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At least 19 recordsLinked to original sources
PubMed2000

Interventions for nausea and vomiting in early pregnancy.

BACKGROUND: Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting. OBJECTIVES: The objective of this review was to assess the effects of different methods of treating nausea and vomiting in early pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials of any treatment for nausea and/or vomiting in early pregnancy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: Twenty trials were included. These trials were of variable quality. Nausea treatments were different anti-histamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin) and P6 acupressure. For hyperemesis gravidarum two trials were identified using treatments with ginger root and ACTH (adrenocorticotropic hormone) injections. Based on 13 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.17, 95% confidence interval 0. 13 to 0.21). REVIEWER'S CONCLUSIONS: Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. The results of the trial using adrenocorticotropic hormone to treat hyperemesis gravidarum show no evidence of benefit. Ginger may be of benefit, but the evidence so far is weak.

Antiemetics↗
PubMed1997

A new nausea model in humans produces mild nausea without electrogastrogram and vasopressin changes.

UNLABELLED: The standard human vection model utilized for nausea has been an optokinetic drum. This model may be difficult to extrapolate to the usual clinical setting. Our goals were to develop an experimental model which could induce low grade nausea in humans and to determine the relationship between mild nausea and changes in the electrogastrogram and plasma vasopressin concentrations. METHODS: Twenty-one volunteers (11 males, mean age: 37 years) participated. At baseline and throughout the study the electrogastrogram was monitored, blood was drawn for vasopressin assay and symptoms of nausea, dizziness and headache were rated on a 0-10-point scale. Subjects were semireclined in a darkened room while viewing moving bars of light rotating at a rate of 85 degrees s-1. Subjects were asked to rate their proneness to motion sickness and their current level of anxiety at baseline. RESULTS: Eight subjects developed mild to moderate (mean: 3.6) nausea during vection. Symptoms of nausea were correlated with a reported history of motion sickness (r = 0.49, P < 0.05) but not with anxiety (r = 0.14, P = 0.54). Degrees of nausea correlated with degrees of dizziness (r = 0.47, P < 0.05) but not with headache (r = 0.29, P = 0.14). Subjects who developed mild nausea were not significantly more likely to exhibit altered electrogastrogram or vasopressin than subjects who did not report nausea. Vasopressin levels during baseline and experimental conditions were highly correlated (r = 0.66, P < 0.005 and r = 0.55 P < 0.005, respectively) with reported baseline anxiety. CONCLUSIONS: (1) This new model in humans induced mild nausea that was unrelated to electrogastrogram and vasopressin abnormalities, (2) high correlation between anxiety and vasopressin suggests that vasopressin may not be directly related to nausea, and (3) these data indicate that onset of nausea mediated centrally can occur without associated electrogastrogram changes.

Adult↗
PubMed1996

Assessment of the multiple dimensions of nausea: the Nausea Profile (NP).

Nausea, unlike emesis, is a subjective experience that is difficult to describe to others, be they clinicians or researchers. Previous research has been limited to examining the frequency, severity, and duration of nausea. The goal of this study was to design a questionnaire that would allow for the evaluation of the characteristics of nausea across individuals and situations. This study consisted of 4 stages: descriptors were generated, categorized into 3 dimensions, and reevaluated to verify their reliability; in the final stage, the developed checklist was compared to a visual-analogue-scale (VAS) report of nausea in subjects exposed to a rotating optokinetic drum to stimulate nausea. The overall nausea checklist score and the VAS score were highly correlated (r = 0.71, p < 0.01). The development and use of the nausea checklist are discussed.

Adult↗
PubMed1988

Defining anticipatory nausea and vomiting: differences among cancer chemotherapy patients who report pretreatment nausea.

