Many people with Multiple Sclerosis (MS) use complementary and other therapies to help manage the impact of the condition and provide an overall sense of wellbeing. These are used in isolation by some or complementary to conventional treatments, including disease-modifying therapies.
It is estimated that around 70 per cent of people with MS have used a form of complementary or other therapy to treat their symptoms (1). Studies have shown that some of the more commonly used complementary therapies amongst people with MS are reflexology, massage, yoga, relaxation, meditation, aromatherapy, and acupuncture (2). The most common reasons for their use are reported to be pain management and relief from the impact of other symptoms associated with MS, including spasticity and mobility (3).
There is anecdotal evidence available from members of the MS community which suggests that complementary therapies have been effective in helping them manage the impact of the condition. Prior to this booklet’s publication, MS-UK conducted a short survey of the MS community asking for more information about their use of complementary therapies. Just over 85 per cent of responders stated that they had used a complementary therapy to manage MS, with anxiety, pain, mobility, spasms and spasticity and fatigue being the most common symptoms they were looking to target. The most popular therapies used by responders were massage, meditation, mindfulness and yoga.
One of the main advantages of using complementary therapies is that it puts you in control of making decisions around your own health, affording you the chance to do something positive to help yourself. Their use for some, therefore, can be empowering.
Research is limited in evaluating the safety and effectiveness of complementary therapies for people affected by MS (1). This is primarily because by their very nature it is difficult to conduct a ‘double-blind’ trial, a research method used in the scientific community which is used to prove the safety and efficacy of a medication or treatment. In these types of trials some participants will receive the real treatment, while others will unknowingly be administered a placebo. It is a controlled environment where results are fundamentally free from user bias and can be easily compared and analysed. You can therefore understand the problems faced by those looking to conduct scientific trials on the efficacy and safety of a complementary therapy such as yoga, which is a distinctive physical activity. That said, many complementary therapies are generally safe to use (4).
An important consideration before starting any course of complementary therapy is potential side effects, which can differ depending upon the type of therapy you use. There are additional issues to consider, such as potential contraindications with conventional treatments that you receive. Therefore, before starting any new therapy, it is important to consult your medical team, such as your GP and MS nurse.
If you do decide to access a complementary therapy, ensure that you are supervised by experienced and qualified therapists. A qualified complementary therapist will aim to treat the whole person and not just the symptoms. Each client is treated as an individual and any treatment should be tailored in accordance with your specific needs.
Cost is also an important consideration. Before booking any treatment, please remember to check this, particularly if there is more than one session required.
Finally, remember, you are an individual, so a therapy that may work for you may not work for someone else, and vice versa. With the right support you can try different types of complementary therapy to find those which you feel comfortable with and also have the desired effect.
As access to complementary therapies via the NHS is very limited, it is likely that you will need to source them privately. A reputable therapist will be fully insured for any liability and should be fully aware of any potential contraindications that may affect you. They should also be members of a professional body for their particular area of expertise. We signpost to these organisations later in this booklet and you can contact them for support in finding a therapist that suits your needs.
You can also access a range of complementary therapies via MS-UK’s online activities portal. These include meditation, mindfulness, seated qi gong and yoga. All of our classes are devised and run by therapists that are accredited specialists in their field.
Complementary therapies are also available via the network of neuro therapy centres scattered around the UK and a variety of private neuro rehabilitation centres.
More information
The MS-UK online activities portal provides access to a range of complementary therapies. Visit our website to find out what is currently available.
You can also find your nearest neuro therapy centre by visiting the network website.
Over the following pages we list a number of popular therapies along with more information about what they are and how they may help you. We also signpost to the relevant UK professional body, where this is applicable. This is not an exhaustive list and there may be other complementary therapies that you are interested in which we do not mention. If so, please contact the MS-UK Helpline who will support you in finding out more about any particular therapy, if this is required.
Originating from China, acupuncture has been practised for thousands of years. It works with the energy or ‘qi’ of the body which flows through channels, known as meridians or conduits (5). It is believed that acupuncture stimulates the nervous system and causes the release of neurochemicals to promote physical and emotional wellbeing.
Acupuncture involves the use of very fine sterile needles, which pierce the skin to reach an acupuncture point. They are inserted very precisely and connect with the body’s qi. It is not considered painful, just a small prick to the skin and maybe a dull ache for a few seconds when the point is reached (6).
