There are many, many types of CAM therapy that may be used by people with MS, most of which we cannot consider in detail here. Furthermore the popularity of such therapies in MS can change very rapidly, with new therapies or new variations of previously available therapies regularly appearing, and the use of others decreasing rapidly after only a brief high profile existence. Thus in this section we consider some of the key CAM therapies that appear to have gained longer term use, or appear to be on the verge of doing so.

Cannabis

There has been a great deal of discussion about the use of cannabis recently in relation to the symptoms of MS. Based originally on individual reports by people with MS that at least two of the more problematic symptoms of MS, tremor and spasticity, seemed to respond well to cannabis, there has been an increasing interest in its use by people with MS. However, at present, cannabis is illegal in Britain – some people with MS have already been prosecuted for possessing, growing or supplying it – and it cannot be prescribed for MS.
Nonetheless the pressure from people with MS to research the effects of cannabis more formally has resulted in the setting up of major clinical trials, the most significant of which are funded by the Medical Research Council, although some are being undertaken by pharmaceutical companies. These trials are not using cannabis in its original form, but are using what are called cannabinoids (one or more of the very many active substances in cannabis). Thus if the trials are a success, it will not mean that cannabis itself will be made available to people with MS, but almost certainly will lead to the use of manufactured drugs that have some cannabinoids as constituents. The results of some of the key trials are now beginning to appear indicating that a statistically significant beneficial effect on such Multiple Sclerosis symptoms as spasticity (and particularly pain associated with such spasticity). In due course one or more products based on such cannabinoids will become available. However, it is important to note that becoming ‘available’ will almost certainly mean only by prescription from a medical practitioner who is willing to offer such drugs. Furthermore, even then such drugs may not become available through the NHS for some time, and may only be available initially through private payment.
Currently, there is evidence that an increasing number of people with MS are using cannabis on an occasional or sometimes regular basis; it has become a very difficult issue because, although they do feel that they gain from taking it, they are having to balance what they feel is a significant reduction in their symptoms against committing an illegal act. Using the drug in any form is illegal, including ‘inactivated’ tinctures with limited narcotic effects. Growing, buying, selling and using cannabis carry penalties including heavy fines and jail sentences, even when there may be a medical justification for its use. There is a group campaigning for a change in the law (the Alliance for Cannabis Therapeutics) to allow the use of cannabis for medically designated purposes, and if you feel strongly about the issue you may wish to join this group (see Appendix 1).

Hyperbaric oxygen

Hyperbaric oxygen therapy (HBO) consists of breathing oxygen under high pressure, usually by sitting or lying in a large pressurized chamber, and this proved to be one of the more popular complementary therapies for MS in the 1980s and early 1990s. The former national charity Action for Research in Multiple Sclerosis was instrumental in supporting the installation and running of pressurized chambers in many local therapy centres. A substantial number of these chambers are still in operation in therapy centres now run by Regional Federations of MS Therapy Centres.
The original theory behind the therapy was that MS might be a vascular (blood system-related) condition in which tiny blood vessels in key parts of the nervous system become blocked by fatty globules circulating in the blood, thus leading to nervous system damage. It was thought that hyperbaric chambers (used to assist the management of nitrogen ‘bubbles’ in the blood of divers suffering from the ‘bends’), might be a way of eliminating these circulating fatty globules, and perhaps – through the use of additional oxygen under pressure – might even repair existing damage. Many people claimed success in managing symptoms, and even slowing down or stopping the course of their MS. However, clinical trials of HBO produced a much less promising outcome. HBO did seem to have an effect for some people in lessening urinary symptoms (such as incontinence) and in reducing fatigue, but had no significant effect on any other symptoms, or on the course of the disease. Many people who say that they feel better as a result of HBO still use the therapy, although most doctors are very sceptical that it has any real effect on Multiple Sclerosis.
Whether you choose to have HBO is, of course, up to you. The main issue from a personal point of view is setting the benefits that you feel you may be obtaining against the practical issues of attending a centre on a regular, often initially daily, basis, and being in a chamber for an hour or more while it is pressurized, reaches its appropriate ‘diving depth’ and then depressurized. Costs for HBO in the therapy centres are often subsidised, but can still be relatively expensive over the initial phase of the therapy.

Herbal products

Although we often think of herbal medicines as being ‘alternative’, in fact a high proportion of both over-the-counter and prescribed drugs have a plant origin. However, in recent years, herbal medicine, often considered as a natural non-manufactured therapy, has become very popular. Practitioners operate under a range of different approaches. Although herbal remedies sound very benign and safe, they can be very powerful and can have side effects. Make sure that any practitioner is very well trained in the properties, toxic as well as beneficial, of the herbs that are used, and also has a good knowledge of MS. Herbal medicine and its practitioners are amongst the newest professionalized groups engaging in complementary medicine, even though herbalism has a very ancient history. Many herbal products available in chemists and health food shops, are capitalizing on the popularity of herbal approaches to health.
A detailed overview of the possible effects of the many hundreds of individual herbal products on MS is beyond the scope of this book, and indeed good herbal practitioners would argue that a careful process of individual diagnosis and therapeutic recommendation is needed for someone with Multiple Sclerosis. However, there are some general guidelines that it is helpful to bear in mind:

• It is wise to think of herbs in the same way that you think of drugs
(indeed many herbs are drugs).
• Many herbs contain compounds that have not yet been fully identified, and some of these may be toxic.
• Good preparation of herbal medicines is critical to ensure both their safety and their efficacy.
• Be very careful when using herbal medicines if you have several medical problems, or are pregnant or breastfeeding.