It is important to distinguish patients whose reports of pretreatment nausea and vomiting reflect classically conditioned anticipatory nausea and vomiting (ANV) from those whose reports reflect the influence of other pharmacological and psychological factors. Therefore, Andrykowski (J. Behav. Med. 9: 33-41, 1986) has suggested that only patients who report pretreatment nausea on Day 1 of a chemotherapy cycle be considered to have developed ANV. As part of a prospective, longitudinal investigation of side effects associated with cancer chemotherapy, three groups of patients were identified: those who (a) never reported pretreatment nausea (noPTN), (b) reported pretreatment nausea but never prior to a Day 1 infusion (PTN), and (c) reported pretreatment nausea prior to a Day 1 infusion (PTND1). Discriminant analysis revealed that the PTN and noPTN groups did not differ, while both differed from the PTND1 group, particularly with respect to factors presumed to facilitate classical conditioning. The results justify excluding PTN patients from the criterion group of patients considered to have developed ANV.

Adult↗
PubMed2002

Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy.

OBJECTIVE: The morbidity of nausea and vomiting of pregnancy varies substantially. In addition to the physical symptoms, the emotional and psychosocial stress must be considered. The method available today to measure the severity of nausea and vomiting of pregnancy stems from chemotherapy-induced symptoms and is too complicated to use clinically. We sought to establish a simple and clinically relevant method for evaluation of the severity of nausea and vomiting of pregnancy that can be used for both clinical practice and research. METHODS: Women with nausea and vomiting of pregnancy were scored by use of the "gold standard" Rhodes' score, which includes 8 items. The Rhodes' score was compared with several short versions of 3 to 4 items. Patients were subsequently followed up a week later to monitor changes in scores. Changes in the Rhodes' scores were correlated with changes in the simplified scores. RESULTS: There was a very tight correlation between the Rhodes' score and the new pregnancy-unique quantification of emesis and nausea (PUQE) scoring system, which was based on the 3 items that included the number of daily vomiting episodes, the length of nausea per day in hours, and the number of retching episodes (r = 0.904; P <.0001). The distribution of severity of cases (between none, mild, moderate, and severe) did not differ between the Rhodes' and the PUQE. Comparing the changes in Rhodes' scores after a week of follow-up versus changes in the new PUQE score, there was a very high agreement (r = 0.95;P <.0001). CONCLUSION: The new PUQE score yields similar results to the gold standard, but more cumbersome, Rhode's score. Clinicians and researchers can easily use PUQE.

Female↗
PubMed2000

Nausea and vomiting remain a significant clinical problem: trends over time in controlling chemotherapy-induced nausea and vomiting in 1413 patients treated in community clinical practices.

Data from 1413 outpatients in community-based clinical practices were collected in order to characterize the use and effectiveness of 5-HT(3) receptor antagonists for control of chemotherapy-induced nausea and vomiting (NV). Patients were divided by treatment starting date into six cohorts for trend analysis. In addition, NV symptoms were compared in 252 patients treated prior to the commercial introduction of the 5-HT(3) receptor antagonist antiemetics, and an equal number of patients treated after their introduction. A comparison of cohorts revealed a significant (P = 0. 027) downward trend over time for the frequency of post-treatment vomiting episodes, but not for frequency of post-treatment nausea (P = 0.69). The average duration of nausea following treatment increased significantly over time (P = 0.003). Although the introduction of 5-HT(3) receptor antagonist antiemetics has apparently led to a significant reduction in the frequency of post-treatment vomiting, there has been an accompanying increase in the duration of post-treatment nausea.

Adolescent↗
PubMed1999

The Index of Nausea, Vomiting, and Retching: a new format of the lndex of Nausea and Vomiting.

