Monday, 28 January 2013

Alternative Medicine..safe? But where is the Evidence?

Senders et al. Mind-body medicine for multiple sclerosis: a systematic review. Autoimmune Dis. 2012;2012:567324. doi: 10.1155/2012/567324.

Background: Mind-body therapies are used to manage physical and psychological symptoms in many chronic health conditions.

Objective: To assess the published evidence for using mind-body techniques for symptom management of multiple sclerosis. Methods. MEDLINE, PsycINFO, and Cochrane Clinical Trials Register were searched from inception to March 24, 2012. Eleven mind-body studies were reviewed (meditation, yoga, biofeedback, hypnosis, relaxation, and imagery).


Results: Four high quality trials (yoga, mindfulness, relaxation, and biofeedback) were found helpful for a variety of MS symptoms.

Conclusions: The evidence for mind-body medicine in MS is limited, yet mind-body therapies are relatively safe and may provide a non-pharmacological benefit for MS symptoms.



Whilst many of you believe in the virtues of non-pharmaceutical approach, the simple fact as shown here, is that there is not enough good evidence to support things one way or another. Who will fund the studies and who will undertake them?

22 comments:

  1. I think this type of thing gives pwople a feel good factor, which isn't a bad thing. IF studies proved soe benefit, what asre the implications? Medicalisation of therapies often seems to end up with a hike in the price to the end user. Witness simple implements adopted by Occupational Therapists that seem to sky rocket in proce.

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    1. At the least, the nonpharmaceutical approaches would give a placebo effect, wouldn't they? That's not a bad thing either.

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    2. Depends on how much money you're willing to pay for a placebo effect I suppose.

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    3. At least you don't get serious adverse effects with a poor outcome. On the other hand we MSers try a combination of CAMs, which will be most probably never be tested on a clinical trial.

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    4. Too true, Rayboy, because my MS is so 'mild' according to the neurologists I've seen over the 15 years, I've been diagnosed as having RRMS, repeated attempts to get DMTs have been rejected, so I've gone down the CAM path since my CIS event 25 years ago. Does this have anything to do with having 'mild' MS, who knows. When I first stared taking D3, at 5000 iu each day, the neurologist I told, looked at me as if I had two heads. Same when I first mentioned I walk between 5 and 8 miles each day, same when I mentioned the possibility of a gut connection, and, oh, so many more CAM treatments that are now prescribed or in clinical trials -usually as add one to standard DMTs. I take quite a few things and do a lot of meditation because I haven't had a choice. And looking at the toxic side affects of the treatments and the benefits of CAM (all researched and not from just googling), I'm glad of this. It doesn't mean I wouldn't be hammering on the door to get treatment if I could. But until then, I'm not going to wait around in a dark room getting depressed and progressively worse.

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    5. Anonymous 10:25
      Could we know more about all these CAM treatments and your regular routine?

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  2. The title of the post is misleading - the study isn't about Alternative Medicine but about mind-body therapies and practices.

    Meditation, yoga, biofeedback, hypnosis, relaxation, imagery, etc can help anybody to deal with the stresses and problems of life. MSers have to deal with the problems that come with MS in addition to the usual problems that everyone has. Hence they need such coping mechanisms even more than healthy people do.

    MSers who stay peaceful & positive may or may not do better objectively, but at least they will be happier.

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    1. It would be interesting to see studies of MSers and meditition in regards to brain atrophy.

      The article
      Ann N Y Acad Sci. 2014 Jan;1307:82-8. doi: 10.1111/nyas.12217. Epub 2013 Aug 7.
      Exploring age-related brain degeneration in meditation practitioners.
      Luders E.

      These findings not only imply a close link between meditation and brain structure, but also suggest possible modulating effects of meditation on age-related brain atrophy.

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    2. I note the article here discusses some benefits for MSers to meditate. I would say it is much more than a placebo effect.

      Neurol Res Int. 2014;2014:704691. doi: 10.1155/2014/704691. Epub 2014 Jul 1.
      Meditation as an adjunct to the management of multiple sclerosis.
      Levin AB1, Hadgkiss EJ2, Weiland TJ3, Jelinek GA4.

      I also see a UK university is currently researching stress management for MSers. Also the benefits of yoga seem positive for MSers.

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    3. The effect of meditation on the immune system is interesting. A stressed person has a weakened immune system and the hypothesis that meditation enhances (strengthens) the immune system by reducing overall stress levels. Measuring the different subsets of leukocytes and lymphocytes (cells that fight viruses and bacteria) of meditators and control group.

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    4. Interesting therefore that many here report that stress brings on a relapse, indicating a strengthened immune response or deleterious effects on regulatory cells perhaps?

