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NCCIH Clinical Digest

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Multiple Sclerosis and Complementary Health Approaches: What the Science Says

November 2019

Clinical Guidelines, Scientific Literature, Info for Patients: 
Multiple Sclerosis and Complementary Health Approaches

NIGMS_NeuronGlia3_MS
Credit: Barbara Calabrese, UC San Diego

Natural Products

Cannabinoids

Orally administered cannabinoids (cannabis extract, synthetic THC), mucosally delivered cannabinoids (cannabis THC and CBD extract oral spray, nabiximols (trade name Sativex), and smoked cannabis have all been studied for therapeutic effects in MS. Based on available evidence, cannabinoids may relieve spasticity and/or pain in people with MS; however, no marijuana-derived medications are approved by the U.S. Food and Drug Administration to treat MS. Sativex has received regulatory approval in more than 25 countries outside the United States for the treatment of spasticity (muscle stiffness/spasm) due to MS. There are insufficient data to determine if smoking marijuana ameliorates symptoms of MS. Additionally, the psychoactive properties and other potential adverse effects need to be considered. Sativex is licensed in the UK for use as an add-on treatment for MS-related spasticity when people have shown inadequate response to other symptomatic treatments or found their side effects intolerable.

There is insufficient data to determine if smoking marijuana ameliorates symptoms of MS. Additionally, the psychoactive properties and other potential adverse effects need to be considered.

What Does the Research Show?

  • A 2018 systematic review and meta-analysis of 17 trials involving a total of 3,161 participants found limited efficacy of cannabinoids (oral or oromucosal) for the treatment of spasticity, pain, and bladder dysfunction in patients with MS. Another 2018 systematic review of 11 reviews providing data from 32 studies (including 10 moderate-to-high quality randomized controlled trials) found sufficient evidence that cannabinoids may be effective for symptoms of pain and/or spasticity in MS.
  • Oral cannabinoids. The 2014 evidence-based guidelines issued by the American Academy of Neurology concluded that oral cannabis extract is established as effective for reducing patient-reported spasticity symptoms and pain. This subjective benefit is possibly maintained for 1 year. The guidelines also concluded that THC is probably effective for reducing patient-reported symptoms of spasticity and pain. This subjective benefit is possibly maintained for 1 year. However, the guidelines state that oral cannabis extract and THC are probably ineffective for reducing both objective spasticity measures and MS-related tremor symptoms. Oral cannabis extract and THC are possibly effective for reducing symptoms and objective measures of spasticity over 1 year.
  • Sativex oromucosal cannabinoid spray. The 2014 American Academy of Neurology evidence-based guidelines concluded that Sativex oromucosal cannabinoid spray is probably effective for improving subjective spasticity symptoms and is probably ineffective for reducing objective spasticity measures over 6 weeks or bladder incontinence episodes over 10 weeks. Further, the guidelines state that Sativex oromucosal spray is possibly ineffective for reducing MS-related tremor over 15 weeks. In addition, a 2010-reported meta-analysis from 666 MS patients who had spasticity that was not well controlled using existing treatments were given either nabiximols (363) or placebo (303). Results showed nabiximols effects are typically seen within 3 weeks. Furthermore, about one-third of the MS patients given nabiximols had a 30 percent improvement from baseline. The authors noted the treatment appeared reasonably safe.
    • A 2015 review of six placebo-controlled clinical trials involving a total of 1,134 patients concluded that cannabinoids (nabiximols, dronabinol, and THC/CBD) were associated with a greater average improvement on the Ashworth scale for spasticity in MS patients compared with placebo; however, this did not reach statistical significance.
  • Smoked cannabis. Based on two small studies, the 2014 evidence-based guidelines issued by the American Academy of Neurology concluded that data are inadequate to determine the safety or efficacy of smoked cannabis used for spasticity/pain, balance/posture, and cognition.