PURPOSE/OBJECTIVES: To determine the reliability of the Index of Nausea, Vomiting, and Retching (INVR), a new format of the Rhodes Index of Nausea and Vomiting Form 2 (INV-2). DESIGN AND SETTING: A parallel form study was conducted at a large, Midwestern teaching hospital and a cancer center. SAMPLE: Convenience sample of 159 subjects: 40 obstetrical, 60 oncological, 59 medical/surgical. METHODS: Two instruments, the INVR and the INV-2, were administered approximately 30-60 minutes apart. One-half of the subjects completed the INVR first, and the other half completed the INV-2 first. MAIN OUTCOME MEASURES: Equivalency measures of reliability correlation coefficients for both instruments. FINDINGS: A high rate of agreement was found in the responses between the two forms. In cases of clear disagreement, the responses to the INVR were more frequently consistent than the responses to the original form. CONCLUSIONS: INVR has tested reliability and is more user friendly for the patient and the healthcare provider. IMPLICATIONS FOR NURSING PRACTICE: Nurses have a focal role in managing symptoms. Managing nausea, vomiting, and retching requires excellent assessment skills of the patient's personal symptom experience and knowledge of pharmacology. Efficient, cost-saving assessments require accurate self-report instruments that permit patients to quantify their symptom experiences. The INVR can provide a scientific base from which to prescribe and teach patients and may improve their quality of life. Reliable and valid self-reporting instruments are essential for managing these adverse symptoms.

Adolescent↗
PubMed1990

[Nausea in cancer patients. An analysis of its frequency and an evaluation of the treatment of nausea].

Frequency of nausea was investigated during the last six months of life of 342 patients who died from cancer in 1987. 44% received antiemetic treatment, but only 2% obtained complete relief. There was a close connection between opiate treatment, cytostatic treatment and nausea. The highest frequency of nausea was found among patients with gastrointestinal and ovarian cancer, whilst the lowest frequency was found in the prostate cancer group. We discuss antiemetic treatments in this connection.

Antiemetics↗
PubMed1998

Patients' pretreatment expectations of chemotherapy-related nausea are an independent predictor of anticipatory nausea.

Based on extensive research with animals, classical conditioning theorists have come to regard contingency as the primary factor in the development of conditioned responses. However, recent experimental work with humans has suggested the possibility that participant expectations may also directly contribute to the development of conditioned responses. To date, this phenomenon has not been investigated in clinical settings. Anticipatory nausea (AN) in chemotherapy patients, widely viewed as the best established example of classical conditioning in clinical medicine, provides an opportunity to examine the contributions of patient expectations to the development of a conditioned response outside the laboratory. The present study of 59 breast cancer patients supported the hypothesis that pretreatment patient expectations make a significant (p < .03) contribution to the development of AN after statistically controlling for the strongest conditioning predictor, contingency. These data imply that patient expectations should be considered when evaluating conditioned responses to aversive medical treatments.

Adult↗
PubMed2002

[Dexamethasone enhances the effect of tropisetron and ondansetron against nausea and vomiting against nausea and vomiting after patient-controlled analgesia].

OBJECTIVE: To study the enhancement by dexamethasone of the effect of ondansetron and tropiesetron against postoperative nausea and vomiting (PONV) in patients receiving patient-controlled analgesia (PCA) and observe the effect of dexamethasone on wound healing. METHODS: One hundred and twenty elective surgical patients receiving PCA were divided into 4 groups, including 2 control groups with the prescription of ondansetron (8 mg) and tropiesetron (3 mg) respectively (control A and B) and 2 observation groups in which the patients were given ondansetron (8 mg) plus dexamethasone (10 mg) and tropiesetron (3 mg) plus dexamethasone (10 mg) respectively (observation groups C and D). The incidence and severity of PONV was observed at 4, 8, 2, 24 h and 2, 3 d postoperatively, and the time and grade of healing of the wound evaluated. RESULTS: Significant difference in PONV between group A and group B was observed (P<0.01), and in the observation groups, PONV was markedly reduced compared with the control groups (C vs A, P<0.01; D vs B, P<0.05). In light of the time and grade of wound healing, the observation groups differed little from the control groups. CONCLUSION: Dexamethasone (10 mg) can greatly enhance the effect of ondansetron and tropiesetron against PONV in patients receiving PCA without interfering the healing of the wound.

Analgesia, Patient-Controlled↗
PubMed2002

Olfactory modulation of nausea during early pregnancy?

