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Complementary and alternative medicine (CAM) is treatment that falls outside of mainstream healthcare.

These treatments range from acupuncture and homeopathy, to aromatherapy, meditation and colonic irrigation.

There's no universally agreed definition of CAM.

Although "complementary and alternative" is often used as a single category, it can be useful to make a distinction between the terms.

The US National Center for Complementary and Integrative Health (NCCIH) uses this distinction:

There can be overlap between these categories.

For example, aromatherapy may sometimes be used as a complementary treatment and in other circumstances is used as an alternative treatment.

A number of complementary and alternative treatments are typically used with the intention of treating or curing a health condition.

Examples include:

To understand whether a treatment is safe and effective, we need to check the evidence.

You can learn more about the evidence for particular CAM practices by reading about individual types of treatment.

See our Health A to Z index for a list of all conditions and treatments on the NHS website.

Some CAM treatments are based on principles and an evidence base that are not recognised by the majority of independent scientists.

Others have been proven to work for a limited number of health conditions.

For example, there's evidence that chiropractic is effective for treating lower back pain.

When a person uses any health treatment, including CAM, and experiences an improvement, this may be due to the placebo effect.

The availability of CAM on the NHS is limited, and in most cases the NHS will not offer such treatments.

The National Institute for Health and Care Excellence (NICE) provides guidance to the NHS on effective treatments that are value for money.

NICE has recommended the use of CAM in a limited number of circumstances.

For example:

If you think you may have a health condition, first see your GP. Do not visit a CAM practitioner instead of seeing your GP.

It's particularly important to talk to your GP before trying CAM if you have a pre-existing health condition or are pregnant.

Some CAM treatments may interact with medicines that you're taking or should not be tried if you're pregnant.

The practice of conventional medicine is regulated by laws that ensure that practitioners are properly qualified and adhere to certain standards or codes of practice. This is called statutory professional regulation.

Chiropractors are regulated in the same way. However, there's no statutory professional regulation of any other CAM practitioners.

Chiropractic is regulated in the same way as conventional medicine.

All chiropractors must be registered with the General Chiropractic Council. You can use the General Chiropractic Council website to find a registered chiropractor near you or check if someone offering chiropractic services is registered.

Apart from chiropractic, there's no professional statutory regulation of complementary and alternative treatments in the UK.

This means:

If you decide to use a CAM practitioner, it's up to you to find one who will carry out the treatment in a way that's acceptable to you. Professional bodies and voluntary registers can help you do this.

Some regulated healthcare professionals, such as GPs, also practise unregulated CAM.

In these instances, the CAM practice is not regulated by the organisation that regulates the healthcare professional (such as the General Medical Council), but these organisations will investigate complaints that relate to the professional conduct of their member.

Many types of CAM have voluntary registers, some of which are accredited by the Professional Standards Authority for Health and Social Care (PSA) or professional associations that practitioners can join if they choose.

Usually, these associations or registers demand that practitioners hold certain qualifications and agree to practise to a certain standard.

Organisations with PSA-accredited voluntary registers include:

This means that these organisations have met the PSA's demanding standards, which are designed to help people make an informed choice when they're looking for a practitioner.

Read about accredited registers on the Professional Standards Authority website

Once you have found a practitioner, it's a good idea to ask them some questions to help you decide if you want to go ahead with treatment.

You could ask:

Page last reviewed: 01 March 2022Next review due: 01 March 2025

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Complementary and alternative medicine - NHS

Alternative treatment (CAM) for MS facts

Multiple sclerosis symptoms vary widely, and a description of "typical" symptoms is difficult. Some signs and symptoms of MS may include:

What is complementary or alternative treatment or CAM?

CAM (complementary and alternative medicine) is care provided in addition (integrative medicine) to or instead of traditional or standard medical practices. This group of therapies is wide-ranging and includes:

Some people who seek out alternative medicine feel that conventional therapy has not successfully controlled their symptoms, or that the potential side effects associated with traditional therapy aren't acceptable. Others find that adding complementary medicine to their program allows improved control of symptoms. When complementary medicine is added to traditional routes, it is referred to as integrative medicine.

