OBJECTIVE: To develop evidence-based recommendations for complementary and alternative medicine (CAM) in MS.
METHODS: We searched the literature (1970-March 2011; March 2011-September 2013 MEDLINE search), classified articles, and linked recommendations to evidence.
RESULTS AND RECOMMENDATIONS:
- Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain) (Level A).
- Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B).
- Clinicians should counsel MSers that these agents are probably ineffective for objective spasticity (short-term)/tremor (Level B) and possibly effective for spasticity and pain (long-term) (Level C).
- Clinicians might offer Sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency (Level B).
- Clinicians should counsel MSers that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B).
- Clinicians might choose not to offer these agents for tremor (Level C).
- Clinicians might counsel MSers that magnetic therapy is probably effective for fatigue and probably ineffective for depression (Level B).
- Fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life (QOL) (Level B).
- Ginkgo biloba is ineffective for cognition (Level A) and possibly effective for fatigue (Level C).
- Reflexology is possibly effective for paresthesia (Level C).
- Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and fatigue (Level C).
- Bee sting therapy is possibly ineffective for relapses, disability, fatigue, lesion burden/volume, and health-related QOL (Level C).
- Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation.
- Safety/efficacy of other CAM/CAM interaction with MS disease-modifying therapies is unknown.
Conclusions: Although it is sometimes hard to define, complementary and alternative medicine (CAM) refers to health care approaches that are developed outside of mainstream and conventional medicine. "Complementary" and "alternative" are often used interchangeably, but there are some differences. "Complementary medicine" generally refers to using a non-mainstream approach together with conventional medicine. "Alternative medicine" refers to using a non-mainstream approach in place of conventional medicine. The boundaries between complementary and conventional medicine can overlap and even change with time. Most CAM therapies are not regulated by the US Food and Drug Administration, which means the quality and purity of CAM therapies may vary significantly.
In guidelines and other publications, recommendation for a clinical service is classified by the balance of risk versus benefit of the service and the level of evidence on which this information is based. The U.S. Preventive Services Task Force uses:
Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweigh the potential risks. Clinicians should discuss the service with eligible patients.
Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients.
Level C: At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Clinicians need not offer it unless there are individual considerations.
Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs
potential benefits. Clinicians should not routinely offer the service to asymptomatic patients.
Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.