Safety

  • In the studies that were the basis for the 2014 American Academy of Neurology guidelines, cannabinoids were generally well tolerated, although some serious adverse effects were reported. Mild or moderate side effects including dizziness, somnolence, drowsiness, lightheadedness, memory disturbance, and difficulty concentrating were more common in participants receiving cannabinoids vs placebo. Less common effects included increased appetite, nausea, vomiting, constipation, and dry/sore mouth, myalgia, seizures, and others. The guidelines noted that because cannabinoids have known psychoactive properties, their potential for psychopathologic and neurocognitive adverse effects is a concern, especially in a patient population that may be vulnerable due to underlying disorders.
  • The guidelines recommend that clinicians counsel patients about the potential for psychopathologic/cognitive and other adverse events associated with cannabinoids. Sativex oromucosal cannabinoid spray is not approved by the U.S. Food and Drug Administration and is unavailable in the United States. Further, the guidelines suggest caution should be exercised with regard to extrapolation of results of trials of standardized oral cannabis extract (which are unavailable commercially) to other nonstandardized, nonregulated cannabis extracts (which may be commercially available in states with medical marijuana laws).
NIGMS_NeuronGlia3_MS
Credit: Barbara Calabrese, UC San Diego

Natural Products

Cannabinoids

Orally administered cannabinoids (cannabis extract, synthetic THC), mucosally delivered cannabinoids (cannabis THC and CBD extract oral spray, nabiximols (trade name Sativex), and smoked cannabis have all been studied for therapeutic effects in MS. Based on available evidence, cannabinoids may relieve spasticity and/or pain in people with MS; however, no marijuana-derived medications are approved by the U.S. Food and Drug Administration to treat MS. Sativex has received regulatory approval in more than 25 countries outside the United States for the treatment of spasticity (muscle stiffness/spasm) due to MS. There are insufficient data to determine if smoking marijuana ameliorates symptoms of MS. Additionally, the psychoactive properties and other potential adverse effects need to be considered. Sativex is licensed in the UK for use as an add-on treatment for MS-related spasticity when people have shown inadequate response to other symptomatic treatments or found their side effects intolerable.

There is insufficient data to determine if smoking marijuana ameliorates symptoms of MS. Additionally, the psychoactive properties and other potential adverse effects need to be considered.

What Does the Research Show?

  • A 2018 systematic review and meta-analysis of 17 trials involving a total of 3,161 participants found limited efficacy of cannabinoids (oral or oromucosal) for the treatment of spasticity, pain, and bladder dysfunction in patients with MS. Another 2018 systematic review of 11 reviews providing data from 32 studies (including 10 moderate-to-high quality randomized controlled trials) found sufficient evidence that cannabinoids may be effective for symptoms of pain and/or spasticity in MS.
  • Oral cannabinoids. The 2014 evidence-based guidelines issued by the American Academy of Neurology concluded that oral cannabis extract is established as effective for reducing patient-reported spasticity symptoms and pain. This subjective benefit is possibly maintained for 1 year. The guidelines also concluded that THC is probably effective for reducing patient-reported symptoms of spasticity and pain. This subjective benefit is possibly maintained for 1 year. However, the guidelines state that oral cannabis extract and THC are probably ineffective for reducing both objective spasticity measures and MS-related tremor symptoms. Oral cannabis extract and THC are possibly effective for reducing symptoms and objective measures of spasticity over 1 year.
  • Sativex oromucosal cannabinoid spray. The 2014 American Academy of Neurology evidence-based guidelines concluded that Sativex oromucosal cannabinoid spray is probably effective for improving subjective spasticity symptoms and is probably ineffective for reducing objective spasticity measures over 6 weeks or bladder incontinence episodes over 10 weeks. Further, the guidelines state that Sativex oromucosal spray is possibly ineffective for reducing MS-related tremor over 15 weeks. In addition, a 2010-reported meta-analysis from 666 MS patients who had spasticity that was not well controlled using existing treatments were given either nabiximols (363) or placebo (303). Results showed nabiximols effects are typically seen within 3 weeks. Furthermore, about one-third of the MS patients given nabiximols had a 30 percent improvement from baseline. The authors noted the treatment appeared reasonably safe.
    • A 2015 review of six placebo-controlled clinical trials involving a total of 1,134 patients concluded that cannabinoids (nabiximols, dronabinol, and THC/CBD) were associated with a greater average improvement on the Ashworth scale for spasticity in MS patients compared with placebo; however, this did not reach statistical significance.
  • Smoked cannabis. Based on two small studies, the 2014 evidence-based guidelines issued by the American Academy of Neurology concluded that data are inadequate to determine the safety or efficacy of smoked cannabis used for spasticity/pain, balance/posture, and cognition.

