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Guideline Finds Little Evidence That Complementary/Alternative MS Therapies Work

Medical marijuana in pill or oral spray form may help

A new guideline from the American Academy of Neurology suggests that there is little evidence that most complementary or alternative medicine (CAM) therapies treat the symptoms of multiple sclerosis (MS). However, the guideline states that the CAM therapies oral cannabis (medical marijuana pills) and oral medical marijuana spray may ease patients’ reported symptoms of spasticity, pain related to spasticity, and frequent urination in MS.

The guideline, which was published in the March 25 print issue of Neurology, states that there is not enough evidence to show whether smoking marijuana is helpful in treating MS symptoms.

The guideline looked at CAM therapies, which are nonconventional treatments used in addition to or instead of physician-recommended therapies. Examples include oral cannabis, oral medical marijuana spray, ginkgo biloba, magnetic therapy, bee-sting therapy, omega-3 fatty acids, and reflexology.

“Using different CAM therapies is common in 33 to 80 percent of people with MS, particularly those who are female, have higher education levels, and report poorer health,” said lead author Vijayshree Yadav, MD, MCR. “People with MS should let their doctors know what types of these therapies they are taking, or thinking about taking.”

For most CAM therapies, safety is unknown, the guideline says. There is not enough information to show whether CAM therapies interact with prescription MS drugs. Most CAM therapies are not regulated by the FDA.

Dronabinol and nabilone are synthetic forms of key ingredients in marijuana. The FDA approved both drugs as treatments for nausea and vomiting associated with cancer chemotherapy that do not respond to standard treatments. Dronabinol is also approved for loss of appetite associated with weight loss in patients with acquired immune deficiency syndrome (AIDS).

The guideline found that certain forms of medical marijuana — in pill or oral spray form only — may help reduce patients’ reported spasticity symptoms, pain due to spasticity, and frequent urination, but not loss of bladder control. The therapy may not help reduce tremor.

The long-term safety of medical marijuana use in pill or oral spray is not known. Most of the studies were short, lasting 6 to 15 weeks, according to the guideline.

Medical marijuana in pill or oral spray form may cause side effects, some of which can be serious. Examples are seizures, dizziness, and thinking and memory problems, as well as psychological problems, such as depression. This can be a concern given that some people with MS are at an increased risk for depression or suicide, the guideline observes. Both doctors and patients must weigh the possible side effects that medical marijuana in pill or oral spray form can cause.

Among other CAM therapies studied for MS, ginkgo biloba might help reduce tiredness but not thinking and memory problems, the guideline observes. Magnetic therapy may also help reduce tiredness but not depression.

Reflexology might help ease symptoms such tingling, numbness, and other unusual skin sensations. Bee-sting therapy, a low-fat diet with fish oil, and a therapy called the Cari Loder regimen do not appear to help MS symptoms, such as disability, depression, and tiredness. Moreover, bee stings can cause a life-threatening allergic reaction and dangerous infections.

Moderate evidence shows that omega-3 fatty acids, such as fish oil, likely do not reduce relapses, disability, tiredness, or MRI brain scan lesions, nor do they improve quality of life in people with MS, the guideline notes.

Sources: Neurology; March 25, 2014; and AAN; March 24, 2014.

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