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Holistic Help

Reprinted from PN/Paraplegia News October 2015

It’s no secret that SCI/D comes with complications. When conventional drug therapies aren’t enough, these complimentary and alternative options come to the rescue.

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Debilitating, seizure-like spasms used to take over Chad Madden’s body up to 50 times each day, until he discovered a solution online.

“I had seen on YouTube that there were parents that were trying to move laws to allow more states to use derivatives of marijuana, which is what I’m using — a drug called Dronabinol,” Madden, a C-2 quadriplegic, says. “And the parents weren’t trying to use it for themselves. They weren’t trying to make some kind of hippy movement or anything, they were honestly trying to find help for their children who were having hundreds of spasms or seizures a day and were on this slew of drugs.”

Medical marijuana is probably the most talked about form of complimentary or alternative medicine (CAM) options, but a plethora of holistic options are available for people with spinal-cord injury or disease (SCI/D).

Acupuncture

Traditionally a Chinese medicine, acupuncture uses thin needles strategically placed in the skin and tissue of the body, most commonly to alleviate pain. In the East, it’s believed that acupuncture helps rebalance energy flow in the body, however, in Western medicine it’s believed to stimulate nerves and muscles to increase blood flow and the body’s natural painkillers.

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“Acupuncture is the most broadly studied of CAM therapies and has evidence for use in pain management,” says National Clinical Nursing Director of the Multiple Sclerosis (MS) Center of Excellence at the Department of Veterans Affairs (VA) Heidi Maloni, PhD, ANP-BC, CNRN, MSCN. “Pain is experienced by 40% to 50% of those with SCI and medications often offer incomplete relief. Acupuncture is then prescribed for headache, osteoarthritis, back, neck and knee pain.”

Vijayshree Yadav, MBBS, MCR, FANA, associate professor of neurology and clinical director of the MS Center at Oregon Health & Science University, as well as staff neurologist at the VA, also uses CAM therapies, frequently referring patients to acupuncture to help her MS patients with pain. Like Maloni, she believes in the complimentary aspect of change, usually referring a patient to acupuncture after trying conventional methods in the pain clinic.

“If one thinks in terms of integrative health care, it’s all about bringing CAM and conventional approaches and/or drugs together to achieve the best possible outcomes for SCI,” Maloni says. “Pain management is the best example. Neither CAM nor traditional Western therapies are sufficient to fully manage pain. Thank goodness an integrative approach is becoming conventional wisdom for pain management.”

Another important aspect of CAM therapies according to Yadav is gauging the patient’s interest. For some patients, she suggests CAM as a last resort; for others, it’s the first option she throws out.

“Most of it is decided by the patient’s temperament … what do they believe in? Because what they believe could be most helpful,” Yadav says. “So they have to believe in a therapy to be able to get the benefit from it. So part of it is what do they believe? Do they believe in an alternative treatment option or not? And if they are open to that, they will probably find some improvement.”


Left: Chad Madden uses a derivative of marijuana to help with the spasticity he gets because of quadriplegia.

Mindfulness-Based Stress Reduction

Pain is a common complication of SCI/D, but oftentimes high blood pressure, weight gain, stress, fatigue, anxiety and depression express themselves, especially in newly-injured people.

Mindfulness-based stress reduction (MBSR) has gained popularity among all populations and addresses the aforementioned issues in people with SCI/D. The treatment uses forms of meditation to help patients become aware of their issues and then work through or accept them.

“The goal of mindfulness is to bring greater balance and acceptance,” Maloni says. She also says it’s a common CAM therapy because it can be taught wherever the patient is, doesn’t require any fancy equipment, is affordable and has a known effect.

Another similar technique is yoga, which is a form of meditation that concentrates on breathing.

“People find [yoga] helpful not only for balance and strength improvement, but also for the meditative aspect of yoga can help with anxiety and depression,” Yadav says. “ … These things are basically just improving your general health and general health, not just physical, but mental health. To heal a body you need both physical and mental health together.”

Diet & Supplement Therapy

The most commonly requested CAM therapy Yadav has seen is diet therapy.

After a diagnosis or new injury, she says many patients will come in asking how they should adjust their diet. She even ran a study on the effect of an extremely low-fat, plant-based, vegan diet on people with MS in which they found it decreases fatigue and helps with weight loss.

Maloni also uses diet and supplements to help her patients with SCI.

“Prevention of urinary tract infections is representative of one area I may rely on CAM with use of probiotics, cranberry … and products that acidify urine (blueberry, prune, and plum),” Maloni says. “Certainly antioxidants, diets rich in omega–3 and omega–6 fatty acids, vitamin D, minerals such as calcium and zinc for wound healing and strong bones, and vitamin H biotin for a strong immune system, hair and nails are recommendations. Getting these through food rather than supplements is ideal.”

However, Yadav has seen supplements such as ginkgo balboa help with fatigue. And another natural drug that has been widely studied is of course, tetrahydrocannabinol (THC), an active ingredient in marijuana and in Madden’s Dronabinol.

Madden went to Maloni to try CAM and now they’re working together to find the right dosage and frequency to help control his spasms. After taking the oral medication four times daily for six weeks, his 50 intense spasms per day are down to 15–20 light spasms per day.

While therapy has helped, Madden still sees a large misconception about it. When his friends hear it’s a marijuana derivative they give him a funny look and people think he has a hook-up for medical marijuana. But he says that’s not the case. The derivative doesn’t give him a high; it just controls his spasms.

“I can’t say enough good things about the Dronabinol effect … I have recommended it to others. The reason why is because it’s made a huge difference in my life in the being able to tolerate spasms or being able to tolerate life without the spasms,” says the Navy veteran. “ … Prior to this I was maxed out on two drugs and I was still having a lot of problems. So it was worth a shot to me if the doctors would agree to it, and fortunately, I have a doctor who agreed to it and it’s been a very helpful change to my medications.”

It’s cases like Madden’s — taking the maximum doses of conventional medication without success — that encourage Yadav and Maloni to use an integrative approach that uses both conventional and CAM therapies.

“In many ways Western or conventional medicine has failed to achieve full wellness for many. Conventional medicine is focused on cure rather than care, espousing a medical model,” Maloni says. “CAM, either mind-body therapies or natural products (herbs and supplements), can offer a model that is often patient driven and holistic.”

CAM Cautions

by Heidi Maloni, PhD, ANP-BC, CNRN, MSCN

It’s important to ask two main questions when it comes to complimentary and alternative medicine (CAM) therapies — Are they safe? And do they actually work to effect intended outcomes?

There’s a strong movement toward evidence-based practice in medical care. Obviously, using therapies that are dangerous or ineffective isn’t what patients or providers wish. Caution is exercised for those who might insist on using CAM therapy exclusively and deny therapies that have known and proven effect.

Additional questions to ask when considering CAM:

-What does the treatment involve?

-How and why is it supposed to work?

-How effective is it?

-What are the risks?

-How much does it cost?

My suggestion is to be open to talking about CAM use with your health care providers. Providers can be supportive and able to recognize any harmful interactions between CAM and conventional therapies or medications.

When buying dietary supplements on the Internet, research the wanted ingredient, know how much of it is in each pill and what other substances, if any, are included in it.

A great place to start researching CAM therapies is with the National Institutes of Health National Center for Complementary and Integrative Health (nccih.nih.gov). Its mission is to establish safety and efficacy of CAM through rigorous scientific studies.

For more information, visit nccih.nih.gov.

 

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