Government watchdog breaks new ground by giving cautious endorsement of some complementary medicines in treating multiple sclerosis
Tuesday November 25, 2003
The role of complementary therapies such as fish oils, reflexology and t'ai chi in treating disease are recognised for the first time in official NHS guidance published today.
The cautious and still only partial endorsement of the possible benefits from such treatments in easing the symptoms of multiple sclerosis comes from the goverment's clinical watchdog for England and Wales, the National Institute for Clinical Excellence (Nice).
Complementary treatments are widely used by patients with the progressive, incurable disease. Even this small step by Nice is a significant recognition of the avenues pursued by patients desperate to find relief from pain, fatigue and other symptoms.
It is understood that another clinical guideline expected soon - for treating depression - will also acknowledge a place for complementary therapy.
The MS guidelines, aimed at health professionals, still leave much of the onus and risk from complementary medicine - both medical and financial - on individual patients.
However, it will mean that doctors raise the issue of alternative treatments with patients early on.
It says patients should be informed that there is "some evidence to suggest" that some might have benefits, even if there is not enough evidence to make firm recommendations.
As well as fish oils, massage and t'ai chi, the treatments include magnetic field therapy, where the patient lies on a pad fixed behind the spine and linked by cable to a computer-controlled bedside unit.
Neural therapy, involving local anaesthetics to clear up "electrical interference", is another option that might work. So is massage and multi-modal therapy, an educational and psychological approach.
But there is no endorsement for other non-orthodox treatments, such as acupuncture, yoga, herbal remedies or aromatherapy. And in all cases, patients should be encouraged to tell doctors if they decide to pursue complementary treatments.
The Multiple Sclerosis Society has two concerns about complementary medicine: that it is used safely and that patients are not overcharged. Such treatment is not usually available on the NHS, and patients often have to bear the costs themselves. The society's leaflet on the issue advises caution.
"Trying everything can be very expensive and demoralising," it says. "If a therapy does not work for you, or you start to feel worse, you may end up feeling that it's your own fault."
Much of the problem is that MS fluctuates and is unpredictable. The Nice guidelines do not mention cannabis-based medicines. Recently published results from a large trial suggested that these might benefit patients, despite an absence of objective evidence of improvement. Nice is to fast-track a review of these if such drugs are granted a licence by another government body which controls use of medicines.
The more mainstream advice in the guidelines calls for rapid diagnosis, preferably well within three months after first referral to a consultant, more specialised services and primary care by GPs to recognise particular problems faced by MS patients, including depression and sexual dysfunction. The diagnosis target will require a huge increase in neurologists to deliver results.
Patient groups welcomed the guidelines, arguing that thousands of people among the estimated 63,000 with MS in England and Wales suffered from a healthcare lottery, although examples of good practice are found in a number of places, including London, Merseyside and Newcastle.
Which treatments are sanctioned?
T'ai chi Ancient Chinese form of body movement focusing on development of internal energy to promote physical and mental wellbeing. Long advocated for tackling heart, breathing and digestive problems as well as relieving stress
Magnetic field therapy Treatment advertised by US companies as effective against all sorts of pain, including arthritis, osteoporosis and sports injuries. Also promoted as treatment for cats, dogs and horses
Massage Stimulates blood flow round the body and helps relaxation. Can cause muscles to go into spasm, so not all patients will benefit
Reflexology Foot massage to stimulate healing in other parts of the body
Magnetic bracelets Sometimes used to prevent tremors by MS patients, but no conclusive research base, and when bought over the counter are not tailored to meet specific needs, according to MS Society
Meditation Focus on the moment and clear the mind to counteract negative thinking. No endorsement from new guidance
Breathing oxygen in pressurised chamber Available at some MS therapy centres, but can be expensive as well as potentially dangerous. It has some real fans, but some other patients report a worsening of symptoms
Jury still out
Cannabis-based drugs Helps feelgood factor and eases symptoms, according to patients in recent trials, despite lack of hard objective evidence that they ease muscle stiffness.
However, signs are that the government will endorse their use if medicines
watchdogs are happy about safety and effectiveness
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