The National Institutes of Health defines complementary and alternative medicine (CAM) as a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine. CAM therapies used alone are often referred to as "alternative". When used in addition to conventional medicine, they may be referred to as "complementary”. The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge.

Americans spend more than $1 billion a year on nontraditional treatments for arthritis. The reasons for seeking CAM treatments vary – many people want relief for pain and suffering that traditional medications have not provided; they hope to avoid potentially serious side effects associated with such medications; and certain conventional medical and surgical treatments cost more than many of us can afford.

Although there has been no rigorous scientific evidence to support the use of CAM by people with ankylosing spondylitis (AS) and its related diseases, some patients have benefited from such treatments.

Prior to beginning any new treatment (whether it be traditional or CAM), it is important to discuss the therapy with all of your doctors. For additional information to assist you in your decision-making about CAM, please refer to the National Center for Complementary and Alternative Medicine.

	Acupuncture - The exact way in which acupuncture works on the body remains unclear, but stimulation of acupuncture points by puncturing the skin with hair-thin needles may lead to release by the brain and spinal cord of opium-like molecules that help relieve pain. Enough research suggests that acupuncture relieves pain in some people, and is safe if performed by a trained professional using sterile or disposable needles. More scientific studies are underway to help determine its effect on various forms of arthritis. Treatments may be time-consuming and expensive, although some health plans cover a certain number of acupuncture treatments per year for a variety of conditions.
	Chiropractic Treatment - Some people with spondylitis swear by regular chiropractic sessions, but doctors do not recommend this treatment for ankylosing spondylitis. "Anyone with limited spinal mobility due to [spondylitis] should avoid manipulation of their back or neck by chiropractors and masseurs because it can be dangerous," claims Dr. Muhammad Asim Khan, rheumatologist, and AS patient. Dr. Khan explains that chiropractic treatments have sometimes inadvertently led to spinal fractures and neurological complications, especially in individuals with fusion (extra bone growth) due to spondylitis.
	Massage - Many people with spondylitis find therapeutic massage very helpful, and if done carefully, it can be a beneficial tool for pain relief and stress reduction. If a massage therapist is aware of a person's spondylitis and understands the disease and any potential manipulation issues, gentle massage can help promote well being. It may provide temporary relief of pain or stiffness, and in some cases improve flexibility because of the increased blood circulation. "In all my years of experience as a physical therapist, I have never known massage to worsen the symptoms of inflammation in a patient with AS. Deep tissue mobilization is nearly always welcomed by those with AS and is usually given in combination with passive stretches and ultrasound, heat or ice," says Mary Rosenberg, Physical Therapist, Los Angeles, CA. Yet some people with spondylitis cannot tolerate the procedure due to increased pain as a result of the massage. Others attribute massage as a trigger for disease flare-ups. Check with your health insurance on whether they cover massage treatment in your plan, and if so, ask how often you can get the massages.
	TENS Unit - This stands for "transcutaneous electrical nerve stimulation". The American Physical Therapy Association defines TENS as application of electrical current through the skin for pain control (APTA, 1990). The unit is usually connected to the skin using two or more electrodes. A typical battery-operated TENS unit is able to modulate pulse width, frequency and intensity.
	Yoga Therapy - Yoga has been practiced for over 5,000 years and can greatly benefit people with spondylitis under the instruction of a knowledgeable instructor who can tailor the program to the individual.
	Oriental Medicine - In our Spring 2008 issue of Spondylitis Plus, there was an in-depth article about oriental medicine and the treatment of spondylitis. Members can read the article by viewing the issue in our member area by clicking here. Due to popular demand, here are the studies that the article referenced: 1. Cao TM, Han HN, Duan YC. Clinical study on long-term treatment of ankylosing spondylitis with integrated traditional Chinese and western medicine. Zhongguo Zhong XiYi Jie He Za Zhi. 2001 Aug;21(8):576-8. 2. Jia J, Wang Q,Zhang T, Li J. Treatment of ankylosing spondylitis with medicated moxibustion plus salicylazosulapyridine and methotrexate-a report of 30 cases. J Trad mChin Med. 2006 Mar;26(1):26-8.