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    5. Not that simple. Some forms of stress 'ramp' up the immune system, studies have shown that both personal conflict and some competitive sports trigger cytokines, but with differing outcomes. It also largely depends on what you feel/think defines stress. This is what pyscho-neuro-immunology (PIN) examines and is pulling together. I'm always quite surprised that quite a few neurologists don't know much about PIN, my cousin who is a consultant obstetrician even did post doctoral training in it - in the 1990s. And yet so little research has gone into the MS and stress connection.

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    6. Well I'll give you an example from our mice. We induce an MS-like disease in the mice by immunising against spinal cord antigens, which works very well with very high incidence but if there is noisy building work (drilling etc) in the building in which they're housed the mice get stressed don't get disease.
      I'm sure there is something in PNI but how you measure it and how you design experiments to investigate the phenomenon is difficult.

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    7. as I said lots of types of stress and frankly I'm not convinced mice experience the same types of stress in all its multi-various forms as humans. Also consider chronic as well as acute stress.

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    8. Which backs up my point on how difficult it is to get empirical evidence rather than anecdotal (which is of course as many say no evidence).

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    9. I think a relapse I had was triggered by stress and worry. There is stress, worry and anxiety and all have different mechanisms I expect. How can you test worry on a mice? With stress the stress may be over weeks rather than hours or a day or two. How can you test weeks of continuous chronic stress on mice?

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    10. Thing is what appears to be an apparent link in causality can lead you astray if you're not careful. This hypothesis is a case in point (it's one of my favourites which can be used in the CCSVI debates).
      http://www.ncbi.nlm.nih.gov/pubmed/15325026

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    11. MouseDoctor 2 there could be something in this article.

      Int J Yoga. 2014 Jul;7(2):147-51. doi: 10.4103/0973-6131.133899.
      Levels of immune cells in transcendental meditation practitioners.
      Infante JR1, Peran F2, Rayo JI1, Serrano J1, Domínguez ML1, Garcia L1, Duran C1, Roldan A3.

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    12. Interesting that there is increasing research evidence to support the application of meditation techniques to help improve cognition and memory in patients with neurodegenerative diseases.

      Ann N Y Acad Sci. 2014 Jan;1307:112-23. doi: 10.1111/nyas.12187. Epub 2013 Aug 7.
      Meditation and neurodegenerative diseases.
      Newberg AB1, Serruya M, Wintering N, Moss AS, Reibel D, Monti DA.
      Author information
      Abstract

      Neurodegenerative diseases pose a significant problem for the healthcare system, doctors, and patients. With an aging population, more and more individuals are developing neurodegenerative diseases and there are few treatment options at the present time. Meditation techniques present an interesting potential adjuvant treatment for patients with neurodegenerative diseases and have the advantage of being inexpensive, and easy to teach and perform. There is increasing research evidence to support the application of meditation techniques to help improve cognition and memory in patients with neurodegenerative diseases. This review discusses the current data on meditation, memory, and attention, and the potential applications of meditation techniques in patients with neurodegenerative diseases.

      © 2013 New York Academy of Sciences.
      KEYWORDS:

      cognition; meditation; memory; mindfulness; neurodegenerative disease

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  3. I had reflexology this afternoon, feel much better now. Makes a nice change from taking pills with their side effects. It works for me, but maybe it wouldn't for other people and if it does me no harm I have nothing to lose.

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    1. Burschka JM, Keune PM, Oy U, et al.
      Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression..
      BMC Neurol. 2014 Aug 23;14(1):165. [Epub ahead of print]Burschka JM, Keune PM, Oy U, et al.
      Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression..
      BMC Neurol. 2014 Aug 23;14(1):165. [Epub ahead of print]

      Is Tai Chi beneficial for people with MS?
      Summary

      Tai Chi is a Chinese martial art that incorporates gentle physical exercise with mindfulness training. This study aimed to investigate the effect of a six month long programme of Tai Chi on people with MS.

      32 people with MS in Germany took part in the study. 15 participants took part in a six month Tai Chi programme where they took part in a 90 minute class every week and 17 were the control group and did no Tai Chi.

      The study found that the participants who had taken part in the Tai Chi programme had significant improvements in their balance, coordination and depression. Participants in this group were also more satisfied with life after the programme. Levels of fatigue remained relatively stable in the Tai Chi group, but increased in the control group.

      The study results indicate that Tai Chi could be useful for people with MS. It appeared to have a beneficial effect on balance and coordination as well as psychological wellbeing. The authors conclude that further larger studies are needed to confirm their results as they only looked at a small group to test the programme they had designed.

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    2. Anon 9.16 If it works for you then keep doing it!

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