Chiropractic care is not usually considered as first line of treatment for patients with Multiple Sclerosis (MS). Recent advancement in non-pharmacologic treatments is now opening the doors to a new management approach, which could help chiropractors offer long-term solutions to ameliorate inflammation and symptoms of MS.
1. What is Multiple Sclerosis?
MS is a debilitating neurodegenerative disease leading to severe physical or cognitive disability. It is usually associated with the presence of chronic inflammatory states, but a complete understanding of its pathogenesis is yet to be found.
In the United States, MS is considered the most common progressive-neurologic disease affecting around 400,000 people (2019) and it is growing exponentially.
The most common clinical manifestation of MS patients is associated with the long-lasting demyelinating process, usually associated with the presence of inflammatory and immune responses. During demyelination, the outer layer of myelinated nerves is lesioned, leading to the neural damage and dysfunction. While our immune system usually acts in a way to protect our bodies from a harmful assault, in chronic conditions excessive immune responses cause biological cascades which are potentially detrimental to our organs. As seen in many other autoimmune diseases, disruptive immune responses release an excessive amount of macrophages, which then cause lesions to myelin sheaths surrounding nerves through phagocytosis (from the Greek phagein ‘to eat’ and kytos ‘cell’, so literally eating cells).
It is not surprising to see patients with MS experience symptoms which resembles many other chronic, neuropathic conditions. Myelinated nerves in MS are affected continuously by an ongoing myelin destruction process, created by disturbances from the blood-nerve barrier in the periphery and from the blood-brain barrier in the central nervous system. Patients with MS then often report pain (in acute or chronic forms) and show neuropathic symptoms such as trigeminal neuralgia, paroxysmal spasms, or dysesthesias.
Current standard of care for MS includes anti-convulsants, anti-depressants and analgesic medication, along with other anti-inflammatory drugs. While anti-depressants and analgesic medication might treat the symptoms of pain and improve the quality of life (with questionable efficacy and increased risk of addiction), anti-inflammatory drugs might, in some cases, help prevent the progression of the demyelinating processes. However, in the past decades, alternative, non-pharmacological therapeutic modalities have been demonstrated to be effective against both the demyelination process and the neural dysfunction.
Read more about this at:
- Ghasemi et al. (2017) Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy.
- Walton et al. (2020) Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition
- Lubetzki and Stankoff (2014) Demyelination in multiple sclerosis
- Höftberger and Lassmann (2018) Inflammatory demyelinating diseases of the central nervous system
- National Multiple Sclerosis Society – Pain & Itching (https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Pain)
- National Multiple Sclerosis Society – Treating MS (https://www.nationalmssociety.org/Treating-MS)
2. VNS and Its Anti-Inflammatory Action:
2. VNS and Its Anti-Inflammatory Action:
The vagus nerve is part of the autonomic nervous system and is in charge of regulating inflammatory and immune responses, along with heart rate and other inner organs. Early applications of vagus nerve stimulation included epilepsy, with implanted devices; however, recent treatment solutions of VNS are non-invasive and are used to treat a wider variety of conditions such as anxiety, chronic headaches, and bipolar disorders.
Auricular VNS (aVNS) is an accessible treatment modality, non-invasive, and targeting cutaneous branches of the vagus nerve. aVNS has been recently approved for the treatment of pain (European clearance for treatment of pain, 2012). From a physiological point of view, stimulating the vagus nerve regulates the well-known cholinergic anti-inflammatory pathway (CAP), efferent nerve of the autonomic nervous system which modulates the release of immune cells and other inflammatory molecules. In chronic inflammatory diseases, aVNS shows significant results into suppressing cytokine production and other pro-inflammatory biomarkers, all without any side effects.
It follows that aVNS could be a novel adjunctive therapy for MS: Current research is focused on the potential of aVNS as an inhibitory therapy against inflammatory storms (reference for it: after trauma, in pathological conditions, including the latest Covid-19 pandemic). aVNS seems like it could play a role in positively impact on the demyelinating process and as such reduce the symptomatology in MS.
Find more resources on the use of VNS for Multiple Sclerosis here:
Read more about this at:
- Breit et al. (2018) Vagus nerve as modulator of the Brain-Gut axis in psychiatric and inflammatory disorders
- Howland (2014) Vagus nerve stimulation
- de Jonge et al. (2005) Stimulation of the vagus nerve attenuates macrophages activation by activating the JAK2-STAT3 signalling pathway
- Verma et al. (2021) Auricular vagus neuromodulation – a systematic review on quality of evidence and clinical effects
- Cronkleton (2021) What to know about vagus nerve stimulation
- Pavlov and Tracey (2012) The vagus nerve and the inflammatory reflex – linking immunity and metabolism)
- Caravaca et al. (2019) An effective method for acute vagus nerve stimulation in experimental inflammation
Electromagnetic Therapies for the Treatment of Peripheral Neuropathy
Electromagnetic therapies offer an effective treatment solution for peripheral neuropathy. It is attractive due to the fact that it is non-invasive, transcutaneous solutions that can help stimulate healing and reduce pain without side effects. Electromagnetic therapies, transcutaneous pulsed radiofrequency, can be used together with VNS in order to provide a comprehensive solution to MS inflammations and secondary neuropathic pain. For example, in a recent clinical trial, patients with trigeminal neuralgia have shown a significant reduction pain scores after being treated with pulsed radiofrequency, with the reduction in pain lasting up to 720 days (https://www.algiamed.com/wp-content/uploads/2022/11/Study-of-the-outcome-of-patients-undergoing-pulsed-radiofrequency-for-the-treatment-of-Trigeminal-Neuralgia-Stimpod-NMS460.pdf). Trigeminal neuralgia is currently listed as one of the most common neuropathic manifestations in patients with MS.
For more info on electromagnetic therapies for long-term pain relief from neuropathic conditions, please read “Enhancing your chiropractic technique with adjunctive PRF therapy” (https://www.algiamed.com/enhancing-your-chiropractic-technique-with-adjunctive-prf-therapy/).
MS patients are not often referred to chiropractic care due to the complexity of their neurological disease; however, most clinical manifestations in MS are related to neuropathic symptoms and chronic pain.
Chiropractors who incorporate vagus nerve stimulation and electromagnetic therapies like pulsed radiofrequency in their treatment regime can easily increase the scope of their practice. Besides other, more common, neuropathic conditions, VNS and electromagnetic therapies are a great solution for difficult to treat pathologies such as patients with multiple sclerosis.