Table 3

Summary of evidence for the reviewed CAM

CAM typeCAMNumber of studiesClass of evidenceConclusionAssessment of evidence
CannabisCannabis extract7I (3), II (4)Significant beneficial effects demonstrated in five studies measuring incontinence, pain, spasticity and muscle stiffness. No effect on primary outcomes (including spasticity) reported in two studiesLimited replication and contradictory results
THC2I (1), II (1)A single study showed a positive effect on incontinence. One study showed no effect on main on spasticityNo replication among primary outcomes
DietBiotin1IISignificant effect on disability progression demonstrated in a single studyNo replication
Ginkgo biloba 1INo effect on cognitive function in a single studyNo replication.
PUFA2IIContradictory evidence on disability in two studies. Positive effect on relapse rate in a single study. No effect on gadolinium-enhancing lesions in a single studyLimited replication and contradictory results
Vitamin D3IIThree studies show no effect of vitamin D supplementation after MS onset on primary outcomes. Some indication of benefit as an add-on treatment in one studyLimited replication and inconsistent study design
ExerciseBalance and gait training3IISome balance and gait training techniques significantly improve fatigue, balance and walking endurance, while others do notNo replication in intervention
Physical activity or exercise generally7IIExercise shown to improve muscle strength mobility-related health outcomes in several studies, and some indication of an effect on psychological symptoms. Primary outcomes were not significantly affected in several studiesLimited replication and inconsistent study design
Yoga2IINo effect on attention and alertness shown in a single study. No effect on MSIS physical component shown in a single study, but some effects on secondary outcomesNo replication
Psychological approachesCognitive–behavioural therapy7IIOverall, CBT appears effective in treating MS-related psychological symptoms and conditions. Significant improvements shown for depression, fatigue, distress and general health. No effect on functional impairment in one studyLimited replication and inconsistent study design
Cognitive rehabilitation1IINo effect on cognitive function in a single studyNo replication
Mindfulness1IISignificantly improved HR-QoL, depression and fatigue in a single studyNo replication
OtherAcupressure1IISignificantly reduced fatigue in a single studyNo replication
Amphetamine salts1IIImproved processing speed in a single studyNo replication
Reflexology2IIContradictory results on its effect on pain in two studiesLimited replication and contradictory results
Relaxation2IIPositive effect on stress and depression reported in a single study, and a significant positive effect on pain reported in a single studyNo replication
  • CAM, complementary and alternative medicines; CBT, cognitive–behavioural therapy; HR-QoL, health-related quality of life; MS, multiple sclerosis; MSIS, MS Impact Scale; PUFA, polyunsaturated fatty acids; THC, tetrahydrocannabinol.