towards CAM; (iv). a perceived benefit was recorded in 61.5% of cases; (v). the referral source was a physician in only 12.8% of cases; (vi). caring neurologist was not consulted in 82% and generalist was not consulted in 67% of cases; (vii). of 61 CAM interventions, 21 were expected to be disease-modifying and 40 symptomatic; (viii). CAM negatively influenced compliance with conventional medical management in very few cases (2/39); (ix). a higher expanded disability status scale (EDSS) was observed in CAM users; and (x). in those who used CAM during last 3 years (21.1%), the approximate mean cost per year per person was 483 euro. In Italy, the use of CAM in MS is widespread but costly. This study has provided further baseline data on which to assess trends in CAM use and has highlighted issues for patients and conventional doctors about the use of CAM to deal with health problems. More research into the implications of concurrent use of CAM with conventional medicine on public health care is required.

L’évaluation médico-économique dans la sclérose en plaques

In multiple sclerosis, evaluation of quality of life is important because the patients are usually confronted with a decrease in physical, cognitive and social functioning. Apart from the personal suffering, the financial consequences for these patients and their family and the economic burden for society are enormous. Measurement of health related quality of life is important for the understanding of disease burden and the impact of specific MS treatments. Rising costs associated with new treatments and spending limits have prompted a search for gratter efficiency. Although health economics research can suggest ways to maximize health benefits within fixed budgets it is currently underused in MS. The purpose of this review of the literature is to explain some of the basic principles underlying both quality of life and economic evaluations, and analyse their contribution to understanding and managing patients with MS. Neurologists should not underestimate how dramatic their contributions can be to this maturing field that will influence the future of MS patients care.

Health care communication issues in multiple sclerosis: an interpretive description

Communication between persons with chronic illness and their professional health care providers is a critical element of appropriate health care. As the field of health care communication evolves, it becomes apparent that aspects of the illness experience shared by those affected by specific diseases might be a source of particular insight into what constitutes effective or appropriate communications. This interpretive description of health care communication issues in multiple sclerosis was based on qualitative secondary analysis of a set of in-depth interviews and focus groups conducted with 12 persons with longstanding MS experience. Analysis of their accounts illustrates an intricate interplay between common features within the disease trajectory and the communications that are perceived as helpful or unhelpful to living well with this chronic illness. From the analysis of these findings, the authors draw interpretations regarding what might be considered communication competencies for those who care for patients with this disease.

Ca2+ dependency of N-cadherin function probed by laser tweezer and atomic force microscopy

This study was undertaken to provide a biophysical basis for the hypothesis that activity-dependent modulation of cadherin-mediated adhesion by transient changes of extracellular calcium ([Ca2+]e) is causally involved in coordination of synaptic plasticity. Characterization of homophilic N-cadherin binding by atomic force microscopy and laser tweezer trapping of N-cadherin-coated microbeads attached to the cell surface of cultured neuronal cells showed that adhesive activity of N-cadherin is effectively regulated between 0.3 and 0.8 mm [Ca2+]e. Furthermore, we show that an increase of [Ca2+]i, which is known to be essential for induction of synaptic plasticity, causes significant reduction of cadherin-mediated bead adhesion that could be completely suppressed by inhibition of actin depolymerization. The results of this study show that N-cadherin has ideal biophysical properties to serve as a Ca2+-dependent sensor for synaptic activity and, at the same time, is strategically located to control synaptic adhesion. A drop of [Ca2+]e and a concomitant increase of [Ca2+]i may act in concert to modulate N-cadherin-based adhesive contacts at synaptic sites.

Complementary and Alternative Therapy Use in Persons with Multiple Sclerosis

Use of complementary and alternative therapies (CATs) is common with both the general population and with people who have multiple sclerosis (MS). The purpose of this study was to describe the reported use and perceived effectiveness of different CATs in a large sample (N = 621) of people with MS. One-third of the participants reported that they were presently using one or more CATs, and 50% had tried one or more CATs in the past. Most CATs were perceived as being helpful. People who were presently using CATs differed little from those who were not with regard to demographic- and illness-related variables. Use of CATs was positively associated with the practice of other health-promoting behaviors. The frequent use of different CATs suggests that clinicians should systematically and nonjudgmentally inquire about CAT use among their patients.

Comments on "the Feldenkrais Method: a dynamic approach to changing motor behavior"

The Feldenkrais Method has recently been discussed to fit within a dynamic systems model of human movement. One basis for this discussion is that small changes in one system--for example, enhanced body awareness--has far reaching implications across the whole of human performance. An alternative view on the Feldenkrais Method is argued here. It is argued that the clinical data do not support the Feldenkrais Method as being an effective way to improve motor performance. Further, it is argued that positive outcomes in pain and other wellness measures following Feldenkrais interventions can be ascribed to self-regulation. As part of this discussion, the role of body awareness, attentional focus, and kinesthesia in motor leaning and control are explored.

Use of unconventional therapies by individuals with multiple sclerosis

OBJECTIVE

To examine the prevalence and patterns of use of complementary and alternative medicine (CAM) among individuals with multiple sclerosis (MS) in the USA and to explore the reasons for use, symptoms treated and perceived effectiveness of these therapies.

