Complementary and alternative (CAMs) Section headline

The Multiple Sclerosis Society More than 100,000 people live with multiple sclerosis in the UK. Every one of them shares the uncertainty of life with MS. We’re funding research and fighting for better treatment and care to help people with MS take control of their lives. With your support, we will beat MS.

As a charity, we rely on the generosity of people like you to fund our vital work. Thousands of people affected by MS turn to us for help and advice each year, and we want to make sure we are there for them whenever they need us. If you would like to make a donation, you can do so by: • Calling us on: 0300 500 8084. Lines are open Monday to Friday, 9am – 5pm • Visiting us at: mssociety.org.uk/donate • Posting your donation to: MS Society, National Centre, 372 Edgware Road, London NW2 6ND. Please make cheques payable to the ‘MS Society.’

Cover image©Shutterstock 2 Helpline: 0808 800 8000 Contents

About this booklet 1 What is complementary and 2 Availability and cost 6 Which should I use? 7 Types of complementary and alternative medicine 13 Other types of non-standard 28 Further reading 33 Useful organisations 35

www.mssociety.org.uk About this booklet

any people with multiple sclerosis (MS) say that complementary and alternative (CAMs) help Mthem feel better. It’s estimated that between 50-75% of people with MS have used complementary or alternative medicine as part of their lifestyle.

Some people feel that doesn’t have all the answers, or that using CAMs gives them more control over their health and well- being. Others find the ‘holistic’ approach (looking at the whole person, not just the illness) to treatment appealing, as this approach looks beyond the physical and takes emotional and spiritual issues into account too.

As well as any direct therapeutic benefits, CAMs can offer psychological help. You might feel that you’ve lost control of your body and traditional medicine can offer no cure and, in some cases, only limited help with symptoms. Following a therapy from outside the mainstream of medicine can offer you a feeling of regaining some sort of control. Even if particular therapies that are tried are not helpful, the process of exploring and experimenting with CAMs can have its own benefits.

This booklet looks at some of the complementary and alternative therapies commonly used by people with MS. But you might come across others, so we also look at things to consider before choosing any therapy: • is there evidence to show that it works? • is it appropriate for you? • how can you find a properly trained and qualified practitioner? There are also some other non-standard therapies available that are generally less well known and are not normally included in the listings of complementary and alternative medicine. We’ve included these because they are sometimes targeted at people with MS.

1 Helpline: 0808 800 8000 What is complementary and alternative medicine ? omplementary and • Natural – this can be misleading. alternative medicine Some ‘natural’ products such C(CAMs) is the name of as snake venom, or even a group of therapies which radioactive chemicals,are aren’t considered to be part harmful. Also, many CAMs of mainstream medical care. are processed and are as There are many different types ‘unnatural’ as any other drugs. of CAMs. The most popular Can I believe the claims? in the UK are , , herbalism, There’s a lot of information available homeopathy and osteopathy. about CAMs, including a range of books and many websites. The What do ‘complementary’, problem can be finding information ‘alternative’, ‘holistic’ and that’s objective and accurate. ‘natural’ mean? This is a particular problem when Therapies might be used in a looking online, where information ‘complementary’ or ‘alternative’ is easily accessible, but often of way. They might also be described questionable quality. Anyone can as ‘holistic’ or ‘natural’. publish a website, without needing • Complementary – used to supply names, qualifications alongside regular health care. or sources, let alone whether the Most people with MS follow the information is based on scientific complementary approach. research. • Alternative – used instead of There are numerous sales pitches conventional health care. that include personal statements and anecdotal claims about all • Holistic – therapies that address kinds of treatments. If you’re emotional and spiritual issues as considering using a CAM therapy, well as physical. be wary of products that make big

www.mssociety.org.uk 2 What is complementary and alternative medicine? promises, say they’re scientifically use any CAMs, as you would for proven or can ‘cure MS’. They prescription treatments. might raise expectations to sell While many people report that the product, but could be a waste a CAM has helped them, others of money or have disappointing give it up as they feel it has little or results. no impact. One research study The charity Sense about Science that questioned more than 3,000 (see page 37) has information that people with MS found that over can help you to judge whether or 55% of those who had tried a CAM not to believe the claims about a stopped because they felt it was particular therapy. You can also ineffective. look out for this logo: Have clinical trials tested what works? People often ask if there’s any ‘evidence’ that a particular treatment works. In comparison to It’s the mark that the information conventional medicine, very little is produced under the Information research has been done on CAMs. Standard, a quality standard There have been some clinical introduced by the Department of trials to test the effectiveness of Health. This aims to help people CAMs in treating MS (see under the to quickly identify reliable sources individual therapies). Compared of quality, evidence-based to the number of clinical trials information. looking at conventional medicine, this area is still poorly researched. In addition, some CAMs might Some researchers have also raised be harmful, or have dangerous questions about the quality and interactions with other medications. design of the trials completed for For this reason, you should talk to CAMs in MS. your doctor before deciding to

3 Helpline: 0808 800 8000 What is complementary and alternative medicine?

One reason for the lack of quality The MS Society is open to funding research in this area is that CAMs research into the use of CAMs in might not be suited to traditional MS. research methods. Does this mean they don’t However, this is beginning to work? change as practitioners become Even though there’s a lack of more aware of the value of research clinical evidence, this doesn’t and finding ways to test their necessarily mean CAMs don’t approaches. benefit some people with MS. Many training courses now include One US research study showed research skills. Sources of funding, that over half of all people with such as the NHS research and MS who had tried various CAMs development programme, are including yoga, herbal treatment, now more open to complementary chiropractic, , and researchers. nutritional supplements, thought they had been helpful.

www.mssociety.org.uk 4 What NICE says The National Institute for Health and Care Excellence (NICE) is a government organisation that decides if treatments work and are worth the money they might cost the Health Service. Their guideline on MS sets out how MS should be treated by the NHS in England, Wales and Northern Ireland. Their recommendations are based on research evidence. The guideline says that there’s some evidence that reflexology, massage, t’ai chi, magnetic field therapy, neural therapy, fish oils and the combination of some forms of complementary therapy (known as ‘multi-modal therapy’) may be helpful for people with MS in terms of their general sense of well-being. However, it goes on to say there’s not enough research evidence to give firm recommendations. The guideline doesn’t mention CAMs that haven’t been well researched in relation to MS. This means that the therapies listed aren’t necessarily those that people with MS most frequently use or know about. But by including complementary and alternative medicine in the MS guideline, NICE has helped bring these therapies out into the open. You don’t need to feel reluctant to talk to your doctors about therapies you want to try or are using – quite the opposite – and the NICE guideline recommends you do just that.