Safety

  • In the studies that were the basis for the 2014 American Academy of Neurology guidelines, cannabinoids were generally well tolerated, although some serious adverse effects were reported. Mild or moderate side effects including dizziness, somnolence, drowsiness, lightheadedness, memory disturbance, and difficulty concentrating were more common in participants receiving cannabinoids vs placebo. Less common effects included increased appetite, nausea, vomiting, constipation, and dry/sore mouth, myalgia, seizures, and others. The guidelines noted that because cannabinoids have known psychoactive properties, their potential for psychopathologic and neurocognitive adverse effects is a concern, especially in a patient population that may be vulnerable due to underlying disorders.
  • The guidelines recommend that clinicians counsel patients about the potential for psychopathologic/cognitive and other adverse events associated with cannabinoids. Sativex oromucosal cannabinoid spray is not approved by the U.S. Food and Drug Administration and is unavailable in the United States. Further, the guidelines suggest caution should be exercised with regard to extrapolation of results of trials of standardized oral cannabis extract (which are unavailable commercially) to other nonstandardized, nonregulated cannabis extracts (which may be commercially available in states with medical marijuana laws).

Ginkgo biloba

According to 2014 clinical practice guidelines issued by the American Academy of Neurology, there is strong evidence that ginkgo biloba is ineffective for improving cognitive function in people with MS. The guidelines also state that there is weak evidence that ginkgo biloba is possibly effective for reducing fatigue.

What Does the Research Show?

  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that ginkgo biloba is ineffective for improving cognitive function in people with MS, but that it is possibly effective over 4 weeks for reducing fatigue in MS. These conclusions are based on four small studies.
  • A 2012 randomized controlled trial involving 120 participants with MS with some cognitive impairment found that ginkgo biloba twice a day for 12 weeks did not improve cognitive performance.
  • A 2011 Cochrane review of four randomized controlled trials evaluated pharmacologic treatments, including ginkgo biloba, for memory disorder in MS. The reviewers concluded that based on available evidence, there is no convincing evidence to support the use of ginkgo biloba as an effective treatment for memory disorder in MS patients.

Safety

  • Side effects of ginkgo may include headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions. More severe allergic reactions have occasionally been reported.
  • There are some data from animal models to suggest that ginkgo can have an effect on the pharmacokinetics of several drugs; however, current available clinical evidence suggests that low doses do not pose a risk for clinically relevant herb-drug interactions.
  • Fresh ginkgo seeds contain large amounts of ginkgotoxin, which can cause serious adverse reactions, including seizures and death. Roasted seeds can also be toxic. Products made from standardized ginkgo leaf extracts contain little ginkgotoxin and appear to be safe when used orally and appropriately.
  • National Toxicology Program (NTP) studies showed that rats and mice developed tumors after being given a specific ginkgo extract for up to 2 years. Further studies are needed to find out what substances in ginkgo caused the tumors and whether taking ginkgo as a dietary supplement affects the risk of cancer in people.

Ginkgo biloba

According to 2014 clinical practice guidelines issued by the American Academy of Neurology, there is strong evidence that ginkgo biloba is ineffective for improving cognitive function in people with MS. The guidelines also state that there is weak evidence that ginkgo biloba is possibly effective for reducing fatigue.

What Does the Research Show?

  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that ginkgo biloba is ineffective for improving cognitive function in people with MS, but that it is possibly effective over 4 weeks for reducing fatigue in MS. These conclusions are based on four small studies.
  • A 2012 randomized controlled trial involving 120 participants with MS with some cognitive impairment found that ginkgo biloba twice a day for 12 weeks did not improve cognitive performance.
  • A 2011 Cochrane review of four randomized controlled trials evaluated pharmacologic treatments, including ginkgo biloba, for memory disorder in MS. The reviewers concluded that based on available evidence, there is no convincing evidence to support the use of ginkgo biloba as an effective treatment for memory disorder in MS patients.

