Complementary/Alternative Medicine Use Changes With MS Progression
The transition from moderate to severe impairment is when many MS patients turn to complementary or alternative medicine
Persons with multiple sclerosis (MS) use complementary and alternative medicine (CAM) most often during the transition from moderate to severe impairment and have a shorter duration of illness than nonusers, according to the findings of a longitudinal survey of 119 patients. At the end of 7 years, relaxation techniques and traditional Chinese medicine (TCM) were the preferred therapies, according to the study, which appeared in the journal Complementary Therapies in Medicine (Kochs et al., 2014).
“It has been reported that MS patients use CAM due to dissatisfaction with conventional treatments or associated side effects, a negative relationship to their physician, the wish for active therapy participation, or physician’s or family members’ [advice,]” wrote Luise Kochs of the gynecology service of HELIOS Hanseklinikum Stralsund in Germany and colleagues. “To date, little is known about objective, positive effects of CAM use during the course of MS. … [L]ongitudinal data on CAM use in patients with MS are very rare.”
The goal of the study was to examine CAM use among persons with MS during the course of their disease and as a function of disability progression, disease duration, stage of impairment, and socioeconomic factors.
In 2002 and 2009, 119 persons with MS underwent semistructured interviews regarding CAM utilization and sociodemographic and disease factors, and depressive symptoms were measured by the Beck Depression Inventory. Various statistical tests allowed comparison of CAM users and nonusers. Most CAM was used as an adjunct to conventional treatment rather than as a replacement for it.
At the second interview 7 years later, fewer persons with MS used CAM; their disease had progressed; and their socioeconomic situation had worsened. CAM use typically occurred during a transition from moderate to severe impairment, characterized by Expanded Disability Status Scale (EDSS) scores between 3.5 and 4.0 points. Median illness duration in CAM users was shorter than in nonusers by about 2 years.
CAM therapies changed over time
During the 7-year study period, there were changes in the modalities of CAM most widely used. Techniques most often reported at the first interview were kinesitherapies (78.5%), vitamins (48.4%), and other dietary supplements (36.6%), whereas relaxation techniques (38.2%), TCM (25.5%), and homeopathy (18.2%) were reported most often at the second interview.
The investigators suggested that possible reasons for the decline in prevalence of CAM use might be dissatisfaction or a bad experience with CAM-associated side effects, as well as financial issues due to cost of CAM therapy coupled with disability-related loss of income. However, this study was unable to address these possibilities due to lack of data regarding reasons for starting or stopping CAM use, or for choice of specific therapies. The study was also limited by lack of data regarding the efficacy of CAM therapies.
“[W]e conclude that patients report most CAM use at a stage of disease with first serious symptoms and first considerable impairments, e.g. a reduction of the maximal walking distance,” the study authors wrote. “At this stage, patients may aim to try every possible treatment for the disease or its symptoms, whereas patients in an advanced stage of disease may have resigned to the fact that they suffer from an incurable disease.”
Key open questions
- What are the reasons why persons with MS tend to discontinue CAM therapies as their disease progresses?
- How effective are various CAM therapies in different stages of MS?
Disclosures and sources of funding
The study authors and Dr. Pucci reported having no financial disclosures.