Alternative therapies: more evidence needed

Type the words “alternative therapies” and “multiple sclerosis” into google and thousands of articles are listed. It is likely that many people with MS have done this, as just over 50% of people with MS have reported using complementary and alternative medicines (CAMs) in the past year. It is therefore important to understand how and if these therapies work, if they are safe and whether they might interfere or interact with conventional therapies.

The World Health Organisation (WHO) defines CAMs as “a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system.” They include diets, exercise regimes, other drugs such as cannabis, and some psychological therapies.

In a study published in the Journal of Neurology, Neurosurgery and Psychiatry, written by Dr Suzi Claflin, Associate Professor Ingrid van der Mei and Professor Bruce Taylor from the Menzies Institute from Medical Research in Australia, the authors conducted an in-depth review of published scientific studies into CAMs. They wanted to investigate the effects of CAMs in MS. They found that only a small percentage of the studies were well designed and used robust scientific methods.

In early 2017, the authors used the online Pubmed Database, that catalogues published research articles, to search for studies into the use of CAMs in MS. They found 1,916 studies. Of these, 38 studies were of the type that met the criteria to be included in the analysis,  that is they were of a similar design to that used to test new drugs or other conventional therapies. These 38 studies mainly investigated the effects of cannabis, diet and supplements, exercise, and psychological approaches to treating MS.

The most consistent shortfall of the CAM studies was that the number of people participating in the studies were too small. This could result in the statistical analysis being skewed leading to a false result that in fact could be due to other factors or to chance alone.

Another common problem was lack of ‘blinding’. This means that the participants of the study and the researchers conducting the measurements and assessments, knew whether they were receiving an active treatment or a placebo (dummy treatment). This can cause problems in a trial as it can affect behaviour and expectations of both the participants and the researchers and can potentially lead to a biased result(s).

Many of the studies also used very different health outcome measures to identify the effects of a treatment. This makes it very hard to compare the studies and know if the results are consistent and reproducible across studies.

The same conclusions were reached by the American Academy of Neurology in a similar review published in 2014.

Both papers suggest that the use of cannabis and psychological treatments may improve specific health outcomes, however the majority of results for other types of CAMs were found to be inconclusive.

These conclusions are disappointing as many individuals with MS feel that CAMs can help to put them in control and make a difference to their quality of life. However, as the authors say “This is not to say that CAMs have no effect on MS, but that there is currently no rigorous scientific evidence to support their use.”

The authors suggest that one solution would be to establish a CAM trial group within the MS research community, to agree on consistent study designs and outcome measures to help improve the quality of the evidence.

MS is a very varied disease and each person’s individual experience is different. If you are considering taking a CAM instead of, or in combination with, a conventional therapy, we recommend that you discuss this with your treating physician.

With thanks to MS Research Australia – the lead provider of research summaries on our website.