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The Use and Effectiveness of Alternative Therapies in Multiple Sclerosis.

Abstract: Multiple sclerosis (MS) is a chronic debilitating disease with no cure. There has been increasing interest in the use of alternative therapies in combination with or in place of traditional therapies. Nurses and other health care professionals must become more aware of reasons persons with MS are using alternative therapies and identify any risks or potential benefits. The role of the health care professional is to educate persons with MS on contemporary research, cost and regulation of these therapies.

Introduction

Multiple sclerosis (MS) is a chronic progressive disease, affecting millions of people world-wide, mostly women. The uncertainty and progressive nature of the disease make it difficult to treat. Consequently, there is an increasing interest in the use of alternative therapies to treat MS.[7]

Multiple sclerosis is a demyelinating disease affecting the central nervous system. An autoimmune process brings about loss of myelin protecting the axons. This interferes with electrical conduction and produces a variety of symptoms. Some of the problems are fatigue, stress, depression and sensory and motor dysfunction.[22]

The cause of MS is unknown and the course of the disease is unpredictable. There are no preventive methods and medical treatment is not only limited but costly. As a result persons with MS may seek alternative therapies. Alternative therapies are defined as therapies used in place of the traditional medical therapies.[11] Alternative therapies may include massage, imagery, acupuncture, aromatherapy, herbalism, therapeutic touch and nutritional therapy.[23]

There are three reasons why interest in alternative therapies is increasing. First, persons with MS are dissatisfied with traditional medical care due to ineffectiveness, adverse effects and high costs of technologies such as magnetic resonance imaging (MRI) and intrathecal baclofen. Second, many want to assume control of their own health care. Many persons with MS see alternative therapies as more natural and closer to spiritual approaches.[1] Therapies such as massage, imagery, music and therapeutic touch are noninvasive, and offer a holistic approach which includes mind, body and spirit.

In 1992, the National Institutes of Health Office for the Study of Unconventional Medical Practices defined touch therapy, acupuncture, music, as well as 26 other modes of therapy as alternative therapies.[23] Other unconventional therapies also include massage, nutritional treatment, herbalism and aromatherapy.[5] Many of these therapies are in use by persons with MS.

This article discusses research and prevalence of alternative therapies use in persons with MS. The effectiveness of the therapies as well as the risks and benefits are addressed.

Research on the Use of Alternative Therapies

Recent studies in the United States and abroad describe the increasing use of alternative therapies in persons with MS.[1] One study examined the patterns of alternative therapy use in the United States in persons with 11 types of medical conditions, one of which was MS. Eighteen unconventional therapies were mentioned. Thirty-four percent of the respondents used at least one alternative therapy with acupuncture, hypnosis, massage and homeopathy used most frequently.[5]

Another study investigated the prevalence of alternative therapies used by persons with MS.[6] The study revealed that physical therapy, massage and nutritional alternatives were the most frequently used therapies. Other therapies included were therapeutic touch, acupuncture and aquatic therapy. The reason given for using alternative therapies was that no cure was offered by traditional medicine. The persons with MS in this study were seeking an alternative to traditional medical treatment.[6]

The effect of alternative therapies on symptom severity and functional status of persons with MS was the focus of several studies. Fawcet et al identified why people sought alternative therapies, the kind of therapies sought and a description of the experiences with each therapy.[7] Of the 16 patients studied, 14 stated that they had improved function and decreased symptom severity with use of alternative therapies.[7]

A similar study by Whitmore and Leake showed that complementary therapies including massage, music, guided imagery and visualization and nutritional supplements, such as megadoses of vitamins B, C and E, increased endurance, reduced stress, eliminated fatigue and enhanced relaxation in persons with MS and other degenerative and chronic diseases.[23] The study was conducted using a telephone survey of 1,500 people with MS. The results indicated that one in three respondents reported using at least one alternative therapy which decreased fatigue, anxiety and stress.[23]