Some herbal medicines interact with proprietary drugs often used to treat MS or its symptoms, so it is particularly important that you talk to your doctor first if you are taking such drugs.
As with other complementary therapies, certain herbal remedies may be of value in relation to general health, and certain symptoms of MS might indeed be helped, but there is no evidence that herbal medicine can alter the course of MS. As a final warning, it is worth noting that some Chinese herbal remedies may contain animal products, of which some may be from banned sources, or not included on the label. For a more detailed review of particular herbal products in relation to MS, see the relevant section in the book by Bowling (see Appendix 2).

Homeopathy

Homeopathy is a system of therapy in which minute doses of a substance are taken on the basis that these will cure or control symptoms that would be produced by the very same substance in much larger doses. This is often described as an approach where ‘like cures like’, which some people argue is similar to that of vaccination, where a very, very small dose of a disease may protect against subsequent infection – although in the case of homeopathy, the small dose is to remedy what is seen as a current ‘disease’. It is argued that, paradoxically in relation to conventional science, the smaller the dose the more powerful the effect. Many scientists argue that the doses are so small that they cannot be detected using laboratory instruments and are thus sceptical about the efficacy of homeopathy, but homeopaths believe that their system of therapy is both effective and safe.
Homeopaths normally focus on the person as much as the disease, and thus any specific symptoms of MS are only one aspect of the person’s life and experiences, used to determine a relevant therapy. As the homeopathy is undertaken on such a person-centred basis, it has proved difficult to undertake clinical trials to prove to the scientific community that it is an effective help for people with Multiple Sclerosis. Increasingly more sophisticated trials are being developed, and some have shown that homeopathic preparations do have a statistically significant effect on
certain symptoms, although not yet in relation to MS. Nevertheless, there are people who claim that homeopathic treatment has substantially helped their symptoms. As might be anticipated from homeopathic theories, if a remedy is given that appears to be relevant to the symptom, an initial ‘aggravation’ of the symptom may occur – in short it can get worse – before any improvement is noticed.

Acupuncture/acupressure

Some people with MS have reported some benefits from either acupuncture or acupressure. Acupuncture, in its traditional form, is based on the idea that energy (chi or qi) flows round the body through channels (called ‘meridians’), which become blocked at times of illness and stress. Acupuncturists use the insertion of very fine needles at key points on these meridians unblocking energy flows to help restore health. Acupressure (often known as shiatzu) works on a similar principle, but uses pressure from fingers or thumbs at these energy points.
As with some of the other complementary therapies, it is difficult to undertake a scientific trial of the value of acupuncture or acupressure, although some very specific testing has been undertaken on pain and nausea relief using particular acupuncture points. The results suggest that, in certain circumstances, acupuncture does appear to relieve pain and nausea; however, it would be wise to seek a diagnosis of why you have pain or nausea from your GP or neurologist, before undertaking such a treatment for pain, in case there are other causes that need to be treated, or indeed other ways of relieving the pain that may be more effective.
There have been some, albeit small, and uncontrolled studies of acupuncture on people with Multiple Sclerosis. Reports from these studies indicated a range of mild benefits in relation to several symptoms, which suggests that larger and better conducted studies should be undertaken. Acupuncture may have some effects on the immune system, although this has not yet been fully explored. However, it should be noted that, although acupuncture is generally extremely well tolerated, there are occasional reports of pain and soreness at the needle site, as well as stiffness and muscle spasms. This may be due both to skin sensitivity, and a tendency to muscle spasms in MS.

Yoga

Yoga is widely used by many people with MS, and there are now both specialist centres and teachers for them. From a practical point of view, in many respects yoga can be seen as providing a form of exercise known to be helpful in keeping your muscles working, as well as providing a form of calming of the mind, helpful in countering depression, stress and fatigue. Yoga is also a form of meditation that requires dedication and time. For those people who can commit to it, it may help not only with individual problems (such as work-related stress), but also everyday living. For some people it can lead to a more rewarding lifestyle. In some circumstances yoga may prove an effective technique for the management of individual symptoms (such as stress or pain), but you will benefit largely from your own efforts.
One advantage of yoga for people with MS is that, in addition to its emphasis on slow movement, and peace and calm, once you have received some training, you can undertake the exercises at home, without any additional equipment or expense. Its emphasis on deep and controlled breathing can also be helpful, particularly if your posture is not what it should be, or if you are sitting for long periods. The main concern with yoga and MS is that you should work well within your limitations in a relaxed way, and be careful not to push yourself too far, or raise your body temperature, as this may increase fatigue. If you are undergoing, or have been undergoing physiotherapy, it may be an idea to consult your physiotherapist before starting yoga.
You can obtain more information about yoga from the Yoga for Health Foundation, which runs special classes for people with MS and other conditions, or from the Yoga Therapy Centre at the Royal London Homeopathic Trust.

