Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology
Limited EvidenceIn Plain Language: urinary tract problems, explained
To develop evidence-based recommendations for complementary and alternative medicine (CAM) in multiple sclerosis (MS). We searched the literature (1970-March 2011; March 2011-September 2013 MEDLINE search), classified articles, and linked recommendations to evidence. Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain) (Level A). Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity (short-term)/tremor (Level B) and possibly effective for spasticity and pain (long-term) (Level C). Clinicians might offer Sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B). Clinicians might choose not to offer these agents for tremor (Level C). Clinicians might counsel patients that magnetic therapy is probably effective for fatigue and probably ineffective for depression (Level B); fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life (QOL) (Level B); ginkgo biloba is ineffective for cognition (Level A) and possibly effective for fatigue (Level C); reflexology is possibly effective for paresthesia (Level C); Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and fatigue (Level C); and bee sting therapy is possibly ineffective for relapses, disability, fatigue, lesion burden/volume, and health-related QOL (Level C). Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation. Safety/efficacy of other CAM/CAM interaction with MS disease-modifying therapies is unknow
Key Findings
- ✓Oral cannabis extract is recommended for treating spasticity symptoms and pain in MS patients, excluding central neuropathic pain (Level A evidence).
- ✓Cannabis-based treatments are probably ineffective for objective spasticity and tremor in the short term, but possibly effective for spasticity and pain in the long term (Level B-C evidence).
- ✓Sativex oromucosal cannabinoid spray (nabiximols) may be offered for spasticity symptoms, pain, and urinary frequency, though it is probably ineffective for objective spasticity and urinary incontinence (Level B evidence).
What This Means for You
Reflexology may help with paresthesia (tingling/numbness sensations) in MS based on limited evidence, but more research is needed to confirm its effectiveness.
What This Means for Practitioners
Reflexology has limited evidence supporting its use for paresthesia in MS patients; positioning it as a complementary option alongside conventional care rather than a primary treatment is appropriate.
Urinary tract problems: common questions
What does this study say about urinary tract problems?
Reflexology may help with paresthesia (tingling/numbness sensations) in MS based on limited evidence, but more research is needed to confirm its effectiveness.
What did this study find?
Oral cannabis extract is recommended for treating spasticity symptoms and pain in MS patients, excluding central neuropathic pain (Level A evidence). Cannabis-based treatments are probably ineffective for objective spasticity and tremor in the short term, but possibly effective for spasticity and pain in the long term (Level B-C evidence). Sativex oromucosal cannabinoid spray (nabiximols) may be offered for spasticity symptoms, pain, and urinary frequency, though it is probably ineffective for objective spasticity and urinary incontinence (Level B evidence).
How strong is this evidence?
This is a systematic review and we rate its evidence limited. It was published in Neurology. This study is indexed here for context; it did not test reflexology itself.
Related Research
Effect of Reflexology to Depressive Symptoms in Women With Overactive Bladder
Treatment of overactive bladder in women
[Zone therapy of children with nocturnal enuresis]
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