Safety

  • Side effects of ginkgo may include headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions. More severe allergic reactions have occasionally been reported.
  • There are some data from animal models to suggest that ginkgo can have an effect on the pharmacokinetics of several drugs; however, current available clinical evidence suggests that low doses do not pose a risk for clinically relevant herb-drug interactions.
  • Fresh ginkgo seeds contain large amounts of ginkgotoxin, which can cause serious adverse reactions, including seizures and death. Roasted seeds can also be toxic. Products made from standardized ginkgo leaf extracts contain little ginkgotoxin and appear to be safe when used orally and appropriately.
  • National Toxicology Program (NTP) studies showed that rats and mice developed tumors after being given a specific ginkgo extract for up to 2 years. Further studies are needed to find out what substances in ginkgo caused the tumors and whether taking ginkgo as a dietary supplement affects the risk of cancer in people.

Omega-3 Fatty Acid Supplementation

There is insufficient data to assess any real beneficial effects of omega-3 fatty acid supplementation on MS. 2014 evidence-based guidelines from the American Academy of Neurology concluded that a low-fat diet with fish oil supplementation is probably ineffective for reducing MS-related relapse, disability, or MRI lesions, or for improving fatigue or quality of life.

What Does the Research Show?

  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on three reviewed studies, a low-fat diet with fish oil supplementation is probably ineffective for reducing MS-related relapse, disability, or MRI lesions, or for improving fatigue or quality of life.
  • A 2012 Cochrane review of six randomized controlled trials examining dietary interventions, including polyunsaturated fatty acids (PUFAs) and vitamins, concluded that PUFAs seem to have no major effect on the disease progression in MS, but they may have a tendency toward reducing the frequency of relapses over 2 years. However, the authors noted that due to the uncertain quality of the PUFA supplementation, available data are insufficient to assess any real benefit or harm from the intervention.

Safety

  • Omega-3 fatty acid supplements generally do not have adverse effects. When adverse effects do occur, they typically consist of minor gastrointestinal symptoms.
  • It is unclear whether people with fish or shellfish allergies can safely consume fish oil supplements.
  • People who take anticoagulants or NSAIDs should use caution when taking omega-3 supplements, because they may extend bleeding time.

Omega-3 Fatty Acid Supplementation

There is insufficient data to assess any real beneficial effects of omega-3 fatty acid supplementation on MS. 2014 evidence-based guidelines from the American Academy of Neurology concluded that a low-fat diet with fish oil supplementation is probably ineffective for reducing MS-related relapse, disability, or MRI lesions, or for improving fatigue or quality of life.

What Does the Research Show?

  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on three reviewed studies, a low-fat diet with fish oil supplementation is probably ineffective for reducing MS-related relapse, disability, or MRI lesions, or for improving fatigue or quality of life.
  • A 2012 Cochrane review of six randomized controlled trials examining dietary interventions, including polyunsaturated fatty acids (PUFAs) and vitamins, concluded that PUFAs seem to have no major effect on the disease progression in MS, but they may have a tendency toward reducing the frequency of relapses over 2 years. However, the authors noted that due to the uncertain quality of the PUFA supplementation, available data are insufficient to assess any real benefit or harm from the intervention.

Safety

  • Omega-3 fatty acid supplements generally do not have adverse effects. When adverse effects do occur, they typically consist of minor gastrointestinal symptoms.
  • It is unclear whether people with fish or shellfish allergies can safely consume fish oil supplements.
  • People who take anticoagulants or NSAIDs should use caution when taking omega-3 supplements, because they may extend bleeding time.

Vitamin D

To date, results of studies have been conflicting, as to whether vitamin D may provide a therapeutic benefit for people with MS. A 2018 Cochrane review found very low-quality evidence suggesting no benefit of vitamin D for patient-improving outcomes among people with MS. However, findings from a 2018 meta-analysis suggest that vitamin D supplementation may have a therapeutic role in the treatment of MS. Further high-quality studies are needed before definitive conclusions can be drawn.

What Does the Research Show?