Massage

There are many forms of massage. Some of them are very vigorous and seek to realign any muscles of the body that the therapists believe are out of line. Such forms of massage should be avoided by people with MS, for many of the problems faced by people with the disease, such as spasticity, are a result of neurological damage, and cannot just be ‘reworked’ by a very vigorous massage. The more relaxing and gentle forms of massage, on the other hand, are potentially of considerable value, not only in relaxing muscles and reducing spasticity, but also in promoting a general sense of wellbeing. It is very important that you check what form of massage the therapist is offering, and ensure that the therapist has been well trained and, above all, knows about MS.

Aromatherapy
Aromatherapy is usually a massage with essential oils; sometimes oils are heated and released into the atmosphere around you. Although, in other forms of massage, an oil is often used as a lubricant during the massage, in aromatherapy specific oils are used for massage or heating and release, following an aromatherapy diagnosis of your state of mind and body. The oils are very concentrated, and should always be used in a carrier oil (such as sweet almond oil) during massage. They must not be taken by mouth. Some of the oils should not be used if you are pregnant, or have certain other conditions, such as epilepsy, and it is crucial that you let your aromatherapist know about these. Although some of the more exotic and far-reaching claims for aromatherapy have never been tested, some people with MS have found it very relaxing and stress-reducing.

Reflexology
Reflexology is a therapy based on the idea that energy and other flows in the body are linked to, indeed terminate, at key points in the feet, providing a ‘map’ of key organs and systems in the body. It is believed that problems in all areas of the body can thus be identified and indeed treated through manipulation of the feet.
Some people with MS have indicated that they have found this therapy helpful and relaxing, although there is no formal evidence that it affects the course of MS, or even major symptoms of the disease. However, as a relaxing therapy, it may benefit some people with the condition.

Chiropractic
Chiropractic is a long-standing approach to health based on a particular view of the ways in which the human body works and may be managed. Practitioners manipulate the bones, muscles and tissues, especially around the spine, to enhance health. In chiropractic, the focus is mainly the nervous system, and enhancing the blood supply around key tissues. Practitioners can use a variety of techniques, which vary in strength.
Chiropractic is founded on the belief that a wide range of bodily pain and disease processes originate in abnormal nerve function. A course of treatment is usually composed of short sessions spaced out over several months. Treatment consists of manipulation of the spinal column and individual vertebrae. Chiropractic recommends itself particularly for back pain and persistent headaches. In very rare instances, manipulation of the spinal column can cause lasting damage, so always ensure that you consult a qualified chiropractor and that you discuss your MS fully before any treatment begins. It is increasingly likely that your own doctor will know more about chiropractic and can discuss any possible benefits or disadvantages with you.

Osteopathy
Osteopathy is a relatively well-regulated and trained profession compared to other complementary therapies, and a practitioner must be registered with the General Council and Register of Osteopaths (see Appendix 1). Osteopathy, like chiropractic, is a long-standing approach to health in which practitioners manipulate the bones, joints, muscles and tissues, especially around the spine, to enhance health. In fact osteopathy regards the entire musculoskeletal system as the critical basis of good, and ill, health. Treatment may involve established medical diagnostic procedures (including X-rays and standard biochemical tests) in addition to manipulation of joints, rhythmic exercise and stretching. Osteopathy can improve mobility in some affected joints. Cranial osteopathy involves gentle manipulation of the bones of the head and spine.
The main concern, as with the other complementary therapies, is the extent to which the use of osteopathy could significantly affect the course of symptoms of MS. Whilst a sense of wellbeing may well result from its use, there is no evidence that it has any effect on the course of MS itself.

As a concluding point, it is important that you take note of what your physiotherapist says about osteopathic or chiropractic treatment, particularly if he or she has wide experience of people with MS, has been treating you for some time, and knows your own situation well. In addition, if you feel that your physiotherapy is helping you manage your MS, then there is every reason to stick with it – particularly as you will almost certainly have to pay additional money for osteopathic or chiropractic diagnosis and treatment. However, some people with MS have found such massage to be of value, but it is not possible to know whether you will be one of these people.

Meditation and relaxation techniques

‘Mind and body’ alternative therapies have become increasingly popular in relation to MS in recent years. The rationale of such therapies is that, if a state of mental relaxation can be achieved, anxiety is decreased, and beneficial physical effects will occur – such as muscle relaxation and reduced blood pressure. There are many different techniques for achieving such mental relaxation. Indeed there are many different meditation techniques some of which are relatively simple to undertake; others require much more training and support.

As far as MS is concerned, particularly in improving muscle relaxation, meditation and relaxation techniques may help reduce the incidence of muscle spasms and spasticity. At a more general level there is an increasing but under-researched possibility that relaxation techniques may improve the operation of the immune system. In general the possible benefits can be set positively against what, is for the most part, a very low-cost alternative therapy.