In addition, Manley found that eating a diet low in fat, high in vitamins [B.sub.6], B[.sub.12], E and C improved the person's sense of control over the disease. The study also provided some evidence of symptom relief in a small number of the people. Conclusive results on the role of this type of diet in influencing MS is lacking.[14]

Maguire found that the use of relaxation and imagery influenced mood and attitudes in persons with MS. The sample consisted of 33 persons with MS.[13] Fifteen persons were in the treatment group and 18 were in the control group. The treatment group received six sessions of relaxation and imagery. The control group continued their regular medical regimen. The treatment group demonstrated decreased anxiety and more positive attitudes toward the illness state as evidenced by changes in illness imagery. Illness imagery was measured before and during treatment and patients showed drawings which depicted their illness. These drawings became progressively more positive. Relaxation produced significant reductions in anxiety and depressed states.[13]

Another study evaluated the effects of a pulsing magnetic field on disease activity in 30 persons with MS.[18] Fifteen of the people wore an active pulsing magnetic field device and the other fifteen received an inactive device. The people wore the device for 10-24 hours a day for 2 months. Findings demonstrated that there were significant improvements in bladder control, fatigue level, mobility and vision in the treatment group.[18]

On the other hand, Stenager et al found that nonmedical treatment did not alter the course of MS.[21] The sample included 49 patients from a hospital neurology unit. Many variables were measured in this study. The results showed no significant effect on the course of MS from the use of nonmedical treatment.[21]

Effectiveness of Alternative Therapies in MS

Alternative therapies may help persons with MS in many ways. Not only do persons with MS have physical changes such as fatigue, decreased mobility, numbness and poor bladder control, but they may also experience anxiety, depression and poor body image. Each therapy has different effects that should be discussed with MS patients considering use of alternative therapies.

One alternative therapy is imagery. Imagery is a psychological process that unites communication between perception and actual body changes.[13] It is thought to lessen anxiety by decreasing sympathetic arousal. Once the person's perception of their body changes, their illness imagery is improved and they feel more in control of the illness.

One of the oldest and most widely used alternative therapies is massage. It signifies caring and nurturing and brings about relaxation, pain relief and reduced stress. Massage decreases muscle spasm and tension and improves gastrointestinal activity. In addition, it causes blood vessel dilation which promotes lympathic drainage to eliminate wastes and spread nutrients in the body.[23]

Pulsing magnetic field therapy is thought to affect persons with MS by altering calcium transport across cell membranes which may facilitate axonal conduction in a demyelinated nerve. It also is thought to alter release of melatonin from the pineal gland and immune function of lymphocytes. The frequency signal may stimulate peripheral nerves to release endorphins. As a result, spasticity is reduced and bladder control and muscle energy improve.[18]

A diet low in fat has been linked to remission of MS symptoms and disease progression.[14] Although the exact pathophysiology is unknown, incidence and frequency of exacerbation of MS also appears to increase as dietary fat content increases. It is recommended that persons with MS consume less than 20g of fat per day.[14]

Vitamins such as B complex and C are believed to alleviate stress and fatigue while vitamin E may increase endurance. In MS, fatigue, decreased strength and stress are the more debilitating symptoms of the disease. The recommended doses are as follows: B complex 30-100ug/day, vitamin C 1000-2000mg/day and vitamin E 100-400IU/day.[23]

Herbal therapy is thought to be a more natural way to heal the body. The herbs most frequently used in the United States for MS are astragalus or milk vetch root and ginseng to treat fatigue, chamomile as an antispasmodic, kava and St. John's wort as an antidepressant and valerian as an antianxiety and antispasmodic.[8] In Southern China, an herb, tripterygium wilfordii hook-F, is used to suppress the immune response and thus the disease.[2]

Aromatherapy is the use of plant extract oil for massage, bath or inhalation. The aroma stimulates different areas of the brain causing release of neurotransmitters. One of the most frequently used types of aromatherapy is marjoram which releases serotonin and helps sleep patterns.[3] Other helpful oils include rose and chamomile to relieve stress, bergamot and lavender to relieve depression and lemon balm to relieve muscle spasms.[19]