Recent studies through the US Centers for Disease Control and Prevention (CDC), specifically the National Health Interview Survey, suggest that as many as 38% of residents within the United States seek out CAM.

Many therapies that are considered within the group of complementary and alternative medicines haven't been studied extensively or investigated in comparison to conventional treatment options.

What is of multiple sclerosis (MS)?

Multiple sclerosis (MS) is a disease that causes demyelination of the brain and spinal cord or a loss of the covering around axons. When this occurs, the axons (the parts of the nerve cells that transmit impulses to other cells) don't work well. As more areas of the central nervous system are affected by the loss of myelin, different symptoms develop.

What are the symptoms of MS?

The specific symptom seen in MS is related to the area of injury in the brain or spinal cord. Examples of symptoms of MS include:

What alternative treatments can be used for MS symptoms?

Fatigue and spasticity seem to respond best to CAM.

Therapies that have been shown to be of some benefit for fatigue have included:

Spasticity has reportedly been reduced with the use of acupuncture and massage therapy. A sense of tingling (paresthesias) has been reportedly improved with reflexology.

Symptoms including depression, memory loss, urinary incontinence, and progression of MS itself (including relapses, disease extent as measured on MRI), and disability have had limited improvement when treated with CAM.

Therapies tested in an effort to improve these symptoms have included:

None of these treatments led to any significant benefit in the studied symptoms.

What about medical marijuana (cannabis) for MS symptoms?

There have been a number of studies looking at the potential benefits of medical marijuana (cannabis) on MS symptoms, including spasticity and chronic pain. There is some suggestion that FDA-approved forms of medical cannabis (Marinol or Sativex) may be beneficial in improving spasticity or bladder frequency. However, there are no reports that ingested or inhaled medical marijuana is beneficial for conditions associated with MS.

The National Multiple Sclerosis Society has more information about medical marijuana for MS symptoms (http://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Marijuana)

Who is eligible to pursue treatment with CAM?

Anyone can participate in CAM therapy. However, it is important to recognize that most of these therapies are not covered by insurance, and may be an "out of pocket" cost for patients with MS.

Patients who decide to pursue CAM need to share this information with their physicians, as some supplements may interact with conventional medication and lead to side effects.

How much does CAM cost?

The costs of CAM can vary widely; regular exercise and yoga can be low or no-cost options, while massage therapy, acupuncture, and some supplements can be quite expensive.

Every patient must have a good relationship with treating healthcare professionals of traditional and non-traditional therapies to best understand potential costs.

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What are the potential risks and side effects of CAM?

Side effects of CAM vary depending on the treatment.

It is important to discuss any potential or ongoing use of CAM with your healthcare professional, who may need to adjust your current therapies to prevent any adverse effects caused by interactions between the two types of therapies.

What different types of CAM were studied in the National Health Interview Survey?

Different types of complementary and alternative medicines that were studied in the National Health Interview Survey from 2002 through 2012 include:

Medically Reviewed on 10/26/2022

References

REFERENCES:

Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin, RL. Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002-2012. National Health Statistics Reports. Number 79; February 10, 2015.

The National Multiple Sclerosis Society. MS Symptoms.

UpToDate. Patient information: Multiple sclerosis in adults (The Basics).

Yadav V, Bourdette D. Complementary and Alternative Medicine: Is There a Role in Multiple Sclerosis? Current Neurology and Neuroscience Reports 2006, 6:259267.

Yadav V, Bever C, Bowen J, et al. Summary of evidence-basaed guideline: Complementary and alternative medicine in multiple sclerosis. Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2014;82;1083-1092.

Excerpt from:

Alternative Treatment (CAM) for MS: Types, Side Effects & Cost

complementary and alternative medicine (CAM), any of various approaches intended to improve or maintain human health that are not part of standard medical care, also known as conventional, or Western, medicine. The various approaches of CAM typically are used in a manner that is complementary to standard medical practices or are used in place of standard medicine. Such approaches are sometimes referred to as holistic or traditional medicine, although those areas of medicine do not cover all forms of CAM. Indeed, CAM includes not only classical systems, such as Ayurvedic medicine and traditional Chinese medicine, which are centred on bringing together the mind, body, and spirit, but also a wide range of other forms of therapy, including chiropractic medicine, biofeedback, art therapy, hypnosis, prayer, specialty diets, and therapeutic touch. Many of those practices are considered to be marginal when compared with conventional practicesthat is, they usually are not a central part of the medical curriculum, nor are they typically prescribed by physicians who practice conventional medicine. However, partly because of the growing evidence base that supports the safety and efficacy of certain CAM approaches, some practitioners of conventional medicine have also become practitioners of CAM.