METHODS

Surveys were mailed to the entire mailing list of the MS Foundation, constituting 11,600 individuals with MS or their family members; 3,140 adults with MS returned surveys, yielding a response rate of 27.1%.

RESULTS

More than half of the responding sample (57.1%) had used at least one CAM modality. The longer that people had MS and the less satisfied they were with conventional health care the more likely they were to use CAM therapies. The most common reasons for using CAMs were the desire to use holistic health care (i.e., treatments that recognized the interrelatedness of mind, body and spirit) and dissatisfaction with conventional medicine. Ingested herbs were the most frequently used CAM modalities (26.6%), followed by chiropractic manipulation (25.5%), massage (23.3%) and acupuncture (19.9%). Women were 25% more likely than men and whites were 30% more likely than non-whites to use CAM therapies. There was no significant relationship between the frequency of use and the reported efficacy of the CAM techniques (r = 0.17, p > 0.10).

CONCLUSIONS

The prevalence of CAM use in this population warrants more research on the efficacy and safety of these therapies, especially those with high usage or high efficacy ratings, such as herbs, chiropractic manipulation and massage, but for which there is little or no research evidence for efficacy or safety.

Quality, efficacy and safety of complementary medicines: fashions, facts and the future. Part I. Regulation and quality

This is the first of two papers which review issues concerning complementary medicines. The first reviews the extent of use of complementary medicines, and issues related to the regulation and pharmaceutical quality of these products; the second considers evidence for the efficacy of several well-known complementary medicines, and discusses complementary-medicines pharmacovigilance. The term complementary medicines describes a range of pharmaceutical-type preparations, including herbal medicines, homoeopathic remedies, essential oils and dietary supplements, which mainly sit outside conventional medicine. The use of complementary medicines is a popular healthcare approach in the UK, and there are signs that the use of such products is continuing to increase. Patients and the public use complementary medicines for health maintenance, for the treatment or prevention of minor ailments, and also for serious, chronic illnesses. The pervasive use of complementary medicines raises several concerns. Many of these arise because most complementary medicines are not licensed as medicines, and therefore evidence of quality, efficacy and safety is not required before marketing. The regulatory framework for herbal medicines and dietary supplements is currently under review. A new system for registration of traditional herbal medicines will ensure that marketed products meet standards for quality and safety. At present, the pharmaceutical quality of many complementary medicines is a cause for concern.

Homeopathy in multiple sclerosis

Multiple sclerosis (MS) is the most common disease of the central nervous system affecting people between the ages of 20 and 40 years in the UK, Northern Europe and the USA. No definitive treatment yet exists to halt the almost inevitable decline in function and accumulation of disability over the years in sufferers. Management is largely directly of symptoms which arise variably in the course of the condition. Such problems as urinary incontinence, sexual dysfunction, cramps and spasms, tremor and trigeminal neuralgia can often be helped to some extent using conventional therapies. These treatments though are not effective in everyone, or cause unacceptable side-effects and there are some commonly reported symptoms, such as fatigue or emotional lability for which there are no generally accepted treatments. Here, a knowledge of complementary and alternative medicine (CAM) can bring benefits to the person with MS. CAM is widely used by people with MS and some studies in this area are briefly summarised. It is interesting to reflect what lies behind all this CAM use and what that might tell conventional medicine about just what it is the MS sufferer really wants from their carers. Homeopathy is a form of CAM unique in the UK in having been available in the NHS since the foundation in 1948. Medical homeopaths in the UK have always been concerned with the integration of the best of conventional and complementary treatments for the benefit of their patients. Glasgow Homeopathic Hospital has around 100 admissions each year of people with MS at different stages of the condition and aims at an integrated response to their distress. Different therapeutic modalities are employed, but a homeopathic approach in particular is of benefit in MS. By its nature, it is a whole-person approach and allows for complete individualisation of treatment, taking account of the minutiae of someone's life. This is discussed and some examples of homeopathic treatments, which seem to be more generalisable for commonly encountered MS symptoms, are given.

Use of complementary/alternative therapies by women with advanced-stage breast cancer

BACKGROUND

This study sought to describe the pattern of complementary/alternative medicine (CAM) use among a group of patients with advanced breast cancer, to examine the main reasons for their CAM use, to identify patient's information sources and their communication pattern with their physicians.

METHODS

Face-to-face structured interviews of patients with advanced-stage breast cancer at a comprehensive oncology center.

RESULTS

Seventy three percent of patients used CAM; relaxation/meditative techniques and herbal medicine were the most common. The most commonly cited primary reason for CAM use was to boost the immune system, the second, to treat cancer; however these reasons varied depending on specific CAM therapy. Friends or family members and mass media were common primary information source's about CAM.

CONCLUSIONS

A high proportion of advanced-stage breast cancer patients used CAM. Discussion with doctors was high for ingested products. Mass media was a prominent source of patient information. Credible sources of CAM information for patients and physicians are needed.