For MS, acupuncture is commonly used to help relieve pain and tension, improve movement, sensation and manage the impact of spasticity. It may also help with managing bladder urgency, and studies have shown that for some people it can be a useful tool in the management of MS-related fatigue (7).
The British Acupuncture Council (BAcC) is a UK-based member-led professional body for traditional acupuncturists. They have almost 3,000 members, all of whom belong to an accredited register. Their website hosts a search facility allowing you to find a therapist in your area.
APS therapy is a safe and effective drug-free symptom management system suitable for the treatment of both neuropathic and musculoskeletal pain. It is a type of micro-current therapy whereby an electrical current is transmitted through the human body via electrodes that make contact with the skin. The currents used are designed to mimic the electrical pulses that the body produces naturally. These are known as action potentials.
Action potentials are the change in electrical potential associated with the passage of an impulse along the membrane of a muscle cell or nerve cell. In cases of neuropathic pain, or improper nerve firing, such as with restless leg syndrome, applying waves of correct action potential frequencies seems to reduce the improper nerve impulses, reducing or completely alleviating pain or symptoms.
APS therapy is a way of reducing pain without using medication. During a small trial at the Bedford MS Therapy Centre, 57 per cent of participants reduced or discontinued analgesic medications as a result of the effects of the therapy. In addition, 78 per cent of participants reported a significant reduction in pain (8).
Aside from pain, other symptoms synonymous with MS that have reportedly been successfully treated using APS therapy include fatigue, insomnia, spasms and spasticity (9).
APS therapy is used by numerous neuro therapy centres across the UK. There are also many independent therapists using APS and it is possible to hire or purchase APS therapy machines for use in the community.
A good place to find out more about APS therapy is the Painfree Potential website, which provides information about relevant scientific studies and research, testimonials from people who have used APS therapy for pain relief, where to find an APS clinic, buying and hiring equipment and much more.
This uses powerful, fragrant essential oils with massage to help you feel relaxed or energised. Essential oils are the essence of the plant, extracted from herbs, flowers, shrubs or trees. Each one is different with its own fragrance and therapeutic use. Some oils have anti-inflammatory properties, others bring about a feeling of relaxation, while some are stimulating.
An aromatherapy massage can help to relax the whole body, and for people with MS particularly it is thought to help improve sleep hygiene, reduce pain, offer support with the mobility of joints and muscles, and provide an improved sense of wellbeing (7).
The International Federation of Aromatherapists (IFA) regulate and accredit standards in aromatherapy for practitioners. They can be contacted for further support in finding an accredited aromatherapist and their website also hosts a practitioner search facility.
This is the practice of gentle manipulation of the body’s joints, ligaments and muscles to help manage the wider impact they may have on our body’s wellbeing. It works by attempting to realign the joints which in turn can relieve pressure on other areas of the body, including the nerves. It is used as a therapeutic intervention for musculoskeletal problems including back and neck pain and also headaches, migraine and sports injuries.
While there is very little scientific evidence to support the benefits of the chiropractic approach regarding the management of MS, realigning the joints may help to improve posture, mobility and could act as a source of pain relief, particularly where nerve compression is a factor (10).
In the UK all chiropractors need to be registered with the General Chiropractic Council (GCC) who act as an independent regulator. It is against the law to practice as a chiropractor in the UK without being GCC registered.
More information The GCC website provides more information about chiropractic care and hosts a searchable database of registered chiropractors.
MS-UK recognise the need for personal choice within the MS community and wishes for people to be as informed as is possible on the use of cannabis for managing MS symptoms. The use of prescribed cannabis for medicinal purposes in the UK was legalised in late 2018. However, its production and distribution are subject to strict criteria, so access can be relatively difficult and sometimes costly.
Medicinal cannabis comes in different guises. Cannabidiol, which is commonly known as CBD, can be taken in capsule format, gummies, as a tincture which is dropped under the tongue or as a massage oil. These are available for general sale in the UK and will usually differ in content and efficacy, particularly when compared to prescribed medical cannabis products.
Nabiximols, known in the UK by the brand name Sativex, is a medical cannabis medication which may be available to you via the NHS. Sativex is an oromucosal spray which is currently only prescribed for the treatment of moderate to severe spasticity. It is licenced in the UK only for people who have not responded sufficiently to first line and other anti-spasticity medication. A recent review which looked at the efficacy of medicinal cannabis found that nabiximols were effective in the management of MS related spasticity, neuropathic pain and improved sleep quality (10).