Prior to the rise of scientific medicine in the 19th century, medical practice was a relatively undifferentiated field. Herbal remedies were prescribed regularly, and the range of practitioners on offer included not only the precursors of contemporary doctors but also groups such as bonesetters and healers. In some cultures those suffering from illness and disease were able to make use of what was a relatively strong cradle of neighbourliness and community support, where the human condition was viewed holistically. In other cultures, however, the sick and disabled were shunned, alienated, or neglected, largely because of a lack of knowledge of disease. With the rise of scientifically based medicine and the development of the modern medical profession, however, the understanding of human disease increased dramatically. Health care became increasingly centred on biomedicine, and a division of labour proliferated. Some doctors, for example, specialized in surgery, whereas others focused on areas such as infectious disease, human development, or mental health. In addition, beginning in the 19th century, scientists discovered ways to isolate and synthesize the active ingredients of plant-based medicines, which gave rise to the modern pharmaceutical industry. By the mid-20th century the advances in medicine had marginalized CAM in Western countries.

In the 1960s and 70s, however, a sort of medical counterculture arose in the West, born from the more general countercultural trend that involved, among other things, a rising interest in Eastern practices of meditation, mysticism, and other philosophies. There was a growing awareness of the limits of conventional medicine, and some believed that modern biomedicine was becoming increasingly counterproductive. Such perspectives were fueled in part by highly publicized medical tragedies, such as those involving thalidomide, which was withdrawn from the market in the early 1960s, and diethylstilbestrol, which was withdrawn in the 1970s; both agents were found to increase the risk of prenatal toxicity. Some people also associated conventional medicine with depersonalization and disempowerment of the patient. Consumers demanded increasing control over their own health, which led to the development of self-help and to the emergence of campaign groups that lobbied on behalf of health consumers and specific groups, such as the disabled and those afflicted by cancer and HIV/AIDS. In the wake of the counterculture, public interest in CAM gained new impetus.

The number of people in Europe and North America who use CAM is considerable. In the United States, for example, a 2007 survey revealed that about 38 percent of adults had used some form of CAM in the past year. A study published in 2010 indicated that about 26 percent of people in England had used CAM at some point in the year prior to filling out the studys survey.

The therapies employed and the extent of their use vary considerably by country. Although the majority of use involves self-help (e.g., use of over-the-counter herbs), a rise in the number of CAM practitioners enabled increasing numbers of people to seek the assistance of CAM providers. Growing numbers of conventional practitioners also employed CAM. In such cases, CAM therapies tend to be prescribed or administered for very specific and evidence-supported purposes, such as the use of acupuncture to relieve pain. As a result, in some cases, the use of CAM by conventional practitioners is not wholly in agreement with traditional principles. Acupuncture, for example, is viewed in traditional Chinese medicine as a panacea, being used to restore balance between the polar forces of yin and yang along meridians.

Reluctance among doctors to employ CAM often is related to the protection of their patients. Despite the ideology of a safe, natural approach to health care frequently espoused by CAM therapists, the approaches used in CAM pose certain hazards to users, ranging from punctured lungs in the case of acupuncture to potentially fatal overdosing from herbal remedies. There are also major gaps in the evidence that has been provided for such therapies. By the late 20th century many complementary and alternative therapies still had not been explored in clinical trials in human patients, unlike most drugs and devices employed in conventional medicine. That was largely because manufactured pharmaceuticals and other medical products were thought to be superior to complementary and alternative therapies, and so the latter did not attract significant investment from governments and biomedical companies. In the early 21st century, however, an increased need for medicines generally resulted in renewed interest in natural-products drug discovery and in unorthodox medical practices, which in turn led to a rise in the clinical exploration of various CAM therapies.