5 Helpline: 0808 800 8000 Availability and cost

ven if they’re available on Paying privately the NHS, you might be If you can’t get a particular CAM on asked to pay something E the NHS, most are easy to access towards the costs of your privately. Charges for individual CAMs. Do check before you go appointments and for full courses for any appointments. of treatment can vary significantly, GP surgeries so check costs before making a commitment. Almost half of GP practices in England now provide access to Be wary if a practitioner pushes some CAMs for NHS patients. you to book many sessions and pay for them in advance, or to Each local practice, primary care ‘bulk buy’ any products. Also, if a trust or hospital trust decides therapy seems to be excessively individually whether or not they’ll expensive, it’s a good idea to provide these therapies on the check what the typical costs are NHS. If they do, they might have for that treatment with one of the complementary and alternative regulatory bodies. medicine practitioners working alongside doctors, or doctors Health insurance schemes might provide it themselves. Some private health insurance Other NHS providers schemes and medical cash plans cover the costs of selected CAMs. CAMs are also often provided by Alternatively, some local Healthy hospices, services, Living Centres and MS National and some hospitals and pain Therapy Centres (MS Therapy clinics. Centres in Scotland) may cover them.

www.mssociety.org.uk 6 Which therapy should I use?

here are many different symptoms, which your doctor types of CAMs, so might need to be aware of. Tdeciding what might help Who provides the therapy? can be overwhelming. While some people may find one type To cover the whole range of of therapy works well for them, people who might provide a another person may find they complementary or alternative don’t get the same benefit. therapy, we use the term ‘practitioner’. Examples include You might consider a number of an acupuncturist, chiropractor, therapies before making a final homeopath, massage therapist or decision. Later in this booklet we osteopath. outline some of the most popular Are they regulated? ones, and also include a list of other non-standard therapies There is little regulation of many suitable for people with MS. complementary and alternative medicine practitioners, and in If you’re interested in a particular some cases it can be easy for therapy, it’s a good idea to take the anyone to set themselves up as a time to find out how that particular practitioner. Key exceptions to this therapy is regulated and to discuss are osteopathy and chiropractic, it with your doctor. both of which have strong Why talk to the doctor? regulatory bodies that have been established by law. These therapies might have an effect on treatments you already What does membership of take – known as contraindications. a professional body really Never change or stop taking mean? prescribed medication without It’s important to choose a talking to your doctor first. The practitioner who belongs to a new therapy might even have professional organisation or a negative impact on your MS regulatory body, where possible.

7 Helpline: 0808 800 8000 Which therapy do I use?

Membership requirements vary, How can I find a so it’s worth checking these so practitioner? you can establish the practitioner’s Some people find a practitioner qualifications. through their doctor, MS nurse Membership could be based on or another member of their any number of different things health care team. Others look – completing a programme of for one independently. In either academic study, a specified case, it makes sense to check number of hours of clinical training, out their qualifications and how or an interview and assessment. their therapy is regulated. Many If you find out they have had very regulatory organisations provide little training, for example, you may advice and details of practitioners not wish to use them. in your area. See ‘Useful organisations’ on page 35. When deciding if a practitioner is ‘fit for purpose’ you may want If you are using their services to to check if they have a specific find a practitioner, you might want qualification or the number of to ask the professional body: years they have been practicing. • how long has the organisation This is better than relying on the existed and how many fact that he or she has paid a members do they have? membership fee to belong to a professional organisation. That • how do practitioners register may not be a wise decision to and must they pay a fee? base your choice on. • what training or qualifications In some cases, there might be must members have? more than one regulatory body, so you might want to check if a • is there a complaints procedure practitioner is also a member of and a system for removing any other bodies. a practitioner from the register

www.mssociety.org.uk 8 Which therapy do I use?

if there have been complaints and feel, what are the benefits? against them in the past? • does the practitioner have • can the organisation provide experience of treating people a list of practitioners? Word with MS, and is the method of mouth can also be a useful appropriate for someone who way of finding a practitioner. has MS? It’s important to check if the • are they insured so that you practitioner is trained and can be compensated if registered with a regulatory or anything goes wrong (for professional organisation. example, professional What should I do before indemnity insurance)? This not making an appointment? only means you can be Once you’ve found a practitioner, compensated if something or if you already have a practitioner goes wrong, it also highlights in mind, you should talk to them good professional standards to establish if the therapy they • what’s the cost of a full course offer is appropriate for you. It’s of treatment and does the first recommended you check the appointment cost more? following before you commit to an appointment: • how long is the course of treatment likely to be? • are they a member of a regulatory body or professional • does the practitioner have any organisation, and if they are, information about their practice what does membership entail? and the therapy that they can send out to you in advance? • how long did they train for, what qualifications do they • is there any preparation you have, and how long have they should make before treatment? been practising? For example, not eating for a short time or wearing a • how does the treatment work particular type of clothing.

9 Helpline: 0808 800 8000 Which therapy do I use?

• is a record of treatment and They should also tell you if they outcomes kept? And can can’t help, and if possible suggest you have access to information, someone else more appropriate. for example if you want a What should I do if I am copy of records for your doctor unhappy with a treatment? or neurologist? Perhaps you don’t like the • is there appropriate access to treatment or the way it makes you the clinic or place of practise? feel; it isn’t working for you; you At the appointment have been hurt or injured; or you don’t like the way the practitioner Before the treatment begins, is behaving towards you. Some of make sure the practitioner is these problems can be relatively aware of your MS, any other easy to sort out, others aren’t. medical conditions you have and any medications you take. At the The first thing is to try to explain appointment, the practitioner to your practitioner what the should take a full history of your problem is. If there’s an issue condition and explain what the with the treatment, maybe it can process will involve. They should be adapted to suit you better. Or welcome any questions you perhaps this particular treatment have and keep you well informed isn’t the one for you. throughout the treatment period. As with conventional medicine, it’s The practitioner should tell you to important for you to have a good see your doctor if they realise you professional relationship with your might have something serious that practitioner. This will help you get your doctor doesn’t know about, the best out of a treatment. But or if they identify any further health relationships don’t always work. conditions that you or your doctor If you find there are problems, aren’t aware of. it may be best to find a different practitioner.

www.mssociety.org.uk 10 Which therapy do I use?

