Prayer appears to benefit individuals with multiple sclerosis - Letter to the Editor

Townsend Letter for Doctors and Patients, Nov, 2003 by Daniel Ko

Editor:

According to the first comprehensive, nationwide survey in the USA of complementary and alternative medicine (CAM) use among individuals with multiple sclerosis (MS), prayer was rated as the most effective intervention.

"The survey results are interesting," comments Allen C. Bowling, MD, PhD, Medical Director, Rocky Mountain Multiple Sclerosis Center, Englewood, Colorado. "Certainly prayer and spirituality seem important and helpful for many MS patients, but formal clinical trials are needed to get a definitive answer."

Primary investigator Sangeetha Nayak, PhD, assistant professor, Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Newark, New Jersey agrees that further studies are required since this type of efficacy self-reporting doesn't constitute clinical evidence. (1) Nevertheless, she says that the subjective experience of having been helped, especially when compared to over 57 other possible therapies, is a signal to biomedical professionals that prayer should be examined closely.

Although there is little information on the role of prayer and spirituality on health, the majority of Americans believes faith can having healing effects. (2,3) For example, there is a dramatic personal account of a woman, Rita Klaus, who has MS and reportedly improved significantly through prayer and religious devotion. (4,5) Some researchers have examined the effect of spirituality on diabetes, which is, like MS, a chronic disease with an unpredictable course and multiple possible symptoms. One study's results indicated that religious devotion was associated with less psychological distress and decreased uncertainty. (6)

From the responses of the 3,140 adults with MS who returned the survey, Dr. Nayak and her colleagues found that 57% of them have tried at least one CAM modality. They also discovered that the longer people had MS and the less satisfied they were with conventional health care, the higher the probability of using CAM therapies. In fact, the most common reason for using CAM was the desire to use holistic health care--treatments that recognize the interrelatedness of mind, body, and spirit. Another study concurred that the most important motivation in looking for alternative medicine was the aim to participate actively in the healing process. (7)

Multiple sclerosis is a slowly progressive central nervous system (CNS) disease characterized by disseminated patches of demyelination in the brain and spinal cord, resulting in multiple varied neurological signs and symptoms, usually with remissions and exacerbations. (8) The most common presenting symptoms are paresthesias in one or more extremities, in the trunk, or on one side of the face; weakness or clumsiness of a leg or hand; or visual disturbances, e.g., partial blindness and pain in one eye, dimness of vision, or scotomas.

There is no cure for MS, but therapies are available that slow down the disease process. Much of the disease management is directed at symptoms, which arise variably in the course of the condition. Such problems as urinary incontinence, sexual dysfunction, cramps and spasms, tremor and trigeminal neuralgia can often be helped to some extent using conventional therapies. However, these treatments are not effective for everyone, or they cause unacceptable side-effects. (9) There are no generally accepted treatments for some commonly reported symptoms, such as fatigue or emotional lability. Therefore, knowledge of CAM therapies can benefit individuals with MS.

The investigators found that vitamins, prayer, and herbs were the most frequently used CAM modalities by MS patients (44.8%, 27.3%, and 26.6%, respectively). Moreover, prayer had been used for an average of 9.53 years, the longest duration of all the modalities covered in the survey. Furthermore, exercise was considered more effective than all other CAM therapies, except prayer, despite being used by a small proportion of the sample (about 5%).

Approximately 74% of MS patients predominately use CAM treatments for symptom relief, followed by slowing down the progress of MS, relapse prevention, and inducing remission. Pain, fatigue, and stress were the most frequently listed symptoms treated with alternative techniques.

The fact that prayer was rated as the most effective of all CAM interventions is not something that would be expected by most conventional healthcare providers, says Dr. Nayak. She suspects prayer affects individuals at the psychological or emotional level by reducing stress, a known factor that exacerbates MS symptoms. This is probably the same reason why other mind-body therapies such as yoga, relaxation techniques, and massage were also given fairly high effectiveness ratings.

Dr. Nayak's findings are consistent with another survey's results. These findings are posted on the Rocky Mountain Multiple Sclerosis Center's website on MS and CAM therapies (see http://www.ms-cam.org). As of August 15, 2003, 1,038 users have taken the survey. One interesting finding is that of the 946 individuals who answered the question, "Would you like your physician or other conventional healthcare provider to pray with you?" 23% replied 'Yes,' while another 20% were unsure.