Complementary and alternative medicine and coping in neuroimmunological diseases

The risk of polypharmacy, comorbidities and drug-drug interactions in women of childbearing age with multiple sclerosis

Background and Aims

Multiple sclerosis (MS) is the most common neuroimmunological disease of the central nervous system in young adults. Despite recommended contraception, unplanned pregnancies can occur in women of childbearing age with MS. MS- and comorbidities-related multimedication in these patients represents a potential risk. We aimed to raise awareness regarding the frequency of polypharmacy and drug-drug interactions (DDIs) in female MS patients of childbearing age.

Methods

Sociodemographic, clinical and pharmaceutical data were collected through patient records, clinical investigations and structured patient interviews of 131 women with MS. The clinical decision support software MediQ was used to identify potential DDIs. A medication and DDI profile of the study population was created by statistical analysis of the recorded data.

Results

Of the 131 female MS patients, 41.2% were affected by polypharmacy (concurrent use of ⩾5 drugs). Polypharmacy was associated with higher age, higher degree of disability, chronic progressive MS disease course and comorbidities. With an average intake of 4.2 drugs per patient, a total of 1033 potential DDIs were identified. Clinically relevant DDIs were significantly more frequent in patients with polypharmacy than in patients without polypharmacy (31.5% versus 5.2%; Fisher's exact test: p < 0.001).

Conclusion

For the first time, a comprehensive range of potential DDIs in women of childbearing age with MS is presented. Polypharmacy is associated with the occurrence of clinically relevant DDIs. This shows the need for effective and regular screening for such interactions in order to prevent avoidable adverse effects.

Selected methods of unconventional medicine and the possibilities of its usage in multiple sclerosis - analysis of the issue based on the PubMed medical database

People with multiple or long-term multiple sclerosis often use complementary or alternative medicine (CAM). CAM is considered a controversial field of treatment by both neurologists and specialists in other fields of medicine. Nevertheless, there is growing interest in this type of treatment. The aim of this study is to review literature related to the most current knowledge regarding the application of alternative medicine methods in patients suffering from multiple sclerosis based on experimental and medical studies. The method used in the study was to search and analyze the latest articles related to unconventional medicine and multiple sclerosis, available in the PubMed medical databas The most common methods of CAM usage in MS include: vitamin and mineral supplementation, intake of omega-3 and omega-6, a special diet, acupuncture, herbal medicine, reflexology, yoga and meditation. Attention has been paid to the problem which is due to high interest in alternatives. Patients with MS often use unconventional in combination with conventional medicine, while remaining under the care of doctors. Patients apply the presented method as complementary therapy, not an alternative. This article is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. null

Conservative care of temporomandibular joint disorder in a 35-year-old patient with spinal muscular atrophy type III: a case study

OBJECTIVE

This article describes the chiropractic clinical management and therapeutic benefits accruing to a patient with temporomandibular joint (TMJ) disorder and spinal muscular atrophy type III.

CLINICAL FEATURES

A 35-year-old white man presented at the university chiropractic outpatient clinic with a complaint of masseter muscle pain and mouth-opening restriction. Temporomandibular joint range of motion evaluation revealed restricted opening (11 mm interincisival), and pain was rated by the patient at an intensity of 5 on a pain scale of 0 to 10.

INTERVENTION AND OUTCOME

Chiropractic care was provided and included TMJ mobilization, myofascial therapy, trigger point therapy, and light spinal mobilizations of the upper cervical vertebrae. Final evaluation of TMJ range of motion showed active opening of 12 mm with absence of pain and muscle tenderness of the jaw.

CONCLUSION

This case suggests that a patient with musculoskeletal disorders related to underlying neurodegenerative pathologies may benefit from chiropractic management adapted to their condition. In the present case, chiropractic treatment of the TMJ represented a viable, low-cost approach with limited adverse effects compared with surgery.

Understanding unexpected courses of multiple sclerosis among patients using complementary and alternative medicine: A travel from recipient to explorer

Complementary and alternative medicine (CAM) is frequently used by patients with multiple sclerosis (MS). Some MS patients experience unexpected improvements of symptoms, which they relate to their use of CAM. The aim of this study was to obtain knowledge and develop understandings of such self-defined unexpected improvement of MS symptoms. Two cases were constructed based on documents and 12 qualitative interviews. Our aim was not to make generalisations from the cases, but to transfer knowledge as working hypotheses. We identified four health-related change processes: the process of losing bodily competence; the process of developing responsibility; the process of taking control; and the process of choosing CAM. The patients explained unexpected improvements in their MS symptoms as results of their own efforts including their choice and use of CAM. In our theoretical interpretations, we found the patients' redefinition of history, the concept of treatment and the importance of conventional health care to be essential, and leading to a change of patients' position towards conventional health care from recipients to explorers. The explorers can be perceived as boundary walkers reflecting limitations within the conventional health care system and as initiators regarding what MS patients find useful in CAM.