If you need to complain In England, contact the Patient Advice and Liaison Service (PALS) If you can’t solve the problem who can answer questions, by talking to your practitioner, problems or concerns of a non- or you’re not satisfied with a medical kind. The PALS number is treatment, you might want to available from a doctor’s surgery or complain. hospital. PALS can also help you Making a complaint can be with the complaints procedure. distressing and time consuming, and you might want to talk this In Scotland, you need to contact through with a friend and have the trust or health board patient someone to support you with the liaison or complaints officer. Each process. health board area also has an Independent Advice and Support There are different approaches Service, run by Citizens Advice, to complaints, depending on which can support you to make a whether you accessed your complaint. practitioner through the NHS or privately. In Wales, the trust or local health board complaints manager is Through the NHS responsible. One approach is to first talk about In Northern Ireland, the local any problems with your doctor or health and social services board is the complementary health care responsible for complaints within service manager (if there is one). the NHS. This might resolve the issue. You can also use the standard NHS Privately complaints process. There are The first thing is to contact any organisations in each part of regulatory authority or professional the UK to help you through this association of which the process. practitioner is a member. Ask if they have a complaints procedure

11 Helpline: 0808 800 8000 Which therapy do I use? and use this if appropriate. False claims and There may also be a complaints advertising procedure associated with a If you think your CAM hasn’t lived practitioner’s clinic. up to claims made about it or Many practitioners will also be you’ve been misled, you might insured, so if you have been hurt want to contact the Advertising or injured you may be able to get Standards Authority (ASA) and compensation this way. However, register a complaint. many types of complementary The ASA oversees advertising and alternative medicines aren’t wherever it appears – on TV, in regulated by law, and not all newspapers, magazines, direct professional associations have mail or web adverts (such as complaints procedures or will help banners, pop-ups and email sale you with a complaint. This is why promotions). The ASA can tell you it’s a good idea to ask all those what can and can’t be said about questions on listed under ‘What a particular product. Unqualified should I do before making an claims about ‘cures’ are generally appointment?’ considered unacceptable If you’ve been harmed or and the ASA can help to get abused advertisements withdrawn. Whether you accessed your If you’ve already paid for a practitioner privately or through treatment and want your money the NHS, if you feel they violated back as you feel you’ve been professional boundaries, you can misled, you might want to contact contact the Clinic for Boundaries your local Trading Standards Studies for support. There’s also or Citizens Advice Bureau (See a charity called Action against Useful organisations page 35). Medical Accidents (see page 35) which aims to help people who’ve been harmed during a health care treatment.

www.mssociety.org.uk 12 Types of complementary and alternative medicine his is a summary of the points on the meridians. CAMs that people with For , hand or TMS most commonly ask finger pressure is applied to the about, as well as therapies acupuncture points. Only small or that have been researched in preliminary studies of acupuncture treating MS. in MS have been completed, and It’s not a list of therapies these are too limited to show recommended by the MS Society, conclusive evidence of benefits for nor is this a comprehensive list of any MS symptoms. all complementary and alternative In other conditions, acupuncture therapies available. See ‘Useful appears to alleviate pain, nausea, organisations’ on page 35. and vomiting. Acupuncture Before you start any therapy, let is generally a well tolerated your doctor know, so you can be procedure, especially when it’s confident it is safe. performed by a well-trained acupuncturist. To avoid infections, Acupuncture and sterile needles must be used. acupressure There are two distinct styles Acupuncture is a component of acupuncture – traditional of traditional Chinese medicine. Chinese and western medical. It’s believed that energy, known They have separate professional as ‘qi’, travels through the body organisations that can provide in specific pathways known as further information and advice, ‘meridians’, and that illness occurs including: Acupuncture when there is a disturbance Association of Chartered of energy. With acupuncture, Physiotherapists (all members are improvement of energy flow is also qualified in physiotherapy); thought to occur with the insertion British Acupuncture Council; of thin, metallic needles in specific British Academy of Western

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Medical Acupuncture; and British Technique’, to others. Medical Acupuncture Society. See There are no formal studies of the ‘Useful organisations’on page 35. Alexander Technique in people Acupuncture practitioners aren’t with MS. Limited studies in other regulated by law. They don’t need conditions suggest that the to have any training or experience Alexander Technique may improve in order to call themselves balance, performance ability, low an acupuncturist. However, back pain, depression, level of to register with one of these disability, and breathing function. associations he or she must hold There are no known adverse certain qualifications and agree effects from the therapy itself, to work according to their codes of but it shouldn’t be used in a way practice. that delays conventional medical Alexander Technique diagnosis or treatment of serious The Alexander Technique was conditions. developed around 1900 by Alexander Technique teachers Frederick M. Alexander, an aren’t required to belong to any Australian actor who had recurrent professional organisation or to episodes of hoarseness while have completed any specific performing. To address this training. However, the Society problem, he experimented on of Teachers of the Alexander himself by observing various head Technique can provide details of and neck positions in a mirror. its members, all of whom have He eventually found positions of completed a training course and the head, neck, and spine that agreed to a professional code of appeared to correct the problem conduct (see Useful organisations by improving posture and making page 35). tasks easier. He then taught Alexander Technique teachers this method, the ‘Alexander who meet a set of national

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occupational standards can Oils should not be taken internally. register with the Complementary There are currently over a dozen and Natural Healthcare Council. professional organisations for aromatherapists in the UK, and Aromatherapy is a healing an aromatherapist isn’t required method that uses essential oils to belong to any of them or have from plants. It was practised in completed any specific training. some form in ancient China and Many of these organisations ancient Greece. The form of are working together as the aromatherapy that is currently Aromatherapy Council, to develop used was originally developed in and maintain education standards the early twentieth century by a for the UK aromatherapy French chemist. In aromatherapy, profession. Aromatherapy the oils may be applied to the skin, practitioners who meet a mixed with bath water or inhaled. set of national occupational The effects of aromatherapy standards can register with the on people with MS haven’t Complementary and Natural undergone careful research. Healthcare Council. See ‘Useful organisations’ on page 35. Some small clinical studies suggest that aromatherapy may Chiropractic improve anxiety, depression, Chiropractic medicine is based on pain and insomnia. But these the idea that the nervous system studies are of variable quality and is important for health and that some of the results have been many diseases are due to poor inconsistent. alignments of the bones of the It’s also worth noting that although spine. These poor alignments aromatherapy is usually well are thought to cause abnormal tolerated, oils may sometimes pressure on the nerves that leave cause rashes or allergic reactions. the spine. Spinal manipulation