Therapeutic touch is a method to transfer energy fields from one person to another without touching. It is thought to foster relaxation and relieve anxiety.[17] However, recent studies proposed the practice as controversial because it does not involve physical contact and is based on energy field interaction. These studies indicated limited scientific grounds for professional use.[15,20]

Acupuncture is an ancient Chinese practice based on the premise that energy fields are blocked in disease. The placement of 6 to 12 needles on certain points of the body called meridians releases endorphins, enkephalins and other neuropeptides. This increases circulation, decreases muscle spasm and anxiety and increases energy.[3]

Impfications for Nursing

Multiple sclerosis is an unpredictable disease. Persons with MS expect to exert some control over disease progression. Nurses can assist individuals to set reasonable goals and identify areas of control.

Health care professionals need to teach persons with MS about the disease process. This knowledge will help persons with MS recognize and control symptoms and promote a sense of optimism. Nurses and other health care professionals need to be educated on the newest medical and alternative approaches for these individuals and educate others. Persons with MS should understand the limits of both traditional medical treatment and alternative therapies. The nurse and the medical team need to develop a nonjudgmental approach to alternative therapies so the person with MS will feel comfortable discussing and then using them for their possible benefit.[11] Nurses must also be involved in research on the safety and efficacy of alternative therapies.

Each person needs to understand the possible risks and benefits of alternative therapies. For example, certain herbs such as chamomile and St. John's wort produce allergic responses such as hay fever and photosensitive skin and tripterygium wilfordii hook-F may have adverse effects when taken with glycoside drugs such as digitalis.[8] St. John's wort should not be taken with other antidepressants or during pregnancy. Other side effects of St. John's wort are gastrointestinal upset and fatigue.[4] Although St. John's wort is not as effective as conventional medications, it is less costly. Megadoses of vitamin E can be toxic; vitamin E also has an antiplatelet effect. Hemorrhage may occur as vitamin E can depress clotting action of the blood.[9,10,16]

The Food and Drug Administration (FDA) has limited regulations regarding herbs. It has been suggested side effects should be listed as well as details on preparation. For example, herbs must be boiled properly in order to obtain the right dosage. Certain plants are smaller and may contain smaller quantities of plant extract. Also, since some manufacturers store herbs in lead containers, there is a risk for possible lead contamination.[8]

People need to understand that alternative therapies should be used with caution if substituting them for traditional treatment; the therapies may also be costly. Persons with MS should be encouraged to discuss the use of alternative therapies with their physician to avoid any contraindications with current treatment regimen. Also, the nurse can suggest alternative therapies that do have a research base, such as the effects of magnetic field therapy.[11] In addition, nurses must develop policies concerning the use of alternative therapies.

Recommendations for Nursing Practice

The literature supports the need for studies to determine the effects of alternative therapies on persons with MS. Further studies need to be done to determine if alternative therapies affect the disease process or simply give the individual comfort and altered beliefs about their disease. Previous studies have not consistently examined the placebo effect. Only two studies used treatment and control groups to examine the use of alternative therapies on MS. Each of the treatment groups received the alternative therapy and control groups received their usual conventional methods. It is not clear if the results of these studies were derived from the alternative therapies or simply the fact that the persons were involved in the studies and exposed to the therapies.[1] Also, it needs to be determined whether use of alternative therapies is altered by demographics, personality types or timing of use from start of symptoms or diagnosis.

Nurses should support a person's decision to seek out alternative therapies in their treatment plans. A frank and honest discussion of the pros and cons of alternative therapy should be addressed to clarify the person's decision-making process.

Summary

Although nurses and other health care professionals can do little to alter the course of MS, there are methods available to enhance physical activity, nutrition, stress management and spiritual growth. One of these strategies may be to support the person in using alternative therapies. The nurse or other health care professionals should give accurate, honest information about the impact of MS. They can provide counseling to support the person's decision about their own health care.[12]

Research is needed to assess why persons with MS seek alternative therapies as well as any benefits obtained from the therapies. Knowledge gained from this research can assist nurses to educate and counsel people with MS in making decisions about the various options they have for their health care.

