Pinning your hope on ... acupuncture.

CAM stands for Complementary and Alternative Medicine, a group of diverse therapies and products that are neither part of conventional medicine as taught in U.S. medical schools, nor generally available at U.S. hospitals. The practice of using an unconventional therapy together with conventional medicine is called "complementary medicine."

What it is

Acupuncture, one of the hallmark treatments of traditional Chinese medicine (TCM), is one of the oldest and most commonly used health practices in the world. TCM is based on the idea that health is maintained through the body's flow of "qi," or energy. Imbalances in qi lead to illness.

Acupuncture stimulates critical points on the body in order to rebalance qi through the use of thin, metallic needles that are inserted into the skin. Other methods can be used to stimulate acupuncture points, including the application of finger pressure (also known as acupressure or shiatsu), electrical impulses delivered through a wand-like instrument (electroacupuncture), small heated cups (cupping), and smoldering herbs (moxibustion).

East is East and West is West

Studies have documented acupuncture's effects but have not been able to fully explain how acupuncture works within the context of Western medicine. Therefore, acupuncture is viewed as a CAM treatment in the United States where it is now widely used, including among people with MS.

In the general population

In 1998, the National Institutes of Health (NIH) established a panel to evaluate acupuncture's benefits. It concluded that there was strong evidence for its use in managing dental pain and certain kinds of nausea. In addition, the panel cited other conditions that may benefit from acupuncture, including headache and stroke rehabilitation. The World Health Association also evaluated acupuncture, and cited its potential benefits for more than 40 conditions, including trigeminal neuralgia and bladder problems.

Studies in people with MS

Despite its widespread use, studies among people with MS are scarce. In one preliminary report from a well-designed trial, acupuncture appeared to decrease bladder urgency and episodes of incontinence. However, the trial was small, involving 41 people for only 16 weeks. There have also been small studies showing that acupuncture may be effective for spasticity, anxiety, depression, dizziness, and sleeping difficulties. More studies are needed to confirm acupuncture's effect on these symptoms.

Experiences of people with MS

How do people with MS view the benefits of acupuncture? The Rocky Mountain MS Center conducted an online survey of about 1,200 people with MS: 277 reported acupuncture use. Two-thirds of the users said pain and anxiety lessened. About 50-60% of users reported that fatigue, depression, muscle stiffness, numbness, and insomnia improved.

In a Canadian survey of 848 people with MS, 217 had used acupuncture. Approximately two-thirds of the users reported improvement to symptoms that included pain, spasticity, bowel and bladder difficulties, tingling, weakness, walking difficulties, coordination problems, and sleep disorders.

Safety

In general, acupuncture is well-tolerated, especially when done by an experienced acupuncturist. In fact, the NIH panel concluded that acupuncture was "remarkably safe with fewer side effects than many well-established therapies." Side effects include bleeding or bruising at acupuncture sites, needle pain, and fatigue.

The immune question is unanswered

Since MS is associated with over-activity of some parts of the immune system, people with MS might well wonder about acupuncture's effect on the immune system. Unfortunately, no study has evaluated this. Studies done in people with cancer, rheumatoid arthritis, lupus, and AIDS show varying responses: in some immune system activity was enhanced, in others inhibited, and in still others there was no effect at all.

Other cautions

People with damaged or prosthetic heart valves should probably not use needle acupuncture because of the risk of infection. People with bleeding disorders or who take blood-thinning medication (warfarin or Coumadin[TM]) may occasionally experience bruising or, more rarely, bleeding complications. Practitioners should use sterile, one-time-use needles to avoid infection risks such as hepatitis.

Electroacupuncture may produce heart rhythm abnormalities in people with a pacemaker, and the fumes from moxibustion may worsen breathing in people with asthma. Acupuncture in the chest area should be done with caution to avoid lung or heart injury.

Herbal preparations for internal use are a component of traditional Chinese medicine (TCM). Despite a long history of use, these herbs have not been well studied. Quality is variable and toxicities have been reported. Furthermore, some of the herbs used have immune-stimulating properties which, in theory, could be harmful to people with MS. We believe it's best to avoid TCM herbs.

Choice ... on pins and needles 

Whether acupuncture is a good choice for you will depend on a number of factors, including your specific symptoms and your financial resources. Insurance may not cover acupuncture.

There is no evidence suggesting that acupuncture can reduce the frequency of MS exacerbations or slow the progression of disability. The surveys and small clinical trials suggest that acupuncture might provide some relief for pain, spasticity, numbness and tingling, bladder problems, anxiety, and depression. Thus, people who choose acupuncture are advised to use it as an addition to--and not a substitute for--standard medical treatments. Always consult an MS health-care professional before starting any new treatment.

Finally, treatment should be provided by a practitioner certified by the National Certification Committee for Acupuncture and Oriental Medicine. To find one in your area, go to www.nccaom.org.

It's important to tell your physician about any dietary supplements or complementary treatments you are considering or taking. It's equally important that your physician listen respectfully to your questions and concerns regarding CAM.

For a list of studies on acupuncture and MS, visit national mssociety.org/ AcupunctureResearch

BY ALLEN C. BOWLING, MD, PHD, AND TOM STEWART, JD, PA-C 

Allen C. Bowling, MD, PhD, neurologist, and Tom Stewart, JD, PA-C, are both at the Rocky Mountain MS Center in Englewood, Colorado, which emphasizes a comprehensive approach to MS care. For more information about CAM and MS, go to www.ms-cam.org.

Dr. Bowling's book Complementary and Alternative Medicine and Multiple Sclerosis, now in its second edition, is available from www.demosmedpub.com.