15 Helpline: 0808 800 8000 Types of complementary and alternative medicine methods (known as ‘adjustments’) these approaches in people with are believed to normalise bone MS. In other groups of people, position and relieve pressure on involvement in religion and the nerves. spirituality has been associated Research of chiropractic therapy with better health outcomes. in MS is limited. The clinical However, whether spiritual and studies are of poor quality, and religious involvement actually other than these there are only causes improved health isn’t reports of individual responses known. to this therapy. In general, Healing methods are generally however, chiropractic therapy may well tolerated. They should not decrease low back pain. Although be a substitute for conventional chiropractic manipulation is medicine and shouldn’t delay usually well tolerated, on rare seeking advice from a doctor. occasions low back manipulation Healing isn’t regulated by law. may cause spine trauma and neck Practitioners aren’t required to manipulation may cause strokes. have completed any specific Chiropractic medicine is regulated training or be a member of any by law in the UK. All chiropractors professional organisation. There must be fully qualified to practise are, however, numerous healing and must register with the General organisations in the UK, which all Chiropractic Council who can work separately. It’s suggested provide a list of practitioners that you ask the questions listed in your area. See ‘Useful under ‘What should I do before organisations’ on page 35. making an appointment?’ Healing Healing practitioners who meet Healing covers a wide range of a set of national occupational approaches, including therapeutic standards can register with the touch, faith healing and prayer. Complementary and Natural There are no research studies of Healthcare Council.

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Herbal medicine Some herbs, as with St John’s Wort, may also provoke MS Herbs contain hundreds of symptoms or interact with chemical constituents. Some medications commonly used in of these chemicals can be MS. In addition, some herbs, such therapeutic and others can be as echinacea and the Ayurvedic harmful. The use of herbs in herb ashwagandha appear to medicine has a long tradition activate the immune system and in many cultures. In traditional could pose a theoretical risk for Chinese medicine, herbal people with MS. therapies were initially developed around 3,000 BC, and many is not currently modern drugs are actually related regulated by law, although to chemicals in herbs. movement towards statutory Today, it is estimated that 25% regulation is underway. of prescription medications and Practitioners aren’t currently 60% of over-the-counter drugs are required to have any specific derived in some way from herbs. training or belong to any Among the various Western herbal professional organisation. products, some may be useful Currently there are a number as therapies for MS. Examples of different professional include cranberry for prevention organisations for practitioners from of urinary tract infection, St John’s various herbal disciplines including Wort for depression, valerian Ayurveda, Chinese, Tibetan and for insomnia, and psyllium for Western herbal medicine. The constipation. Some studies report European Herbal and Traditional beneficial effects with some forms Medicine Practitioners Association of herbal medicine. However, works with most of them and these studies are difficult to can provide information about interpret and are of variable quality. different disciplines. See ‘Useful organisations’ on page 35.

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Homeopathy treatment even if the treatment has no actual therapeutic effect. Homeopathy is one of the more popular CAMs. Its basic Research studies haven’t clarified principles are contrary to those of this issue. Furthermore, there are conventional medicine and basic no rigorous studies of homeopathy science. Specifically, according in MS. However, due to the to the homeopathic principle of extremely dilute preparations used ‘like cures like,’ if a large amount in homeopathy, this approach is of a substance causes a particular generally thought to carry little risk. symptom then miniscule amounts of that substance will relieve that It’s claimed that some same symptom. Homeopathic conventional medications medicines are made by adding a may antagonise the effects of lot of water or alcohol (also called homeopathic remedies. However, dilution) to a very small amount of homeopathy shouldn’t be used the active substance and vigorous in a way that delays conventional shaking. People skeptical of medical diagnosis or prevents use homeopathy claim that when a of treatments that are proven to be substance is diluted enough, there effective. will be no active substance left and Homeopathy isn’t regulated it can then no longer help you. by law and there’s no single Homeopathy is controversial. professional organisation or As with many other forms of qualification for homeopaths in alternative medicine, there’s the UK. Conventional health care concern that responses to professionals, such as doctors, homeopathic preparations are nurses, dentists and pharmacists, ‘placebo responses’. In other who’ve trained in and practise words, because people believe homeopathy can join the Faculty of taking a homeopathic treatment Homeopathy. is going to have a positive effect, they feel better after homeopathic

www.mssociety.org.uk 18 Types of complementary and alternative medicine

Details of local Faculty members Massage who can provide you with Massage is a healing method that treatment are available from the has been practised for thousands British Homeopathic Association. of years. It was used in ancient Other homeopaths not qualified Egypt and China. The more in conventional medicine can join popular forms of massage that are the Society of Homeopaths if they currently used are derived from meet set training requirements and Swedish massage, which was agree to a professional code of developed by Swedish doctors in conduct. However, they won’t be the nineteenth century. able to give conventional medical advice. Massage may be practised on its own or as one component of more There are also two NHS broad-based healing methods, homeopathic hospitals in the UK such as aromatherapy. offering outpatient services to people referred by their doctor. One small study of massage They are considered one of the in people with MS found that it cheaper and safer ways of getting was associated with increased this kind of treatment and are self-esteem, improved social based in Glasgow and London. functioning, reduced anxiety and depression, and improved image When provided on the NHS, you’ll of one’s body. be asked to pay a prescription charge for any homeopathic Another small MS study found remedies. NHS homeopaths are that a slow ‘stroking’ massage also subject to standard NHS (that uses the flat of the hand) regulation, so should you have over the spine was associated any problems, you can follow the with improvement in anxiety and standard complaints process. muscle stiffness.

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Massage is usually well tolerated of ways and situations, including but should be used with caution as a form of prevention for people in women who are pregnant and experiencing recurring depression, in people with recent injuries, as recommended by NICE. ulcers, enlargement of the Practicing Mindfulness can teach liver or spleen, fever, infection, you to pay attention to the present clotted blood vessels, jaundice, moment without judgement, cancer, heart disease, or arthritis. using techniques like meditation, Massage isn’t regulated by law breathing, and yoga. Over time it and practitioners aren’t required helps you become more aware to have any specific training or of your thoughts, feelings and be a member of any professional body sensations so that, instead organisation. However, there are of being overwhelmed by them, various organisations massage you’re better able to manage practitioners may join, many of them. which are working together as the General Council for Massage A register of qualified mindfulness Therapies. trainers can be found under ‘Useful organisations’on page 35. Massage practitioners who meet a set of national occupational Multi-modal therapy standards can register with the Multi-modal therapy refers to Complementary and Natural a treatment programme that Healthcare Council. includes visualisation techniques, Mindfulness meditation, guided imagery, expressive therapy (such as art Mindfulness can help you manage and ), concentration your thoughts and feelings. This and memory exercises, stress mind-body based approach can management, behaviour change the way you relate to modification, and other self- experiences. It’s used in a number regulation techniques.