Medical cannabis can also be accessed privately via specialist clinics, prescribed by authorised doctors who have experience in this area. The dosage and type of product prescribed will be decided according to your condition and wider health concerns, ranging from oils, topical creams and dried flower which is suitable to be administered via a vape.
If you are thinking about supplementing with a CBD product, or interested in access to prescribed medical cannabis, it would be wise to speak to your GP and MS support team in the first instance. At the very least this will ensure that any potential contraindications with existing medications are considered from the outset.
More information Read our online blog that explains more about the history of medical cannabis, its potential benefits for people with MS and how it can be accessed in the UK.
www.ms-uk.org/medical-cannabis-and-ms-information/
The UK-based Medical Cannabis Clinicians Society have developed a useful guide to medical cannabis. Inside you will find information about the many aspects of cannabis medication in the UK, including the science behind it, access and safety.
https://www.ukmccs.org/wp-content/uploads/2022/04/Medical-Cannabis-Frequently-asked-questions.pdf
This is one of the oldest known therapies and has been used for thousands of years to help ease stiffness in muscles and joints, relieve pain, improve blood and lymph circulation, and increase wellbeing. It can be used to stimulate the various systems of the body and can also help with posture, ease stress and release tension. It has been found that for people with MS, massage lowers anxiety, reduces pain, promotes relaxation and improves patient wellbeing (11). A recent review of previous studies also found that using massage as a complementary therapy helped to alleviate the impact of MS-related fatigue (12).
There are a number of different types of massage, some gentle, others more vigorous. These include
There are many other types of massage therapy that may also provide some symptomatic relief.
Massage practice is not officially regulated within the UK. However, in our further information section we signpost to the Complementary and Natural Healthcare Council (CNHC). They include massage therapists in the voluntary register of accredited practitioners which meet their code of practice standards.
This is an ancient practice by which a person learns to be present in the moment, allowing them to become more relaxed, and peaceful. It helps to slow the mind and encourages you to be kinder and gentler to yourself. Meditation encourages a gradual release of all thoughts and feelings. It is seen by researchers to be one of the most effective forms of stress reduction techniques and has been shown to relieve biological markers of stress (13).
With regular practice, meditation can help you to
There are a number of different forms of meditation including transcendental meditation and mindfulness. Fundamentally, meditation is usually well-tolerated and offers a number of health benefits including stress reduction, relieving anxiety, depression, increased self-esteem and also pain relief (14).
More information The British School of Meditation provides training to people wishing to teach this form of therapy. Their website hosts a searchable database of accredited meditation teachers based within the UK.
Mindfulness has been practiced for a number of centuries and derives from eastern secular and religious institutions, including Buddhism and Hinduism (15). In practice, it provides a way of being able to be ‘in the moment’, setting aside anxieties about the past or the future, and being grounded in the present. It does this by using techniques such as meditation, breathing and yoga.
While historically mindfulness has its roots set firmly in eastern cultures, it has become popular in western societies in recent times. It is acknowledged that one of the main influencers of this growing popularity is Jon Kabat-Zinn, who founded the Center for Mindfulness in Medicine, Healthcare and Society at the University of Massachusetts, USA. He developed what is known as Mindfulness Based Stress Reduction (MBSR) in the late 1970s, which is a short-term programme using mindfulness techniques to foster stress reduction. MBSR has lasted the test of time and is used by many mindfulness practitioners around the globe as a foundation to help people manage the stresses of everyday life (16).
There is a growing body of evidence which shows that practicing mindfulness can be beneficial to people affected by MS, particularly with regard to managing anxiety, stress and low mood. For example, one particular study found that people with MS reported improvements in emotional balance and brain processing speed after receiving just four weeks of mindfulness training (17). Practicing mindfulness meditation has also been shown to help people with MS improve sleep quality, including managing the impact of insomnia (18).
It is recommended by the National Institute for Health and Care Excellence (NICE) that health professionals consider mindfulness as a way of treating MS-related fatigue and as a preventative practice for people with experience of recurrent depression (19,20).
The British Association for Mindfulness-based Approaches (BAMBA) is a professional body of mindfulness practitioners, teachers and training organisations. Their mission is to promote safe, ethical and inclusive practices in this field. Their website provides a search facility which will help you to find a mindfulness teacher that has sufficiently achieved their good practice guidelines.