  • A 2018 Cochrane review of 12 randomized controlled trials involving a total of 933 participants with MS found very low-quality evidence suggesting no benefit of vitamin D for patient-important outcomes. The reviewers concluded that vitamins D appears to have no effect on recurrence of relapse, worsening of disability, and MRI lesions. Effects on health-related quality of life and fatigue were unclear.
  • A 2018 meta-analysis of 12 studies involving a total of 950 participants found that vitamin D may be useful in the treatment of MS; however, the findings were not sufficient to recommend vitamin D supplementation at present.
  • Results of a large, 5-year randomized trial in 468 participants with MS suggest that low blood levels of vitamin D may be a risk factor for long-term disease activity and progression. However, more studies need to be conducted to determine if vitamin D supplementation affects disease course and progression.

Safety

  • Limited intervention studies in MS suggest that vitamin D supplements are generally well tolerated in MS.
  • High doses may cause fatigue, abdominal cramps, nausea, vomiting, renal damage, and other adverse effects.

Vitamin D

To date, results of studies have been conflicting, as to whether vitamin D may provide a therapeutic benefit for people with MS. A 2018 Cochrane review found very low-quality evidence suggesting no benefit of vitamin D for patient-improving outcomes among people with MS. However, findings from a 2018 meta-analysis suggest that vitamin D supplementation may have a therapeutic role in the treatment of MS. Further high-quality studies are needed before definitive conclusions can be drawn.

What Does the Research Show?

  • A 2018 Cochrane review of 12 randomized controlled trials involving a total of 933 participants with MS found very low-quality evidence suggesting no benefit of vitamin D for patient-important outcomes. The reviewers concluded that vitamins D appears to have no effect on recurrence of relapse, worsening of disability, and MRI lesions. Effects on health-related quality of life and fatigue were unclear.
  • A 2018 meta-analysis of 12 studies involving a total of 950 participants found that vitamin D may be useful in the treatment of MS; however, the findings were not sufficient to recommend vitamin D supplementation at present.
  • Results of a large, 5-year randomized trial in 468 participants with MS suggest that low blood levels of vitamin D may be a risk factor for long-term disease activity and progression. However, more studies need to be conducted to determine if vitamin D supplementation affects disease course and progression.

Safety

  • Limited intervention studies in MS suggest that vitamin D supplements are generally well tolerated in MS.
  • High doses may cause fatigue, abdominal cramps, nausea, vomiting, renal damage, and other adverse effects.

Bee Venom

Based on a few small studies, bee venom therapy seems to have no effect on either MS symptoms or disease progression. There are serious side effects associated with bee venom, including risk of anaphylactic reactions and death, which could limit any efficacy of bee venom therapy for the treatment of MS.

What Does the Research Show?

  • Based on a review of one small study, the 2014 evidence-based guidelines from the American Academy of Neurology concluded that bee sting therapy is possibly ineffective for reducing MS-related relapses, disability, fatigue, total MRI lesion burden, new gadolinium-enhancing lesion volume, or health-related quality of life.

Safety

  • There are serious side effects associated with bee venom, which could limit any efficacy of bee venom therapy in the treatment of MS.

Bee Venom

Based on a few small studies, bee venom therapy seems to have no effect on either MS symptoms or disease progression. There are serious side effects associated with bee venom, including risk of anaphylactic reactions and death, which could limit any efficacy of bee venom therapy for the treatment of MS.

What Does the Research Show?

  • Based on a review of one small study, the 2014 evidence-based guidelines from the American Academy of Neurology concluded that bee sting therapy is possibly ineffective for reducing MS-related relapses, disability, fatigue, total MRI lesion burden, new gadolinium-enhancing lesion volume, or health-related quality of life.

Safety

  • There are serious side effects associated with bee venom, which could limit any efficacy of bee venom therapy in the treatment of MS.

Mind and Body Practices

Mind and Body Practices

Yoga

There is some limited evidence suggesting beneficial short-term effects of yoga on fatigue and mood in people with MS, but scientific studies overall had a high risk of bias and definitive conclusions could not be drawn.

What Does the Research Show?