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People with MS who received this gentle massage and rhythmic joint specific treatment programme movements. during a research study showed Studies indicate that these improvement in various areas, techniques decrease low back including verbal learning, abstract pain. One small, short-term study thinking, depression, strength, found that a combination of and sensation. osteopathic manipulation and a Due to the many components specific exercise program led to of this therapy, it’s difficult to improved strength and walking determine which therapy may ability in people with MS. have produced the beneficial Further studies of specific effects. Some of the specific osteopathic methods in MS are components of multi-modal needed to better understand how therapy have been studied in this therapy may help. MS, and more information is given in relevant sections of this Osteopathic manipulation is publication. generally well tolerated, but, like chiropractic manipulation, there’s Osteopathy a low risk of spinal trauma with low Osteopathy was founded in back manipulation and stroke with the United States in 1874 by Dr neck manipulation. Andrew Still. It works with the body’s musculoskeletal system, Osteopathy is regulated by law which is made up of the bones, in the UK. All osteopaths must joints, muscles and ligaments. be fully qualified to practise and must register with the General Osteopaths use their hands to Osteopathic Council. The diagnose and treat any problems Council can also provide details found. Techniques include of osteopaths in your area (see manipulating muscles, sometimes Useful organisations on page 35). using short sharp movements,

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Pilates and quality of life in people with MS who use a wheelchair. Pilates is a form of bodywork that was created during World War I It’s generally assumed that the by Dr Joseph Pilates, a German Pilates method is well tolerated. inventor, boxer, and dancer. Pilates teachers aren’t regulated in The technique was originally the UK and aren’t legally required developed to help soldiers to have any specific qualifications. recover from war injuries. With It’s suggested that, before going the Pilates method, individuals to a class, you ask the questions focus on the use and control of listed under ‘What should I do specific muscles during body before making an appointment?’. movements. There’s also an emphasis on breathing. One very Reflexology small study has suggested that In reflexology, pressure is applied Pilates could be a suitable form of to specific areas, or zones, of the exercise for people with MS and foot. These zones are believed suggested that it was generally to correspond to different areas safe. However, it didn’t show any of the body. The application of benefit for treating MS symptoms. pressure is thought to improve One small study of elite gymnasts health by increasing energy flow found improved strength, jump in the body. This concept of an height, and reaction times after a underlying life force is similar to programme that included Pilates, that of some other alternative leap training, and pool training. healing systems such as Another small study found acupuncture. improved flexibility after Pilates One MS research study, which training. wasn’t well designed, found improvement in multiple MS An MS Society-funded research symptoms with reflexology, while project, found that Pilates may a better designed and larger study improve pain, posture, function found that there was improvement

www.mssociety.org.uk 22 Types of complementary and alternative medicine in muscle stiffness, bladder and can give you details of member sensory symptoms. organisations. A study looking at the effect of Reflexology practitioners who reflexology on pain found it was no meet a set of national occupational better than a sham treatment – but standards can register with the both showed a clinically significant Complementary and Natural reduction in pain Healthcare Council. A recent review of all of the Reiki published clinical trials of Reiki is a form of reflexology in many medical that was developed in Japan in conditions concluded that there the mid 1800s. Reiki practitioners was no convincing evidence are given ‘attunements’ which that reflexology was an effective help them draw upon and channel treatment for any condition. healing energy. It’s believed that Reflexology is a low-risk therapy Reiki practitioners can direct and and there are no known serious infuse healing energy into the side effects. It should be used body. This process is thought to with caution in those with foot rebalance energy and activate the conditions, including gout, ulcers, body’s own healing processes. vascular disease and arthritis. There are no formal studies of the Reflexology isn’t regulated by law effects of Reiki on people with and practitioners aren’t required MS. However, Reiki is generally to have any specific training or well tolerated, though it’s claimed be a member of any professional that it should be used with caution organisation. However, there in those with diabetes and are various organisations pacemakers. reflexologists may join. Many Reiki isn’t regulated by law and are working together as the practitioners aren’t required to Reflexology Forum and they have any specific qualifications.

23 Helpline: 0808 800 8000 Types of complementary and alternative medicine

It’s suggested that, before making Relaxation methods are generally an appointment, you ask the low risk, though they should be questions listed under ‘What used with caution by those with should I do before making an serious psychiatric condition, appointment?’ on page 9. such as schizophrenia, severe depression and anxiety. Relaxation Relaxation and meditation may produce fear of losing control, Relaxation is a component anxiety, and disturbing thoughts. of several different forms of complementary and alternative Relaxation methods shouldn’t medicine, including meditation, be used as a substitute for guided imagery, hypnosis or conventional medicines for MS hypnotherapy, biofeedback, and related symptoms. Relaxation mindfulness-based stress and meditation practitioners reduction and progressive muscle aren’t regulated in the UK and relaxation. People with MS often aren’t legally required to have report that they feel stress and any specific qualifications. It’s anxiety. suggested that, before making an appointment, you ask the There have been studies of MS questions listed under ‘What and various relaxation methods. should I do before making an One small study reported reduced appointment?’on page 9. anxiety and improved physical symptoms with meditation Shiatsu and imagery; another small Shiatsu is an ancient Japanese study found decreased anxiety form of massage. In Shiatsu, and a more positive outlook gentle pressure is applied to the with imagery and relaxation meridians which, according to techniques. Another study using traditional Chinese medicine, are a mindfulness-based intervention the pathways for energy flow in the found benefits in quality of life, body (see section on acupuncture depression and fatigue. and acupressure on page 13). In

