Introduction:
In recent years, professionals specializing in patient care for spondyloarthritis have acknowledged that adopting a hands-on, comprehensive approach that places the affected person at the focal point of their treatment, actively involving them in decision-making processes, can yield optimal outcomes. This is attributed to the potential for enhanced psychological well-being and satisfaction among affected individuals. Consequently, experts recommend a patient-centered strategy, encompassing both pharmacological and non-pharmacological methods and interventions, as the fundamental aspect of treating spondyloarthritis. This article endeavors to present multidisciplinary non-pharmacological intervention in ankylosing spondylitis.
What Do Alternative Therapies Mean?
The National Institutes of Health describes complementary and alternative medicine (CAM) as a collection of various medical and healthcare systems, practices, and products that currently fall outside the scope of conventional medicine. If employed independently, CAM therapies are commonly termed alternative, while when utilized alongside conventional medicine, they are termed complementary. The categorization of CAM is dynamic, evolving as therapies proven safe and effective are integrated into conventional healthcare and new healthcare approaches emerge.
What Is Conventional Treatment for Ankylosing Spondylitis?
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease, with inflammatory back pain typically serving as the initial and predominant symptom. The primary musculoskeletal manifestations encompass sacroiliitis, spondylitis, peripheral arthritis, and enthesitis. The disease generally follows a progressive course, underscoring the imperative need for stringent disease management to avert functional decline. The optimal approach to treating AS involves a combination of nonpharmacological and pharmacological interventions. Individualizing treatment is strongly recommended, taking into account patients' specific signs, symptoms, and pertinent factors such as accompanying illnesses and psychosocial conditions. Medical interventions encompass nonsteroidal anti-inflammatory drugs (NSAIDs), tumor necrosis factor-alpha (TNF-α) inhibitors, and interleukin (IL)-17A inhibitors. Despite not being considered standard AS treatments, Complementary and Alternative Medicine (CAM) modalities have gained widespread usage among AS patients.
What Are the Benefits of Alternative Therapies for Ankylosing Spondylitis?
The objectives of this approach, as determined by experts, encompass pain alleviation and an endeavor to enhance muscle strength, endurance, flexibility, mobility, balance, and overall fitness. Additionally, it aims to uphold or increase involvement in a robust social life to counteract feelings of isolation. Equally significant goals include the prevention of postural abnormalities and joint contractures.
What Are the Alternative Therapies for Ankylosing Spondylitis?
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Massage Therapy: It comes in diverse modalities, and as per numerous self-reported assertions, it is believed to contribute to relaxation, stress reduction, alleviation of muscle tension, mitigation of chronic pain, and enhancement of overall well-being. When approached with care, it can serve as a valuable instrument for alleviating pain and reducing stress. If a massage therapist is well-informed about an individual's spondylitis condition, comprehends the nature of the disease, and is mindful of potential manipulation challenges, a gentle massage can contribute to overall well-being. This approach may offer temporary relief from pain or stiffness and, in certain instances, enhance flexibility due to improved blood circulation. However, certain people with spondylitis may find the procedure intolerable due to the heightened pain induced by the massage. Some people also associate massage with triggering episodes of their disease flare-ups.
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Acupuncture: While the precise mechanism by which acupuncture affects the body is not fully understood, the stimulation of acupuncture points through the insertion of hair-thin needles into the skin may trigger the release of opium-like molecules by the brain and spinal cord, potentially contributing to pain relief. Some studies propose that acupuncture can be effective in alleviating pain for certain individuals and is deemed safe when administered by a trained professional using sterile or disposable needles. Ongoing scientific research is being conducted to assess its impact on different forms of arthritis.
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Yoga Therapy: It has been practiced for over 5,000 years and can be highly beneficial for individuals with ankylosing spondylitis when conducted under a trained instructor who can customize the program to meet their needs.
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TENS Unit: TENS refers to transcutaneous electrical nerve stimulation and involves the application of electrical current through the skin for pain control. This unit typically utilizes two or more electrodes connected to the skin. A standard battery-operated TENS unit can adjust pulse width, frequency, and intensity.
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Chiropractic Treatment: The term chiropractic encompasses various treatment modalities, including manual therapies, high-velocity spinal manipulation, passive modalities, exercise programs, touch therapy, no-touch therapy, and pain education. The Treatment Guidelines in Axial Spondyloarthritis by the American College of Rheumatology strongly advise against spinal manipulation with high-velocity thrusts for AS patients with spinal fusion or spinal osteoporosis. In any patient with established axial spondyloarthritis, spinal manipulation should be avoided due to the potential risks associated with undiagnosed osteoporosis and the unknown effects of joint manipulation in actively inflamed joints. Exercising extreme caution is imperative before considering chiropractic treatment, as individuals with axial spondyloarthritis face risks such as spinal fractures, spinal cord injury, and even paraplegia.
Why Do Individuals With Ankylosing Spondylitis Choose Alternative Therapies?
Primary Motivation for Alternative Therapy Usage:
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The primary reason for using complementary and alternative medicine (CAM) in rheumatic diseases, including arthritis such as Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) is to alleviate pain.
Additional Reasons for Alternative Therapies Usage:
Affected individuals cite various reasons for choosing alternative modalities, including:
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Perceived naturalness compared to pharmacological treatments.
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A willingness to try alternative approaches.
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Belief in fewer side effects than pharmacological treatments.
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Negative perceptions about the efficacy of pharmacological treatments.
A study on individuals with rheumatoid arthritis found that dissatisfaction with conventional treatment, concerns about side effects, and perceived ineffectiveness of drugs were prominent reasons for choosing alternative therapies. In the study, the main reported reasons for using alternative therapies include belief in its usefulness (73.2%), the perception that it will treat the disease (50.0%), pain relief (39.2%), avoiding deterioration (33.9%), and satisfaction derived from other users (25.0%).
In a study on alternative therapy practitioners, it is emphasized that alternative therapies are most effective for symptom management when used in conjunction with mainstream healthcare rather than as an alternative.
Conclusion:
The utilization of alternative therapies in rheumatic diseases is multifaceted, driven primarily by the desire to alleviate pain but influenced by a range of factors, including perceived naturalness, a willingness to explore alternatives, concerns about side effects, and dissatisfaction with conventional treatments. The study underscores the importance of considering alternative therapies to complement mainstream healthcare for effective symptom management. Despite the absence of robust scientific evidence supporting the efficacy of alternative therapies for individuals with ankylosing spondylitis and related conditions, there are instances where patients have reported positive outcomes from such treatments.