  • A 2014 systematic review and meta-analysis of seven randomized controlled trials involving a total of 670 patients found some evidence for positive short-term effects of yoga on fatigue and mood, but not on outcomes such as mobility or cognitive function. The reviewers noted a high risk of bias in the studies included in the review, but despite the risk, yoga seems to be equally effective as exercise interventions in improving both patient-reported and clinician-rated outcomes.
  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that the data are inadequate to assess the effect of yoga on disability, spasticity, fatigue, cognition, mood, balance, or walking speed in people with MS.
  • A 2016 randomized controlled trial involving 90 participants with multiple sclerosis found that yoga and other exercise programs may help improve some MS symptoms, including energy social function, mental status, fatigue, and pain.

Safety

  • In the studies included in a 2014 systematic review and meta-analysis, yoga was not associated with serious adverse events.
  • People with certain medical conditions, including MS, should modify or avoid some yoga poses.

Yoga

There is some limited evidence suggesting beneficial short-term effects of yoga on fatigue and mood in people with MS, but scientific studies overall had a high risk of bias and definitive conclusions could not be drawn.

What Does the Research Show?

  • A 2014 systematic review and meta-analysis of seven randomized controlled trials involving a total of 670 patients found some evidence for positive short-term effects of yoga on fatigue and mood, but not on outcomes such as mobility or cognitive function. The reviewers noted a high risk of bias in the studies included in the review, but despite the risk, yoga seems to be equally effective as exercise interventions in improving both patient-reported and clinician-rated outcomes.
  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that the data are inadequate to assess the effect of yoga on disability, spasticity, fatigue, cognition, mood, balance, or walking speed in people with MS.
  • A 2016 randomized controlled trial involving 90 participants with multiple sclerosis found that yoga and other exercise programs may help improve some MS symptoms, including energy social function, mental status, fatigue, and pain.

Safety

  • In the studies included in a 2014 systematic review and meta-analysis, yoga was not associated with serious adverse events.
  • People with certain medical conditions, including MS, should modify or avoid some yoga poses.

Reflexology

There is insufficient evidence to support the use of reflexology for most symptoms of MS, including pain, health-related quality of life, disability, spasticity, fatigue, depression, and others. However, 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on four studies, reflexology is possibly effective for reducing MS-associated paresthesia over 11 weeks.

What Does the Research Show?

  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on four studies, reflexology is possibly effective for reducing MS-associated paresthesia over 11 weeks. However, the guidelines state that data are inadequate to support or refute the use of reflexology for pain, health-related quality of life, disability, spasticity, fatigue, cognition, bowel or bladder function, depression, anxiety, or insomnia in MS.
  • A 2011 update of a systematic review evaluating the evidence of 23 randomized controlled trials of reflexology in patients with any type of health condition found that 8 studies suggested that reflexology is effective for several conditions, including MS. However, the reviewers concluded that the best clinical evidence does not demonstrate convincingly that reflexology is an effective treatment for any condition.
  • A 2009 double-blind, randomized, sham-controlled trial in 73 participants with MS found that reflexology was not superior to the sham control; however, significant decreases in pain, fatigue, depression, disability, spasm, and quality of life were observed in both groups.

Safety

Reflexology is generally considered safe for most people; however, vigorous pressure applied to the feet may cause discomfort for some people.

Reflexology

There is insufficient evidence to support the use of reflexology for most symptoms of MS, including pain, health-related quality of life, disability, spasticity, fatigue, depression, and others. However, 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on four studies, reflexology is possibly effective for reducing MS-associated paresthesia over 11 weeks.

What Does the Research Show?

  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on four studies, reflexology is possibly effective for reducing MS-associated paresthesia over 11 weeks. However, the guidelines state that data are inadequate to support or refute the use of reflexology for pain, health-related quality of life, disability, spasticity, fatigue, cognition, bowel or bladder function, depression, anxiety, or insomnia in MS.
  • A 2011 update of a systematic review evaluating the evidence of 23 randomized controlled trials of reflexology in patients with any type of health condition found that 8 studies suggested that reflexology is effective for several conditions, including MS. However, the reviewers concluded that the best clinical evidence does not demonstrate convincingly that reflexology is an effective treatment for any condition.
  • A 2009 double-blind, randomized, sham-controlled trial in 73 participants with MS found that reflexology was not superior to the sham control; however, significant decreases in pain, fatigue, depression, disability, spasm, and quality of life were observed in both groups.

