CAM was used more frequently among U.S. adults with common neurological conditions than those without. Adults with back pain with sciatica, memory loss, migraines, or regular headaches used CAM more often than those with seizures, stroke, or dementia. Mind/body therapies were used the most; alternative medical systems were used the least. Despite the high prevalence of CAM, approximately one-half of adults with common neurological conditions did not discuss their CAM use with their health care provider. Adults without common neurological conditions were more likely than those without these conditions to report using CAM because their provider recommended it or because conventional treatments were perceived ineffective or too expensive.
The estimated prevalence of the neurological conditions examined in the NHIS is consistent with previously reported rates in the general population.[10
] Rates of CAM use among adults with common neurological conditions in this survey (44.1%) fell within the wide range of published prevalence rates of CAM use for various neurological conditions. [6
] Consistent with studies of other chronic conditions, we found that CAM use was higher among women, those with higher educational attainment and incomes. [5
Thus, CAM use among adults with neurological conditions is popular. Research regarding its efficacy in neurological conditions is promising. Based on evidence from 39 trials, the US Headache Consortium treatment guidelines suggest that complementary therapies (relaxation training, thermal biofeedback combined with relaxation training, EMG biofeedback, and cognitive behavioral therapy) may be considered as treatment options for prevention of migraine, with Grade A evidence.[7
] In the same guidelines, they did recognize that evidenced-based treatment recommendations are not yet possible regarding the use of hypnosis, acupuncture, or cervical manipulation in the treatment of migraine headaches. A recent randomized trial of yoga for the treatment of migraine without aura demonstrated a significant reduction in migraine headache frequency and associated clinical features.[13
] A recent systematic review also concluded that there is strong evidence for mind/body therapies for migraine treatment.[27
Evidence is emerging for CAM interventions in back pain management. A meta-analysis of acupuncture for low back pain concluded that acupuncture is more effective than sham treatment for short-term relief of chronic pain.[17
] Another meta-analysis showed only fair evidence for the effective treatment of chronic low back pain with acupuncture, massage, and yoga.[8
] There is only fair evidence to suggest that spinal manipulation may have small to moderate benefits for treatment of acute low back pain. A trial comparing active chiropractic manipulation to simulated manipulations in patients with acute back pain and sciatica with disc protrusion revealed that active treatment was more effective in treating pain than simulated spinal manipulation.[23
Thus, there is promising evidence for certain CAM treatments for headaches and back pain. Further research is needed to continue to evaluate the efficacy of CAM in these and in other neurological conditions. Many previous studies were preliminary or had methodological issues such as small sample sizes and/or inadequate control groups. It is also important for patients and physicians to recognize that some CAM therapies may be potentially dangerous. For example, Ginkgo has anti-platelet effects that could cause unnecessary bleeding in stroke patients or interact with anticoagulants. Case reports of some herbs suggest proconvulsive effects.[22
] Many common herbs (e.g. Ginkgo biloba and St. John's wort) interact with anti-epileptic therapies and other prescribed drugs through alterations of hepatic metabolism.[9
] Potential for herb-drug interactions also pertain to concomitant medications which patients take for non-neurological chronic medical conditions; many of these conditions were prevalent among NHIS respondents with neurological conditions. Most concerning, however are case reports of stroke following chiropractic manipulation.[12
There is a substantial disconnect between patients and doctors about CAM use. Surprisingly, one-third of adults with common neurological conditions reported using CAM because their provider recommended it. Although anecdotally many physicians do not feel comfortable recommending some CAM therapies because of the paucity of data on its efficacy in neurological conditions, many patients reported using these therapies anyway, and often did not inform their health care providers. We found it interesting that acupuncture, which has been studied frequently and found to be effective in patients with some neurological conditions, was used less frequently by adults with common neurological conditions than most other CAM modalities examined. Clinicians should make a concerted effort to ask patients about their CAM use, discussing possible risks and benefits.
Our study has limitations. NHIS is cross-sectional, relies on self-reporting, and is subject to misclassification and recall bias. NHIS is conducted in the U.S. and may not be generalizable to other countries. NHIS includes details about a limited number of neurological conditions, selecting only conditions with a high prevalence in the general population. Patients with other conditions commonly seen by neurologists, such as multiple sclerosis, are not fully addressed. Moreover, the severity of the conditions is not assessed. Even though respondents reported use of CAM from the prior 12 months, some conditions are reported if present in the prior 3 months. Because of small sample sizes, our study could not assess whether CAM was used specifically for the conditions examined.
In summary, CAM use is common in U.S. adults with neurological conditions, and used more frequently by adults with these conditions than those without. This finding supports our hypothesis that patients with neurological conditions may seek alternative therapies because of the chronicity of their problems and the lack of full relief from conventional therapies. Most physicians do not know about their patients' CAM use, thus it is critical to reinforce the importance of clinicians asking and discussing the use of CAM with their patients. Although there is a high prevalence of CAM use among adults with common neurological conditions nationally, there is only limited evidence for its efficacy. Thus, a chasm continues to exist between our scientific knowledge of these therapies and their use by patients. Robust trials are critically needed to bridge this gap and to provide evidence on the efficacy of CAM therapies in patients with neurological conditions, so that patients suffering from these conditions can benefit from treatments that are shown to be effective and can be counseled about those with potential adverse effects.