The Value of Integrative Medicine Approaches for Multiple Sclerosis

Megan Weigel, DNP, APRN-C, APHN-C, MSCN

Data on the use of integrative medicine (IM) for patients with multiple sclerosis (MS) were presented at the 37th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), October 13-15, with investigators finding varying results in terms of patient evaluations and results from the Multiple Sclerosis Self-Efficacy Scale (MSSE), the MS Wellness Questionnaire, and the 36-Item Short Form Survey (SF-36).

The program, entitled “Inspire My Soul,” or “Inspire MS,” was held virtually over Zoom and included sessions on nutrition, yoga, art creation, soul therapy, among others. While patient impressions were positive, with 1 participant describing the 6-week workshop as “cathartic,” results from the MSSE suggested a negative impact on Self-Efficacy Control and no to negligible effect on Self-Efficacy Function and DQ-Wellness measures. The MS Wellness Questionnaire, which outlines validity and is under review, found similar results, with the program having no to negligible effect on DQ Wellness. Investigators did note improvements in certain quality-of-life scales on the SF-36, according to means. 

As IM approaches can be costly and are not normally covered by insurance in the United States, investigators aimed to better evaluate effectiveness within the MS patient population. Megan Weigel, DNP, APRN-C, APHN-C, MCSN, founder, First Coast Integrative Medicine, Jacksonville, who presented the findings at ECTRIMS, sat down with NeurologyLive to discuss the surprising data, which she indicated may be the result of the response–shift phenomenon, as well as areas for future research. 

NeurologyLive: Can you provide background and a summary of data from the “Inspire MS” program? 

Megan Weigel, DNP, APRN-C, APHN-C, MCSN: I developed Inspire MS as a 6-week, weekly workshop series to expose people living with MS to integrative medicine modalities that they might not have access to otherwise, because they're not covered by insurance, and they're also pretty costly.

Within the Inspire MS program, we specifically brought in expert consultants to give workshops about integrative medicine, guided journaling, nutrition with cooking demonstrations, yoga therapy and breath work, primordial meditation—we did music therapy, sound healing, art therapy, a balance clinic, [where] we played a couple of balance games, and we also actually composed a song with a famous songwriter at the very end, which was really therapeutic and tied everything together. We wanted to see the effect that that would potentially have on wellness and quality of life.

Were any of the findings surprising in any way?

When we evaluated the study, we had our MS participants fill out the MS Self-Efficacy Scale, the MS Wellness Questionnaire, and also the SF-36 component of the MS Quality of Life Inventory. They completed it before they did the workshops, and then they completed it again at week 6.

We expected, really, to find benefit in all of those scales because our evaluations were just so glowing, and the experience that people told us about during the workshop series was really just incredible. In actuality, what we found was that there was no to negative effect on the MS Self Efficacy Scale and the MS Wellness Questionnaire, and on the SF-36, there was only a positive effect based on means—again, we had a really small sample size—in a few scales. 

This trend is not unheard of in programs like this because the programs are short and the actual time it takes to implement change like that can take a lot longer. There's a paradigm called the “response–shift” that we're hoping to do some more research on in MS specifically, to help us identify how we can best measure what the patients are telling us is happening during the study.

How did the use of telemedicine impact this study? Do you see it being used for this type of treatment in the future?

Inspire MS was originally developed to be an in-person workshop, and because of COVID-19, we had to pivot—that's the word of the century, right? We had to pivot and make it a virtual workshop. Part of that was the adaptation [of the program], and I think that adaptability of the participants just spoke to how quickly everyone grabbed on to telemedicine during the pandemic. 

To us, as researchers for something like this, it also gave us access to people from all over the country. We had participants in Jacksonville, where we were based, but we also had them up and down the east coast, on the west coast, and in between. I think that as much as it is nice to be back in-person with people in the office, in an exam room—certainly we know that people had hid behind the camera a little bit during COVID-19—we also know that telemedicine allows for people to access things that they couldn't otherwise access. Particularly in MS, a person might have a 2- or more-hour drive to their comprehensive MS center, [and] by the time they get there, they're exhausted, so they can't even necessarily access all the services that are available to them. From our standpoint, with a program like Inspire MS, [telemedicine] certainly makes it more accessible. It also makes it cheaper to duplicate. 

From a telemedicine standpoint, in general, I hope it's here to stay because I do think it's an incredibly valuable tool, particularly in MS. For example, say a patient calls and has a relapse—a phone call doesn't necessarily do it justice, but hopping on a quick video call can really give that person the best treatment.

What benefits can integrative medicine offer patients with MS? What further research is needed?

I see huge benefits for integrative medicine and multiple sclerosis, particularly because the basic tenet of integrative medicine, by definition, is that healing is possible, even when a cure is not. We don't have a cure for multiple sclerosis yet, and when a patient asks us, “When is there going to be a cure?”—15 years ago, I was saying the same thing as I am now: “It's right around the corner.” MS therapeutics is bursting at the seams with new therapies, which is amazing. 

For me, what integrative medicine brings, by nature, is this conventional medical wisdom of disease-modifying therapies are necessary and important for the right person, but also this complementary and alternative, and even “Eastern” model of care that is more nurturing and focuses more on healing. Some of these tools just really give the patient more empowerment, [for example], let me find my purpose, let me find how I can bring creativity in my life, how can I find joy? Does eating healthier help me to feel better? There are just a lot of different modalities that empower the patient, again, allowing that person to develop more of a healing lifestyle.

In your opinion, what has been the biggest step forward for MS care this year?

The biggest step forward for the MS population within this past year, I really think is adaptability to the unknown and also, seeking and trusting sources of information that are reliable. We certainly have had at least 3 MS therapeutic babies born during the pandemic, which also adds to our armamentarium of treatment, but I can't help but think that the virtual space, the telemedicine space has really enhanced the care of people living with MS, when it comes to convenience.

Is there an overarching theme you've taken away from ECTRIMS 2021?

From this ECTRIMS conference, most of what I watched was within the nursing forums, and I I'm just so encouraged and enthused by the nursing research that's happening across the world to enhance the care of people living with MS.

Transcript edited for clarity. For more ECTRIMS coverage, click here.

REFERENCE

Connelly L, Fox M, Weigel M. Evaluation of a 6-week integrative medicine series on quality of life, self-efficacy, and wellness in MS. Presented at ECTRIMS Congress 2021; October 13-15; Virtual. Presentation 044.