Osteopathy is based on the belief that a person’s wellbeing stems from abnormalities in the body’s structure and function, looking at the interconnectedness of the skeleton, muscles, ligaments and connective tissues. The principle of osteopathy is that when these body parts work harmoniously your body is given the best possible chance to stay healthy.
Therefore an osteopath recognises and treats problems in the bones, joints, muscles and ligaments with the aim of helping the body to heal naturally, using touch techniques, physical manipulation, stretching and massage. While helping to relieve muscle tension and improving the mobility of joints, these techniques can also enhance blood flow and nerve connectivity to the areas of focus (21).
Outside of the general benefits that osteopathic therapy can offer, there is some evidence, albeit limited, that shows it can be used to support people with MS. Two recent small-scale studies have shown that this type of therapy can be a useful tool in the management of fatigue, anxiety, depression and improve quality of life for people affected by MS (22,23).
In the UK all osteopaths are regulated by the General Osteopathic Council (GOsC), who ensure that each practitioner meets the necessary professional standards, including undertaking continuous professional development.
The GOsC website provides in depth information about osteopathic therapy. They also host a searchable database of osteopaths who are regulated to practice within the UK.
Oxygen therapy, also known as hyperbaric oxygen therapy (HBO), involves breathing 100 per cent pure oxygen through a mask whilst inside a pressurised metal chamber. The chamber is a sealed unit, usually large enough to seat six to eight people. Over the course of an hour it is filled with a higher concentration of oxygen than normal air under pressure. As you breathe, the oxygen saturates your blood and tissues.
While there is a lack of scientific evidence to underpin the efficacy of oxygen therapy for the treatment of MS and related symptoms, anecdotally people with MS have reported improvements in fatigue levels and bladder problems, post-therapy.
Oxygen therapy is available in many neuro therapy centres. Treatment requires regular attendance at the centre, usually three to four times per week initially. A treatment plan may consist of a course of around 20 sessions, each one lasting one hour, spread over a month. Top-up sessions may then be required but with less frequency.
Pilates was developed in the early 20th century by Joseph Pilates, a German fitness instructor who created the program as a means of rehabilitation for people who are recovering from injuries. It focuses on building stability and strength, improving posture, muscle tone and flexibility using a series of low impact exercises. The techniques used to perform the specific exercises work in tandem with both mind and body, so it helps to create a general sense of wellbeing.
A recent systematic review of studies that looked at Pilates as a means of managing the impact of MS found that it can help people with MS improve overall quality of life, helps in the management of fatigue and balance, and can improve walking ability (24).
Pilates exercises are inclusive and accessible in that they can be conducted whilst standing or seated
The Pilates Foundation was founded in 1996 and is the UK’s first association for Pilates teachers, supporting them in developing professional excellence. Their website provides information about Pilates and has a search facility to help you find a teacher.
Reflexology is a complementary therapy that predominantly works on the feet, but can also be performed on the hands, face and ears. It is a non-invasive therapy that is effective in promoting deep relaxation. The therapy can trace its roots back to Ancient Egypt, India and China and was originally introduced to the Western world as ‘Zone therapy’ in the early 1900s by Dr William Fitzgerald.
The main theory of reflexology is that there are reflex points all over the feet, and also on your hands and ears, that correspond with different areas of the body. Working these points can help to bring balance to the body, reduce tensions and improve sleep, something that is often much needed if you have MS.
Reflexology works safely alongside standard healthcare, however a reflexologist cannot claim to cure, diagnose or prescribe. Each treatment is individual and tailored to your needs, and a full consultation, which includes considerations of your medical history, should be undertaken prior to starting therapy. This ensures that the most appropriate treatment is provided to you.
As with many other complementary therapies, scientific evidence which underpins the efficacy of reflexology in managing MS and its symptoms is limited. That said, over the past two decades a number of small-scale studies have returned positive results. In 2003, a study involved 53 people with MS receiving an 11 week-long course of treatment, with a view to understanding its impact in managing bladder issues, muscle strength, spasticity and sensory disturbances. The study concluded that given the improvements reported by participants after receiving the course of treatment, reflexology can be influential in managing these symptoms (25).
More recently studies have found that reflexology can also help with the management of constipation, pain, fatigue and improve quality of life for people with MS (26,27).
Ultimately a reflexology session helps to nurture deep relaxation, which is much needed when you live with the uncertainties of a long-term health condition such as MS.