References

[1.] Astin JA: Why patients use alternative medicine. JAMA 1998; 19:1548-1553.

[2.] Borchers AT, Hackman RM, Keen CL et al: Complementary medicine: A review of immunomodulatory effects of Chinese herbal medicines. Am J Clin Nutr 1997; 66:1303-1312.

[3.] Colbath JD: Holistic health options for women. Crit Care Nurs Clin North Am 1997; 4:589-599.

[4.] De Smet PA, Keller K, Hansel R, Chandler RF: St. John's wort as an antidepressant. Brit Med J 1996; 313:241-242

[5.] Eisenberg D, Kessler R, Foster C et al: Unconventional medicine in the United States. New Engl J Med 1993; 4:246-252.

[6.] Fawcett J, Sidney JS, Hanson M J, Riley-Lawless KR: Use of alternative health therapies by people with multiple sclerosis: An exploratory study. Holistic Nurs Pract 1994; 2:36-42.

[7.] Fawcett J, Sidney JS, Riley-Lawless KR, Hanson MJ: An exploratory study of the relationship between alternative therapies, functional status, and symptom severity among people with multiple sclerosis. J Holistic Nurs 1996; 2:115-128.

[8.] Gray MA: Herbs: Multicultural folk medicines. Orthop Nurs 1996; 2:49-56.

[9.] Halbert SC: Diet and nutrition in primary care. Complementary and Alternative Therapies in Primary Care 1997;4: 825-837.

[10.] Jonas W: Alternative medicine and the conventional practitioner. JAMA 1998;9:708-709.

[11.] Keegan L: Getting comfortable with alternative and complementary therapies. Nursing 1998; 4:51-53.

[12.] Lazar JS, O'Connor BB: Talking with patients about their use of alternative therapies. Complementary and Alternative Therapies in Primary Care 1997; 4:699-711.

[13.] Maguire BI: The effects of imagery on attitudes and moods in multiple sclerosis patients. Alternative Ther 1996; 5:75-79.

[14.] Manley P: Diet in multiple sclerosis. The Practitioner 1994; 238:358-362.

[15.] Meehan TC: Therapeutic touch as a nursing intervention. J Adv Nurs 1998; 1:117-125.

[16.] Pinnell N: Page 971 in: Nursing Pharmacology. WB Sanders, 1996.

[17.] Ramsey SM: Holistic manual therapy techniques. Complementary and Alternative Therapies in Primary Care 1997; 4: 759-783.

[18.] Richards TL, Lappin MS, Acosta-Urquidi J et al: Double-bind study of pulsing magnetic field effects on multiple sclerosis. The Journal of Alternative and Complementary Medicine 1997; 1:21-29.

[19.] Rimmer L: The clinical use of aromatherapy in the reduction of stress. Home Healthcare Nurse 1998; 2:123-126.

[20.] Rosa L, Rosa E, Sarner L et al: A close look at therapeutic touch. JAMA 1998; 13:1005-1010.

[21.] Stenager E, Stenager N, Knudsen L, Jensen K: The use of non-medical/alternative treatment in multiple sclerosis-a 5 year follow-up study. Act Neurology Belgium 1995; 18-22.

[22.] Svensson B, Gerdie B, Elert J: Endurance training in patients with multiple sclerosis: Five case studies. Phys Ther 1994; 11:26-34.

[23.] Whitmore SM, Leake NB: Complementary therapies: An adjunct to traditional therapies. Nurse Practitioner 1996; 8: 10-13.

Questions of comments about this article may be directed to: Pamela Newland, RN, BSN, 102 Parkview Court, Troy, Illinois 62294. She is on the nursing faculty at Jefferson College, in Hillsboro, Missouri.
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Author:Newland, Pam
Publication:Journal of Neuroscience Nursing
Geographic Code:1USA
Date:Feb 1, 1999
Words:2845
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