www.mssociety.org.uk 24 Types of complementary and alternative medicine

this respect, Shiatsu is similar to characterised by sequences of acupuncture. However, the major body postures that are connected focus of Shiatsu is prevention. by slow, graceful movements. There haven’t been any formal T’ai chi is believed to balance research studies of Shiatsu in MS. opposing life forces and Generally Shiatsu is a low-risk create emotional balance. The therapy, though there are very movements in t’ai chi may be rare reports of serious injury to the modified for those with disabilities. arteries in the neck with Shiatsu of One study of 19 people with MS the neck area. found improved walking speed, muscle stiffness, vitality, social and Shiatsu isn’t regulated by law and emotional functioning and ability to practitioners aren’t required to carry out physical and emotional have any specific qualifications. roles. There are, however, many different Shiatsu organisations practitioners A study of ‘mindfulness of may belong to. movement’, a component of t’ai chi, in 16 people with MS found These various organisations improvement in multiple MS work together as the Shiatsu symptoms. More rigorous studies Society to develop a single of t’ai chi in MS are needed to gain register of qualified practitioners. a better understanding of how it Shiatsu practitioners who meet may help. a set of national occupational standards can register with the T’ai chi is usually well tolerated, Complementary and Natural though it may strain joints and Healthcare Council muscles and temporarily worsen MS fatigue. T’ai chi should be T’ai chi used with caution or avoided by T’ai chi is a traditional Chinese those with acute low back pain, martial art that has been practised osteoporosis, significant joint in China for centuries. It’s injuries and bone fractures.

25 Helpline: 0808 800 8000 Types of complementary and alternative medicine

T’ai chi teachers aren’t regulated in difficult postures should be done the UK and aren’t legally required with caution by pregnant women to have any specific qualifications. and those with heat sensitivity, It’s suggested that, before making fatigue, decreased balance, and an appointment, you ask the significant heart, lung, or bone questions listed under ‘What conditions. should I do before making an Yoga isn’t regulated by law and appointment?’. practitioners aren’t required to Yoga have any specific qualifications. Yoga is a mind-body therapy that There are, however, over ten was developed in India thousands different yoga organisations of years ago. Yoga is meant to practitioners may belong to. These unite the mind, body, and spirit. include the British Wheel of Yoga, Major components of hatha yoga, which is recognised by Sport one of the more popular forms of England as the national governing yoga, are breathing, meditation, body for yoga. A number of and posture. Yoga postures yoga organisations are working may be modified for those with together as the British Council for disabilities. Yoga Therapy to develop a single register of qualified practitioners Despite its popularity, there are (see Useful organisations on page relatively few studies of the effects 35). of yoga on MS and other health problems. One well-designed The Council can provide details clinical trial in MS found that both of member organisations yoga and conventional exercise and information about yoga. improved fatigue. Another smaller Yoga practitioners who meet study found that yoga improved a set of national occupational attention in people with MS. standards can register with the Complementary and Natural Yoga is a low-risk therapy. Healthcare Council. However, vigorous exercise or

www.mssociety.org.uk 26 The Complementary and Natural Healthcare Council The Complementary and Natural Healthcare Council (CNHC) was set up in 2008 to act as a voluntary regulating body for practitioners in a number of therapies. Its aim is to improve public safety by providing details of registered practitioners who have met agreed professional standards. However, practitioners don’t have to register with the CNHC. For details of which therapies are regulated, along with a list of registered practitioners, contact the CNHC. See ‘Useful organisations’ page 35.

27 Helpline: 0808 800 8000 Other types of non-standard therapies here are also other studies indicate that they may help non-standard therapies with managing MS symptoms Tthat are often used by, including spasticity and pain. or targeted at, people with A cannabis-based drug, called MS. Some of these are listed Sativex, is licensed in the UK for below. With the exception of managing spasticity. There’s more cannabis, which is a controlled information about Sativex in the substance, the therapies aren’t MS Society booklet Muscle regulated by law. spasms and stiffness and at Practitioners (if a therapy involves www.mssociety.org.uk one) aren’t required to have any Several surveys have suggested specific qualifications. To find that significant numbers of out more before you make an people with MS use cannabis to appointment, we suggest you ask manage their symptoms. Because the questions listed under ‘What medically tested cannabis-based should I do before making an treatments aren’t widely available, appointment?’ on page 9. some people with MS seek Cannabis and cannabis cannabis from other sources extracts Cannabis is a class B controlled People have claimed that drug. Possession, production cannabis, also known as and supply of cannabis are all marijuana, is an effective treatment illegal, and what is supplied can for MS symptoms. Cannabis vary widely in nature and strength. contains chemicals known Information about the penalties for as ‘cannabinoids’ including cannabis possession is available tetrahydrocannabinol (known from the Home Office. as ‘THC’ for short). These Be aware that cannabis has many cannabinoids have a variety of side effects including dizziness, biological effects, and clinical

www.mssociety.org.uk 28 Other types of non-standard therapies sleepiness, feelings of intoxication, In the most rigorous study to nausea, increased risk of seizures, date, cooling was associated poor pregnancy outcomes, and with mild improvement in walking, impaired driving. vision, fatigue, strength, and cognition. Cooling is generally well High doses of cannabis may tolerated, though garments may decrease reaction time, impair be cumbersome. There may also heart function, and produce be discomfort with the onset of coordination and visual difficulties. cooling. In the minority of people Chronic use of cannabis may with MS who are sensitive to cold impair lung function, cause heart temperatures, cooling can make attacks, increase the risk of lung, MS symptoms feel worse. mouth and throat cancer, and has been linked to psychological Honey bee venom problems. Bee venom therapy is a type of Cooling apitherapy, which refers to the use of bees or bee products to In people with MS, it’s known treat medical conditions. In bee that small increases in body venom therapy, bees are placed temperature can make MS on specific areas of the body with symptoms feel worse. This tweezers. Typically, treatment observation has led to the sessions involve 20 to 40 stings development of various cooling and are done three times weekly. methods. There are simple cooling The early results of a study that methods, such as staying in air- looked at the impact of bee venom conditioned areas and drinking therapy in an animal model of cold liquids. More complex MS found it was ineffective or cooling techniques use specially produced worse results than seen designed cooling suits. There in the placebo-treated animals. have been many studies about cooling in MS. Fatigue is frequently The highest quality clinical trial of reported to improve with cooling. bee venom therapy in people with

