Use of complementary and alternative medicine among people with multiple sclerosis in Eastern Turkey

Objective:The purpose of this study was to examine the use of complementary and alternative medicine (CAM) in patients with multiple sclerosis (MS) living in eastern Turkey as well as the factors affecting the use of CAM modalities. Methods:This is a descriptive and cross-sectional study. Data were obtained from 130 patients with MS at the neurology clinics of Ataturk University. Results: Out of all patients surveyed, 61.5% reported use of at least one form of CAM. The most common three modalities used by these patients were herbs taken orally, relaxation therapies and prayer, with rates of 55.5%, 26.3% and 18.8%, respectively.Massage and relaxation therapies were perceived as very effective by more than half of study participants.It was determined that variables such as education level, residential area and duration of disease affected the use of CAM (P < .05). Conclusions: CAM therapy is widely used by patients with MS in eastern Turkey. Neurology Asia 2016; 21(1) : 63 – 71 Address correspondence to: Nuray DAYAPOGLU, PhD, Department of Medical Nursing, Faculty of Health Sciences, Atatürk University, Erzurum, Turkey. Tel: +90 442 231 14 54 E-mail: [email protected] INTRODUCTION Multiple Sclerosis (MS) is a relapsing or progressive neurological disease with an unknown etiology and only partially effective treatment. In industrialised countries, prevalence rates vary between 15–145 per 100,000. It is estimated that the prevalence of MS in Turkey is about 30–40 in 100,000, and the total number of MS patients is 35,000. People with MS may experience a variety of symptoms, including paraesthesia, ataxia, spasticity, paralysis, fatigue, pain, visual disorders, lack of coordination, tremors, bowel problems, bladder and sexual dysfunction and visual disorders. Currently, there is no cure for MS. However, treatments to slow the progress of the disease and control MS symptoms are available. Conventional MS treatments are limited, and many have significant adverse effects, prompting the increased use of complementary and alternative medicine (CAM) among MS patients. According to the National Center for Complementary and Alternative Medicine (NCCIH), “complementary” generally refers to using a nonmainstream approach together with conventional medicine, while “alternative” refers to using a nonmainstream approach in place of conventional medicine. The two major categories of CAM include natural products (such as herbs, botanicals and probiotics) and mind and body interventions (such as massage therapy, meditation, relaxation techniques, exercises and traditional Chinese medicine). The use of CAM treatments has been increasing among people with MS during the last 15 years. The literature reports the prevalence of CAM therapy use in MS varies from 33% to 80%. The largest study was conducted in the U.S. by Nayak et al. (n = 3140), which found that 64.9% of individuals with MS used at least one CAM. Other smaller studies conducted in Italy, Australia and Spain reported that 35.7%, 67.4% and 40.9% of MS respondents used at least one CAM, respectively. An unknown number of patients with MS in Turkey are using CAM products or practices. There have been different studies on the use of CAM in eastern Turkey. These studies report frequent use of CAM among adult (70%), older adult female (48.3%) and cancer patients (41.1%). The CAM methods used might vary according to geographical area and culture. For example, the rate of the use of prayer to improve MS symptoms in the U.S. is consistently reported to be much higher than in the Europe. Traditional Chinese medicine consists of herbal medicines and other forms of treatment, including acupuncture, massage (Tuina), exercise (qigong) and dietary therapy. CAM practices have been widespread in Anatolia for centuries and remain so in modern times. This CAM practices cover a wide spectrum ranging from herbal prescriptions to Neurology Asia March 2016 64 religious practices.The six most used CAM therapies in MS include reflexology, massage, yoga, relaxation, meditation, aromatherapy, and acupuncture. Patient characteristics that are predictive of CAM use in MS are reported to be similar to those reported in the general population and include female gender, high education, high income, long MS duration and low self-assessed state of health. However, these results are not entirely consistent in terms of age, MS duration and self-assessed state of health. Health care professionals need to know about the use of CAM by patients with MS so that they can determine whether patients are using CAM therapies that may interact negatively with mainstream treatments. Of significant concern is the safety of CAM methods and practices. Because many patients with MS are using CAM therapies, health care professionals must be knowledgeable about their use. However, the frequency and patterns of the use of CAM therapies by patients with MS in eastern Turkey is largely unknown. The aims of this study were (a) to determine the prevalence of CAM use among patients with MS, (b) to determine the types of CAM used, (c) to describe sociodemographic and medical factors associated with the use of CAM (d) and to assess the perceived effectiveness of CAM in eastern Turkey.