2026 American Academy of Neurology Abstract Website

Objective:

Understand correlations of complementary and alternative medicine (CAM) use based on Rural-Urban Commuting Area (RUCA) Codes in Multiple Sclerosis (MS) patients.

Background:

MS patients report persistent symptoms and medication side effects despite use of FDA-approved treatments.^1–4 In the U.S., non-white individuals experience worse clinical outcomes compared to white patients, with disparities linked to healthcare access and socioeconomic status.^5,6 Geographical residence serves as a proxy for healthcare access, with rural residents facing reduced access to specialized care and worse outcomes.⁶ As of 2022 only 185 MS clinics were identified nationwide, with rural areas having significantly lower odds of access compared to metropolitan regions.⁶ At least one-third of MS patients use CAM, defined as unconventional therapies used instead of or alongside allopathic medicines.^1,2,4Given the self-directed nature of CAM, rural residents may be more likely to adopt such therapies.

Design/Methods:

A survey of 875 MS patients was conducted in 2018 to assess CAM use. Data were analyzed in RStudio (v4.5.0). Total CAM use was defined as the sum of all therapies, while category-specific sums (e.g., herbs/supplements) represented use within each domain. CAM use and RUCA status were respectively treated continuously and categorically (urban/rural) using USDA RUCA codes.⁷

Results:

Participants reported past or current use of an average of 15 unique CAM therapies. Rural status correlated positively with requiring walking assistance and specific CAM modalities (e,g., exercise, supplements) and trended positively regarding total CAM use. Education correlated positively with use of disease-modifying drug therapies, regardless of RUCA status.

Conclusions:

In our study, rural status correlated with disability, CAM use type, and trended positively towards higher total CAM use across categories. This data was previously analyzed, but did not account for RUCA status, which has significant implications for disability status and CAM use, with education, access, and functional status shaping therapy selection.