29 Helpline: 0808 800 8000 Other types of non-standard therapies

MS found that it didn’t produce lungs, pressure injury to the ear, significant beneficial effects. Bee cataracts and seizures. venom therapy is generally a low It’s an accepted therapy for some risk procedure, though mild side medical conditions, including effects include itching, hives, burns, decompression sickness, fatigue, anxiety, and swelling and severe infections, radiation- redness at the sting site. Very induced tissue injury and carbon rarely, bee stings may cause a monoxide poisoning. Although the severe and potentially fatal allergic NICE Guideline for MS, which sets reaction. standards for treatment in the NHS Hyperbaric oxygen in England, Wales and Northern therapy Ireland, doesn’t recommend Hyperbaric oxygen therapy is a hyperbaric oxygen therapy for the form of treatment in which oxygen treatment of MS, some people is administered under increased with MS report benefits from using pressure in a specially designed this type of treatment. chamber. Hyperbaric oxygen Magnetic field therapy increases the oxygen content in The use of magnetic fields as the blood and in different body a therapy for MS has been tissues. studied mainly with pulsed There have been a few clinical trials electromagnetic therapy. This uses examining the effect of hyperbaric devices that emit weak, pulsing oxygen in MS. Reviews of these electromagnetic fields at a specific studies indicate that there is no frequency. The devices are often definite beneficial effect. Usually placed on acupuncture points. hyperbaric oxygen doesn’t cause There are many theories serious side effects, though mild about how these devices may visual symptoms may occur. be therapeutic. One theory Sometimes it can cause serious suggests that they may correct side effects, including collapsed disease-associated electrical

www.mssociety.org.uk 30 Other types of non-standard therapies imbalances and thereby produce One small study of neural therapy acupuncture-like therapeutic in people with MS found that effects. However, mixed results there was improvement in about have been obtained in clinical trials two-thirds of people, and the – some have shown improvement improvement occurred within in spasticity, pain, bladder minutes of the injections. Larger function, hand function, fatigue, and more rigorous studies of the and quality of life, and some effects of this therapy in people have not. with MS are needed to back up these results. It’s generally believed there’s a low risk of side effects associated Meanwhile, neural therapy is with weak magnetic field devices. generally thought to be well However, pregnant women and tolerated. Repeated injections those with pacemakers and other may cause scarring, and the local implanted electronic medical anaesthetic may produce allergic devices should consult a doctor reactions. before using this therapy. Replacement of mercury Neural therapy amalgam fillings Neural therapy is a form of energy It’s been proposed that the therapy that was developed in removal of dental amalgam is Europe in the 1920s. With this therapeutic for MS. Amalgam, therapy, small amounts of local which is composed of mercury anaesthetic are injected under as well as silver, copper, tin, and the skin in specific locations. zinc, is used in 80-90% of tooth The sites of injection may be restorations. acupuncture points or old scars. It’s claimed that the immune This procedure is thought to system and nervous system are restore the normal flow of energy damaged by small amounts of in the body or provide energy to solid mercury and mercury vapour damaged tissue. that is released from the amalgam.

31 Helpline: 0808 800 8000 Other types of non-standard therapies

There‘s no evidence that mercury Dental amalgam removal is causes MS or that the removal generally expensive, though there of dental amalgam improves the are few risks associated with it. On course of MS. It’s been estimated rare occasions it may cause injury that amalgam accounts for 10% or to nerves or tooth structure. less of mercury intake.

New Research Research into complementary and alternative medicine is ongoing. Read more about new treatments and updates to established ones in the Research section of our website. This includes details of any research projects funded by the MS Society, and any opportunities to get involved. There’s also a research blog, which explains more about the research process. Visit www.mssociety.org.uk/ research, or call the UK Information ResourcesTeam for more information.

www.mssociety.org.uk 32 Further reading The following books are all available to borrow from the MS Society library. Email [email protected], call 020 8438 0900 or visit www.mssociety.org.uk/library Polman, C. et al. MS: The guide to treatment and management, 2006. Published by Demos Medical Publishing, ISBN: 1932603514 Bowling, A. Complementary and alternative medicine and multiple sclerosis, 2007. Published by Demos Medical Publishing, ISBN: 9781932603545 Bowling, A. and Stewart, T. Dietary Supplements and Multiple Sclerosis: A Health Professional’s Guide, 2004. Published by Demos Medical Publishing, ISBN: 1888799900 Pinder, M. Complementary health care: a guide for patients, 2005. Published by The Prince of Wales’ Foundation for Integrated Health, ISBN: 0953945383 Barnett, H. Which? Guide to Complementary Therapies, 2002. Published by Which? Books, ISBN: 0852028938 Ernst, E. et al. The Desktop Guide to Complementary and Alternative Therapy, 2006. Published by Mosby Elsevier, ISBN: 0723433835 Zollman, C. et al. ABC of Complementary Medicine (Second edition), 2008. Published by BMJ Books, ISBN: 9781405136570

33 Helpline: 0808 800 8000 Further reading

The following websites can also provide useful information: www.nccam.nih.gov -The US National Center for Complementary and Alternative Medicine examines scientific evidence for the use of complementary and alternative medicines with the aim of disseminating authoritative information to the public and professionals. Their website has useful information about treating specific conditions and symptoms.

www.neurologycare.net/cam - A website focused on MS- relevant complementary and alternative therapies was created and is updated by Allen Bowling, MD, PhD. This site provides evidence- based information on more than 50 different therapies.

www.mssociety.org.uk 34 Useful organisations

General support and information organisations are listed first, followed by professional or regulatory bodies for complementary and alternative therapies – overall bodies first, then alphabetically by therapy.

General support and Citizens Advice information In England and Wales ASA (Advertising Standards 3rd Floor North Authority) 200 Aldersgate Street London Contact if you would like to make a EC1A 4HD complaint about an advertisement. 03000 231 231 Mid City Place (not an advice line) 71 High Holborn citizensadvice.org.uk London WC1V 6QT 020 7492 2222 In Scotland asa.org.uk 1st Floor, Spectrum House Action against Medical 2 Powderhall Road Accidents Edinburgh RH7 4GB Independent charity that can 0131 550 1000 (not an advice line) provide advice if you have www.cas.org.uk experienced harm as a result of treatment. In Northern Ireland 117High Street Citizens Advice Regional Office Croydon 46 Donegall Pass Surrey CR0 1QG Belfast BT7 1BS Helpline 0845 123 2352 citizensadvice.co.uk (Monday to Friday, 10am-5pm) avma.org.uk

35 Helpline: 0808 800 8000 Useful organisations

Clinic for Boundaries Studies MS Therapy centres in Can offer support to people Scotland. who have been harmed, or may have been harmed, as a result Duncrievie House of the violation of professional College Road boundaries. Methven 49 - 51 East Road Perth PH1 3PB London N1 6AH 01738 840 357 020 3468 4194 mstherapycentres.org.uk professionalboundaries.org. uk NHS online and telephone advice Home Office NHS Choices For information about the penalties Provides telephone and online for possession of cannabis. advice about NHS services and Direct Communications Unit health in England and Wales. 2 Marsham Street 111 London SW1P 4DF nhs.uk (England) 020 7035 4848 nhsdirect.wales.nhs.uk homeoffice.gov.uk (Wales)

