Multiple Sclerosis and Complementary Health Approaches

March 2023

Credit: Barbara Calabrese, UC San Diego

Many people with multiple sclerosis (MS) use complementary health approaches to help reduce relapses or relieve symptoms, such as pain, muscle spasticity, fatigue, cognition, and depression. Some mind and body practices, such as yoga, may help ease some symptoms of MS, but there is currently no definitive evidence to suggest that any dietary supplement is effective to reduce relapses or symptoms of MS.

The American Academy of Neurology issued evidence-based guidelines in 2014 on complementary and alternative medicine use for MS and concluded that evidence was available to develop practice recommendations for use of cannabinoids, ginkgo biloba, low-fat diet with omega-3 supplementation, magnet therapy, reflexology, and bee venom therapy. This issue of the digest provides the state of the evidence for some of these and other commonly used complementary health approaches for MS.

What the Science Says:
Multiple Sclerosis and Complementary Health Approaches

Modality and Summary of Current Research

There is some limited evidence suggesting beneficial short-term effects of yoga on fatigue and mood in people with MS, but scientific studies overall had a high risk of bias and definitive conclusions could not be drawn.

There is insufficient evidence to support the use of reflexology for most symptoms of MS, including pain, health-related quality of life, disability, spasticity, fatigue, depression, and others. However, 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on four studies, reflexology is possibly effective for reducing MS-associated paresthesia over 11 weeks.

There is some limited, low-level evidence that suggests that magnet therapy may have modest beneficial effects on spasticity outcomes in people with MS, but the studies have been of low methodological quality. There are also some data from two studies, suggesting that magnet therapy may be useful in reducing fatigue in people with relapsing-remitting MS.

Although hyperbaric oxygen therapy is often heavily marketed to people with MS, there are no consistent data that support the use of hyperbaric oxygen therapy for the treatment of MS.

Orally administered cannabinoids (cannabis extract, synthetic tetrahydrocannabinol [THC], mucosally delivered cannabinoids (cannabis THC and cannabidiol [CBD] extract oral spray, nabiximols (brand name Sativex), and smoked cannabis have all been studied for therapeutic effects in MS. Based on available evidence, cannabinoids may relieve spasticity and/or pain in people with MS; however, no marijuana-derived medications are approved by the U.S. Food and Drug Administration to treat MS. Sativex has received regulatory approval in more than 25 countries outside the United States for the treatment of spasticity (muscle stiffness/spasm) due to MS. There are insufficient data to determine if smoking marijuana ameliorates symptoms of MS. Additionally, the psychoactive properties and other potential adverse effects need to be considered. Sativex is licensed in the United Kingdom for use as an add-on treatment for MS-related spasticity when people have shown inadequate response to other symptomatic treatments or found their side effects intolerable.

According to 2014 clinical practice guidelines issued by the American Academy of Neurology, there is strong evidence that Ginkgo biloba is ineffective for improving cognitive function in people with MS. The guidelines also state that there is weak evidence that Ginkgo biloba is possibly effective for reducing fatigue.

There is insufficient data to assess any real beneficial effects of omega-3 fatty acid supplementation on MS.

2014 evidence-based guidelines from the American Academy of Neurology concluded that a low-fat diet with fish oil supplementation is probably ineffective for reducing MS-related relapse, disability, or magnetic resonance imaging (MRI) lesions, or for improving fatigue or quality of life.

To date, results of studies have been conflicting as to whether vitamin D may provide a therapeutic benefit for people with MS. A 2018 Cochrane review found very low-quality evidence suggesting no benefit of vitamin D for patient-improving outcomes among people with MS. However, findings from a 2018 meta-analysis suggest that vitamin D supplementation may have a therapeutic role in the treatment of MS. Further high-quality studies are needed before definitive conclusions can be drawn.

Clinical Guidelines

Complementary and Alternative Medicine in Multiple Sclerosis (American Academy of Neurology)

Scientific Literature

Information for Your Patients

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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