The Association of Reflexologists (AoR) is a UK-based independent association for reflexologists. They boast over 5000 members, supporting them with continuous professional development and upholding the best possible professional standards. Their website provides a searchable database of their members.
This is a form of hands-on healing therapy which concentrates on the body’s energy flows to promote healing and wellbeing. It takes its name from two Japanese characters – ‘rei’ which means universal spirit and ‘ki’ which means ‘vital life force or energy’ (28). It is thought that reiki has been practiced, in one form or another, for a number of centuries. The current form of reiki most commonly used is known as ‘Usui Reiki Ryoho’ and was developed in Japan by Mikao Usui in 1922 (29).
Fundamentally, reiki therapy is underpinned by the concept of ‘life force’ which is energy that flows through our bodies, nourishing our cells and organs. Negative thoughts and feelings that affect us can disrupt this life force, the flow of positive energy, causing problems with the function of our cells and organs. It is thought that this transference of positive energy helps to dissipate negative energies, promoting healing and more efficient bodily function.
There has been a fair amount of research conducted in recent times that shows reiki therapy can be an effective tool in the management of anxiety, stress, pain and general wellbeing (30). However, this does not extend to how effective it can be to help manage the impact of these and other symptoms specially in people with MS. The International Association of Reiki Professionals (IARP) suggest that reiki therapy can help people with MS as it may bolster immune system function, can help with pain, anxiety and depression management, plus it is reasonably well tolerated.
Scientific evidence is required for a better understanding of how reiki can support people with MS. It is therefore encouraging to know that one such study is intended to take place during 2024, involving 60 participants who have received a diagnosis of relapsing remitting MS (RRMS) (31). Hopefully the results provide both positive and interesting reading.
Reiki therapy can be accessed via some neuro therapy centres and private practitioners.
The UK Reiki Federation (UKRF) supports UK-based reiki practitioners in their quest for continuous professional development and training. Their website provides a whole host of information about the therapy, including a searchable database of reiki practitioners in the UK.
Yoga originates from India and has been practiced for over 5,000 years. The main components of yoga involve physical postures, regulation of breathing, meditation, and relaxation. It is generally safe to practice, however, there are many styles of yoga which differ in terms of their focus and difficulty (32). Therefore, supervision may be required for beginners, particularly in finding the most appropriate style and starting point.
In terms of the benefits of practicing yoga, various studies have shown that these can be wide ranging. The findings of recent studies underpin how yoga can be instrumental in promoting better mental wellbeing, improve physical strength, flexibility, balance, posture and overall quality of life (33).
There is a growing body of evidence which shows that yoga can be useful in supporting people with MS, for a variety of reasons. For example, very recently a small-scale study found that just a 12 week long course of yoga could help people with RRMS and secondary progressive MS (SPMS) improve their overall quality of life, including physical and mental health functions (34).
A separate study found that people with RRMS who took part in a six-week programme, which combined yoga with group discussions centred on promoting resilience, saw significant improvements in fatigue and anxiety. The program, developed by the US-based LoveYourBrain Foundation, was originally devised to help people rehabilitate after they had experienced a traumatic brain injury (35). While evidence is required to understand the long-term efficacy of their approach for people with MS, the results returned so far are certainly encouraging.
Yoga is an inclusive therapy and can be practiced by people with varying levels of physical mobility. Earlier in this booklet we signposted to MS-UK’s online activities programme which includes accessible yoga classes that can be undertaken from both standing and seated positions.
The British Wheel of Yoga (BWY) is a UK-based charity and member organisation. Their mission is to promote greater understanding of the benefits of yoga and support practitioners who are looking to further their professional development. The BWY website provides access to a searchable database of yoga professionals in the UK.
Federation of Holistic Therapists (FHT)
This is the largest UK-based professional association for therapists in the UK. They have thousands of members who are skilled in a wide range of complementary and other therapies. The FHT support members in accessing relevant accreditation, running their own scheme which ensures all therapists meet the highest possible standards, whatever their expertise. Their website hosts a searchable database of therapists who are skilled in many different fields.
Complementary and Natural Healthcare Council (CNHC)
This is an independent UK regulator for complementary healthcare practitioners, set up with the support of the UK government as a means of offering the public protection and providing them access to a register of healthcare practitioners. All practitioners that appear on their database are required to uphold professional standards in accordance with the CNHC’s code of conduct, ethics and performance criteria.