Safety

Reflexology is generally considered safe for most people; however, vigorous pressure applied to the feet may cause discomfort for some people.

Magnet Therapy

There is some limited, low-level evidence that suggests that magnet therapy may have modest beneficial effects on spasticity outcomes in people with MS, but the studies have been of low methodological quality. There are also some data from two studies, suggesting that magnet therapy may be useful in reducing fatigue in people with relapsing-remitting MS.

What Does the Research Show?

  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that magnet therapy is probably effective for reducing fatigue in relapsing-remitting MS, and probably ineffective for reducing depression in relapsing-remitting MS over 15 weeks. There is insufficient evidence to support the use of magnet therapy on reducing MS-related disability, bladder control problems, or spasticity, or on improving cognition, mobility, sensation, or vision.
  • A 2013 Cochrane review of nine randomized controlled trials involving a total of 301 participants concluded that there is “low level” evidence for non-pharmacological interventions, including magnetic stimulation for beneficial effects on spasticity outcomes in people with MS. The studies included in the review were of low methodological quality and high risk of bias.

Safety

  • Magnets may interfere with the functioning of the medical device (e.g., pacemaker, insulin pump) and may not be safe for some people. Otherwise, magnets are generally considered safe when applied to the skin.
  • Reports of side effects or complications have been rare.

Magnet Therapy

There is some limited, low-level evidence that suggests that magnet therapy may have modest beneficial effects on spasticity outcomes in people with MS, but the studies have been of low methodological quality. There are also some data from two studies, suggesting that magnet therapy may be useful in reducing fatigue in people with relapsing-remitting MS.

What Does the Research Show?

  • The 2014 evidence-based guidelines from the American Academy of Neurology concluded that magnet therapy is probably effective for reducing fatigue in relapsing-remitting MS, and probably ineffective for reducing depression in relapsing-remitting MS over 15 weeks. There is insufficient evidence to support the use of magnet therapy on reducing MS-related disability, bladder control problems, or spasticity, or on improving cognition, mobility, sensation, or vision.
  • A 2013 Cochrane review of nine randomized controlled trials involving a total of 301 participants concluded that there is “low level” evidence for non-pharmacological interventions, including magnetic stimulation for beneficial effects on spasticity outcomes in people with MS. The studies included in the review were of low methodological quality and high risk of bias.

Safety

  • Magnets may interfere with the functioning of the medical device (e.g., pacemaker, insulin pump) and may not be safe for some people. Otherwise, magnets are generally considered safe when applied to the skin.
  • Reports of side effects or complications have been rare.

Hyperbaric Oxygen Therapy

Although hyperbaric oxygen therapy is often heavily marketed to people with MS, there are no consistent data that support the use of hyperbaric oxygen therapy for the treatment of MS.

What Does the Research Show?

  • A 2010 meta-analysis of 12 randomized studies concluded that hyperbaric oxygen therapy does not produce any clinically significant benefits in MS.
  • A 2004 Cochrane review had similar findings. The review of nine studies of hyperbaric oxygen therapy for the treatment of multiple sclerosis found no consistent evidence to confirm a beneficial effect. The reviewers also noted that based on available evidence, routine use is not justified.

Safety
When safety guidelines are strictly adhered to, hyperbaric oxygen therapy appears to be generally safe. The predominant complication is pressure equalization problems within the middle ear. Serious complications are rare.

Hyperbaric Oxygen Therapy

Although hyperbaric oxygen therapy is often heavily marketed to people with MS, there are no consistent data that support the use of hyperbaric oxygen therapy for the treatment of MS.

What Does the Research Show?

  • A 2010 meta-analysis of 12 randomized studies concluded that hyperbaric oxygen therapy does not produce any clinically significant benefits in MS.
  • A 2004 Cochrane review had similar findings. The review of nine studies of hyperbaric oxygen therapy for the treatment of multiple sclerosis found no consistent evidence to confirm a beneficial effect. The reviewers also noted that based on available evidence, routine use is not justified.

Safety
When safety guidelines are strictly adhered to, hyperbaric oxygen therapy appears to be generally safe. The predominant complication is pressure equalization problems within the middle ear. Serious complications are rare.

References

References

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