MS National Therapy Centres Health information and self-care A federation of centres offering advice for Scotland. a variety of therapies in England, Telephone 111 Wales and Northern Ireland. nhs24.com PO Box 2199 Buckingham, MK18 8AR 01296 711699 msntc.org.uk

www.mssociety.org.uk 36 Useful organisations

Research Council for Institute for Complementary Complementary Medicine and Natural Medicine Aims to develop the evidence base Administers the British Register for complementary medicine. of Complementary Practitioners. London South Bank University, Can-Mezzanine 103 Borough Road, 32-36 Loman Street London SE1 0AA London SE1 0EH [email protected] 020 7922 7980 rccm.org.uk icnm.org.uk

Sense about Science Acupuncture Equipping people to make sense Acupuncture Association of of science and evidence. Chartered Physiotherapists 14a Clerkenwell Green For physiotherapists who also London EC1R 0DP practise acupuncture. 020 7490 9590 Sefton House, Adam Court senseaboutscience.org Newark Road Peterborough PE1 5PP Professional or regulatory 01733 390007 bodies aacp.uk.com Complementary and Natural Healthcare Council British Academy of Western The national voluntary regulator Medical Acupuncture for complementary health care For doctors, nurses and practitioners. physiotherapists who also practise Albert Buildings acupuncture. 49 Queen Victoria Street 76 Langdale Road London EC4N 4SA Bebington 020 7653 1971 Wirral CH63 3AW cnhc.org.uk 0151 343 9168 bawma.co.uk

37 Helpline: 0808 800 8000 Useful organisations

British Acupuncture Council Aromatherapy Professional organisation The Aromatherapy Council for traditional acupuncture Can provide information about practitioners. aromatherapy and lists of 63 Jeddo Road practitioners. London W12 9HQ [email protected], 020 8735 0400 aromatherapycouncil.org.uk acupuncture.org.uk Chiropractic British Medical Acupuncture General Chiropractic Council Society Regulates UK chiropractors For medical practitioners who also and can provide lists of local practise acupuncture. practitioners. 60 Great Ormond St, London 44 Wicklow Street WC1N 3HR` London WC1X 9HL 020 7713 9437 020 7713 5155 medical-acupuncture.co.uk gcc-uk.org

Alexander Technique Herbal medicines The Society of Teachers of the The European Herbal Alexander Technique and Traditional Medicine Can provide information and Practitioners Association details of local practitioners. (EHTPA) Grove busines Center An umbrella body for professional Unit W48 herbal associations. 560-568 High Road 25 Lincoln Close Tottenham Tewkesbury London N17 9TA Gloucestershire GL20 5TY 020 7482 5135 01684 291 605 stat.org.uk ehtpa.eu

www.mssociety.org.uk 38 Useful organisations

Homeopathy Mindfulness British Homeopathic Mindfulness Association Association 4 Whaley Lane Offers information on homeopathy Whaley Bridge, High Peak and can provide lists of medically Derbyshire, SK23 7AE qualified homeopaths. 01663 733202 Hahnemann House mindfulnessassociation.org 29 Park Street West Luton LU1 3BE Osteopathy 01582 408675 General Osteopathic Council britishhomeopathic.org Regulates UK osteopaths and can provide lists of local practitioners. Society of Homeopaths Osteopathy House Provides information about 176 Tower Bridge Road homeopathy and lists of London SE1 3LU homeopaths. 020 7357 6655 11 Brookfield osteopathy.org.uk Duncan Close Moulton Park Reflexology Northampton NN3 6WL Reflexology Forum 01604 817890 Umbrella group for UK based homeopathy-soh.org reflexology organisations. Dalton House Massage 60 Windsor Avenue General Council for Massage London SW19 2RR Therapies 0800 037 0130 27 Old Gloucester Street reflexologyforum.org.uk London WC1N 3XX Telephone 0870 850 4452 gcmt.org.uk

39 Helpline: 0808 800 8000 Useful organisations

Shiatsu yoga organisations which can Shiatsu Society provide information about member This group represents a number of organisations and yoga. the Shiatsu organisations. [email protected] PO Box 4580 bcyt.org.uk Rugby Warwickshire CV21 9EL British Wheel of Yoga 0845 130 4560 25 Jermyn Street shiatsusociety.org Sleaford Lincolnshire NG34 7RU Yoga 01529 306 851 British Council for Yoga Therapy bwy.org.uk Umbrella group for over 10 UK

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www.mssociety.org.uk 40 Notes:

41 Helpline: 0808 800 8000 Notes:

www.mssociety.org.uk 42 Further information Resources from the MS Society Our award winning information Library resources cover every aspect of living with MS. For more information, research articles and DVDs about MS, 020 8438 0999 contact our librarian. [email protected] 020 8438 0900 www.mssociety.org.uk/ [email protected] publications www.mssociety.org.uk/library

Helpline The Freephone MS Helpline offers confidential emotional support and information for anyone affected by MS, including family, friends and carers. Information is available in over 150 languages through an interpreter service. 0808 800 8000 (weekdays 9am-9pm) [email protected]

43 Helpline: 0808 800 8000 section headline

About this resource Disclaimer: We have made With thanks to Kathy Franklin, every effort to ensure that the Nikki Embrey and all the people information in this publication is affected by MS who contributed to correct. We do not accept liability this booklet. for any errors or omissions. The law and government regulations If you have any comments on this may change. Be sure to seek local information, please send them to advice from the sources listed. [email protected] or you can complete our short online References survey at www.surveymonkey. A list of references is available on com/s/MSresources request, and all cited articles are available to borrow from the MS Society library (there may be a small charge). Contact the librarian on 020 8438 0900, or visit www. mssociety.org.uk/library

This resource is also available in large print. Call 020 8438 0999 or email [email protected]

www.mssociety.org.uk 44 Contact us MS National Centre MS Society Scotland Telephone 020 8438 0700 Telephone 0131 335 4050 [email protected] [email protected]

MS Helpline MS Society Northern Freephone 0808 800 8000 Ireland Telephone 028 9080 2802 (weekdays 9am-9pm) [email protected] [email protected] MS Society Cymru Online Telephone 020 8438 0700 www.mssociety.org.uk www.facebook.com/MSSociety [email protected] twitter.com/mssocietyuk

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