Much debate remains about how to assess the efficacy of CAM. The need for large-scale randomized controlled trials is highly controversial, particularly because many complementary and alternative therapies have been used by humans for centuries and because certain conventional medicines that have been scrutinized by such means have later been discovered to cause severe side effects, resulting in their removal from the market. There are also significant methodological questions about whether the randomized controlled trial is the best way to evaluate complementary and alternative therapies, especially when they are employed holistically. Many treatments associated with CAM are targeted toward individuals, rather than toward conditions (e.g., diabetes or heart failure) as in conventional medicine, suggesting that alternative methods of assessment may be more appropriate. For example, randomized controlled trial methodology attempts to eliminate the placebo effect, but some researchers have claimed that the placebo effect should be more fully employed in studies of complementary and alternative therapies. Other methods, such as case studies and consumer-satisfaction surveys, are attractive evaluative tools for CAM.

Many small-scale controlled trials of CAM have been conducted, with comparisons to placebos and to conventional approaches. Some of those trials have produced encouraging resultsfor example, the use of acupuncture in the relief of chronic pain. However, from the standpoint of conventional research methodologies, the numbers of participants usually has been too restricted to make firm judgments about the likely efficacy of particular complementary and alternative therapies. In such cases, systematic reviews of trial data can be helpful, provided that clear criteria to assess the quality of the studies are employed and that there is a sufficient number of credible trials on which to build the meta-analysis. In the field of herbal medicine, such systematic reviews have suggested that extracts of St. Johns wort (Hypericum perforatum) can provide symptomatic relief in cases of mild to moderate depression and that peppermint oil is more effective than a placebo for the treatment of irritable bowel disease.

Beyond evidence from randomized controlled trials, the data set on CAM is enriched by a plethora of individual case studies, many of which indicate the positive qualitative outcomes that can be obtained from such therapies. The use of CAM also tends to produce high levels of consumer satisfaction. The subjective views elicited in such research, however, must be weighed against a variety of methodological pitfalls in interpreting such results. Nonetheless, data from case studies and consumer surveys have indicated that unorthodox therapies could help to fill the vacuum created in areas where conventional medicine has little to offer. Case studies and surveys have also emphasized the fact that the many diverse approaches of CAM vary in their effectiveness and use. In the United Kingdom, for example, research has suggested that therapies such as herbalism, homeopathy, and osteopathy tend to be relatively more effective for users than approaches based on crystal therapy, iridology, and radionics. Such variations in evidence for specific forms of CAM have necessitated careful and critical scrutiny of claims about curative or palliative powers.

Even where it is felt that CAM can benefit patients, major challenges remain. For example, complementary and alternative therapies may not be accessible to consumers within state-financed health provision and insurance programs. Furthermore, complementary and alternative therapies are not inexpensive versions of conventional medicines or practices. Some CAM approaches can, in fact, be quite costly, particularly when repeat visits are made to a practitioner. Thus, patients cannot turn to CAM to save on health care costs.

Another issue concerns the extent to which CAM is regulated in terms of protecting the interests of health consumers. The remedies themselves, as well as CAM practitioners, have been increasingly subject to regulation, but the parameters of regulation are not always well balanced. For instance, despite growing trends toward professionalization, the practice of CAM in some countries may be exclusively concentrated among certain doctors, medical groups, or allied health professionals. In other countries, CAM is loosely assigned to anyone who wishes to be engaged in the field, with CAM systems largely based on voluntary regulatory arrangements to which not all practitioners are legally bound.

Finally, CAM does not simply challenge biomedicine in terms of best practice. In its most radical forms, it also challenges some of the assumptions underpinning medical orthodoxy and questions the medical concept of disability. Many of those currently involved in practicing CAM, for example, no longer see consumers in medicalized terms as patients. Rather, individuals are seen as actively participating in their own well-being. Given its links to the counterculture, the self-help aspect of CAM therefore may not be viewed simply as an appendage to medicine. Some see it instead as challenging the power of the medical profession. Scientifically based medicine remains dominant, but the approaches that are categorized as CAM are expected to become more fully integrated into conventional medicine, which ultimately could give rise to a new medical orthodoxy.

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Complementary and alternative medicine | History & Facts