When nothing has worked: the people turning to natural and complementary therapies

There is a particular kind of tiredness that comes from being a “complex case”. It is the fourth referral, the third medication change, the side effects that arrive before the benefits do. For many people living with chronic pain, seizures, anxiety, gut disorders or poor sleep, the conversation with their doctor eventually reaches a point where both sides are out of obvious next steps.

That is often when people start looking elsewhere: at diet, movement, talking therapies, supplements and treatments they would once have dismissed as “alternative”. Some of those routes are backed by strong evidence and are recommended by NICE, the body that advises the NHS. Others are untested, and a few carry real risks. Knowing which is which is the whole point of this piece.

A bigger group than you might think

Chronic pain alone affects between a third and a half of UK adults, according to a review of population studies published in BMJ Open, which put the figure at just under 28 million people. Around one in three people with epilepsy do not get full control of their seizures from medication. And in the largest real-world study of depression treatment, STAR*D, a substantial share of patients still had not recovered after several different treatment steps.

These are not fringe cases. They are a large group of people for whom standard treatment has helped partly, briefly or not at all.

Why “just one more medicine” is a hard sell

Reluctance to start another drug is often treated as stubbornness. It is usually experience. People with long-term conditions are more likely to be on several medicines at once, and each new one adds side effects and the risk of interactions. In 2021, a national review for the Department of Health found that at least 10% of prescription items dispensed in primary care in England, around 110 million a year, may not need to have been issued.

The NHS has moved in the same direction. NICE’s 2021 guideline on chronic primary pain, meaning pain with no clear underlying cause, told doctors not to start opioids, gabapentinoids, anti-inflammatories or even paracetamol for it. The evidence of benefit was weak and the risk of harm was real. For many patients, that guidance confirmed what they had already found out the hard way.

Wanting fewer pills is not anti-medicine. Often it is exactly what the guidelines now recommend.

Pain

For chronic primary pain, the options NICE does recommend are non-drug ones: supervised group exercise, psychological therapies such as acceptance and commitment therapy (ACT) or CBT for pain, and a single course of acupuncture or dry needling. None of these is a cure. The evidence is that they help people move more, cope better and suffer less from their pain, which is often what matters most.

• Group exercise programmes are run by many NHS physiotherapy services. Ask your GP for a referral.
• Pain management programmes combine movement, psychology and education, and are available through specialist NHS pain clinics.
• NICE supports one course of acupuncture, not ongoing sessions, even when the first course helped.

Seizures and neurological conditions

The best-evidenced “natural” therapy in this whole field is a diet. The ketogenic diet, which is very high in fat and very low in carbohydrate, has been used for drug-resistant epilepsy for a century. NICE’s 2022 epilepsy guideline says people whose seizures are not controlled by medication should have it available as an option. Cochrane reviews have found that it increases the number of people whose seizures are at least halved.

For spasticity and mobility problems, such as those that follow stroke, multiple sclerosis or spinal injury, physiotherapy, regular stretching and positioning remain the foundation. Many people also find that hydrotherapy, yoga or tai chi help them keep moving. These are best done alongside, not instead of, specialist neurological care.

Anxiety, depression, stress and PTSD

NICE’s 2022 depression guideline lists group exercise among its first-line options for less severe depression, alongside talking therapies. Mindfulness-based cognitive therapy (MBCT) is recommended to help people who have recovered from repeated episodes of depression avoid relapsing. For PTSD, NICE recommends trauma-focused CBT and EMDR (eye movement desensitisation and reprocessing), both of which are free on the NHS through NHS Talking Therapies, which you can usually refer yourself to.

Herbal remedies are where caution matters most. St John’s wort, the best-known herbal antidepressant, interacts with a long list of medicines, including the contraceptive pill, some antidepressants and blood thinners. “Natural” does not mean it will not interact with what you already take.

Gut conditions

Irritable bowel syndrome is a good example of where complementary approaches have moved into the mainstream. The British Society of Gastroenterology’s 2021 guideline supports peppermint oil for overall symptoms and abdominal pain. It also supports gut-directed hypnotherapy and IBS-specific CBT, which it suggests considering when symptoms have not improved after 12 months of drug treatment. A low-FODMAP diet can help too, but it should be done with a dietitian, because cutting out food groups without guidance can do more harm than good.

Sleep, memory and appetite

Poor sleep runs through almost every condition here. The first-line treatment NICE recommends is not a pill but cognitive behavioural therapy for insomnia (CBT-I). In 2022 NICE also recommended Sleepio, a digital CBT-I programme, as an alternative to sleeping tablets in primary care.

For people living with mild to moderate dementia, NICE recommends group cognitive stimulation therapy: structured sessions of activities and discussion designed to keep thinking and memory active. For loss of appetite and weakness, particularly in older people or those with serious illness, a referral to a dietitian is often the most useful step, rather than a supplement chosen online.

Women’s health

In 2024 NICE updated its menopause guidance to recommend menopause-specific CBT, both alongside HRT and for women who cannot or prefer not to take it. It helped with sleep and with how distressing hot flushes and night sweats felt. NICE notes some evidence that black cohosh and isoflavones may ease hot flushes. It also warns that their safety is uncertain, that products vary and that interactions with other medicines have been reported.

Palliative and complex care

Hospices were embracing complementary therapy long before the rest of medicine. Many offer massage, aromatherapy, reflexology and relaxation alongside medical care. They do not claim these treat illness. They offer them because comfort, calm and dignity matter, especially when cure is no longer the goal. If you or someone you care for is under palliative care, ask the team what is available locally.

How to try something new safely

• Tell your GP, specialist or pharmacist before starting any supplement or herbal remedy, especially if you take prescribed medicines.
• Never stop or reduce prescribed medication on your own, particularly for epilepsy, mental health conditions or pain.
• Be wary of anything that promises to cure a long-term condition, or is sold with testimonials instead of evidence.
• Ask what a therapy costs over time. Many evidence-based options, including group exercise, talking therapies, CBT-I and dietitian support, are free on the NHS.
• Keep a simple symptom diary, so you and your clinician can tell whether something is genuinely helping.

Turning to natural and complementary approaches is not giving up on medicine. Done well, with the right professionals involved, it is often exactly what modern guidance recommends. The key is to choose the approaches that have been tested, and to be honest with your care team about what you are trying.

This article is for general information and is not medical, legal or financial advice. Laws differ between countries. Read our editorial standards.