Is non-traditional therapy for multiple sclerosis overwhelming in Saudi Arabia

Objectives:To describe the prevalence, knowledge and attitudes about complementary and alternative medicine (CAM) use and the proportion that seek advice from their physician about CAM use.Methods:This cross-sectional observational study was performed in multiple sclerosis (MS) clinic of King Fahd Hospital of Universityin Alkhobar, Kingdom of Saudi Arabia from January-June 2017. A total of 133 patients have completed the survey.Results:The mean age of patients was 32.3±7.6 years and 84 (63.2 %) were female. Approximately 83.5% of the patients reported the use of CAM. Among all the reported forms of CAM, vitamins were the most prevalent form, followed by cupping, special prayers and meditation. The majority of patients (62%) obtained knowledge of CAM through social media. A significant number of patients (75.6%) did not disclose the use of CAM to their physician. There was a trend for using CAM more in highly educated, older age, and female patients. The most commonly reported rationale to use CAM was overall improvement in health status.Conclusion:The use of CAM among Saudi patients with MS is highly prevalent, without disclosure of its use to physicians. These factors should be taken into account in the doctor-patient consultation to avoid adverse events.

Multiple sclerosis (MS) is a chronic neurological disorder, typified by a relapsing and progressive course of symptoms, resulting in long-term severe disability. Multiple sclerosis was thought to be uncommon in Kingdom of Saudi Arabia, but the prevalence of MS is increasing in the Gulf region, particularly in Kingdom of Saudi Arabia, and the latest prevalence estimates are 40/100,000 in 2008.1,2 These increasing numbers of MS patients represent a challenge to provide treatment, health promotion, employment, and rehabilitation for severely disabled patients.3 The etiology of MS is still unknown. Multiple sclerosis patients face many challenges in their daily routine life, like other patients suffering from chronic diseases. Treatment for MS is not curative, though many disease modifying drugs (DMDs) are available with United States of America’s Food and Drug Administration (FDA) approval; the available treatment options for MS often have several adverse side effects and a very high cost. Therefore, MS patients turn to CAM with the hope to cure their MS, minimizing the relapses and treating their symptoms, even though the efficacy may not be established. Complementary and alternative medicine is defined as “a group of diverse medical and health-care systems, practices and products that are not presently considered to be part of conventional modern medicine”.1There is a worldwide interest in CAM. Its use ranges from 9-70% of the total population, despite insufficient scientific evidence for its use.4 Complementary and alternative medicine is popular among patients as well as healthy individuals.4 There are variations in CAM practices between countries, which depend on their traditions and the prevalence of diseases. Also, the methods that are used in different studies differ.4,5Patients suffering from MS are significant users of CAM.6 The prevalence of CAM use among MS patients has been reported in several studies, with a wide range of prevalence between 33-70%.6 Knowledge about CAM practices and the prevalence in MS patients in Arab countries is limited. To document the influence of psychosocial, religious and cultural factors on health beliefs and behaviors in Kingdom of Saudi Arabia, having a religious background, studying CAM is of utmost importance.4,7 Health care facilities are free for the nationals in Kingdom of Saudi Arabia and provided by The Ministry of Health, but the ministry does not cover CAM. However, a center for CAM was established by a ministerial decree (No. 236) on 10/8/1429 H (12/8/2008 G). This center, being a reference center for CAM and related issues, has the objectives to monitor the CAM practices among different health care services and to regulate them using evidence-based support.8 In a 2015 publication, Kingdom of Saudi Arabia was ranked very high in scientific research related to CAM among all Arab countries.9 This highlights the importance of CAM-related research in Kingdom of Saudi Arabia to document how their different psychosocial, cultural and religious background can influence the use of CAM and to see the effects on their health beliefs and attitudes.10We aimed to determine the prevalence of CAM use among MS patients in Kingdom of Saudi Arabia, as well as to document their knowledge and behaviors concerning CAM, the used types and the reasons behind them and the frequency of the patients disclosing the use of CAM to their physician. We also wanted to determine any association of demographic characteristics, health behaviors and health status with CAM use and disclosure.