OBJECTIVES: To investigate whether nausea and vomiting and olfactory sensitivity are correlated, we determined whether subjects with little or no nausea and vomiting are less sensitive to odours than subjects who indicate a high degree of nausea and vomiting, and whether subjects with relatively low olfactory sensitivity are less prone to nausea and vomiting than subjects with relatively higher olfactory sensitivity. DESIGN: Cross sectional study. SETTING: The Unit of Perinatal Physiology, Department of Obstetrics, University Hospital, Zurich, Switzerland. POPULATION: Fifty-three women in early pregnancy. METHODS: Following a detailed history related to olfaction and nausea and vomiting, subjects filled in a nausea profile which provided a 'general nausea score' comprised of the factors 'somatic distress', 'gastrointestinal distress', and 'emotional distress'. Olfactory function was assessed using pen-like odour dispensing devices ('sniffin' sticks'). Tests included n-butanol odour threshold, odour discrimination and odour identification. MAIN OUTCOME MEASURES: Olfactory function assessed by means of the sniffing sticks nausea profile. RESULTS: Correlational analyses between results of olfactory sensitivity and scores from the nausea questionnaire were not significant. Further, when subjects were divided into groups with relatively low or relatively high overall scores in the nausea profile, olfactory sensitivity did not differ between groups. Similarly, other analyses did not indicate a modulation of nausea and vomiting through olfactory sensitivity. CONCLUSIONS: These findings do not support the hypothesis that higher olfactory sensitivity relates to an increase of nausea. However, they do support the idea that olfactory-induced nausea is independent of subjectively perceived intensity. Olfactory-induced nausea appears to be due to the cognitive processing of olfactory information which, in early pregnancy, is reported to be altered in an unsystematic fashion.

Adolescent↗
PubMed1997

Effect of postchemotherapy nausea and vomiting on health-related quality of life. The Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group.

The purpose was to measure the effects of postchemotherapy nausea and vomiting (PCNV) on health-related quality of life (HQL) in patients receiving either moderately or highly emetogenic chemotherapy. The study sample consisted of 832 chemotherapy-naive patients with cancer who received either moderately or highly emetogenic chemotherapy as part of multicenter trials of new antiemetics. The patients completed the self-report European Organization for Research and Cancer (EORTC) core Quality of Life Questionnaire (QLQ-C30) before chemotherapy (baseline) and 1 week (day 8) and 2-4 weeks after chemotherapy. They also completed a self-report nausea and vomiting (NV) diary for 5-7 days after chemotherapy. To determine the effects of PCNV on HQL, the change in scores between the baseline and day 8 HQL assessments was calculated for each domain and symptom in the QLQ-C30 and compared in four subgroups of patients: those with both nausea and vomiting, those with nausea but no vomiting, those with no nausea but with vomiting, and those with neither nausea nor vomiting. The group with both nausea and vomiting showed statistically significantly worse physical, cognitive and social functioning, global quality of life, fatigue, anorexia, insomnia and dyspnea as compared to the group with neither nausea nor vomiting (0.0001 < P < 0.05). Patients with only nausea but no vomiting tended to have less worsening in functioning and symptoms than those having both nausea and vomiting. Increased severity of vomiting (> 2 episodes) was associated with worsening of only global quality of life and anorexia as compared with 1-2 episodes of vomiting (0.0001 < P < 0.01). By 2-4 weeks after chemotherapy all HQL scores had either returned to their baseline levels or were better than baseline. PCNV adversely affects several quality-of-life domains, but patients with only nausea experience less disruption than do those with both nausea and vomiting. Patients with 1-2 episodes of vomiting experience almost the same degree of disruption of HQL as do patients with more than 2 episodes of vomiting.

Analysis of Variance↗
PubMed1999

An assessment of prochlorperazine buccal for the prevention of nausea and vomiting during intravenous patient-controlled analgesia with morphine following abdominal hysterectomy.

The effectiveness of prochlorperazine buccal as an anti-emetic for the prevention of post-operative nausea and vomiting in patients using intravenous patient-controlled analgesia with morphine following abdominal hysterectomy has been assessed in a randomized, double-blind, placebo-controlled study. Forty-nine female patients participated with 26 allocated to the prochlorperazine buccal group and the remainder to the placebo group. Each received either placebo or prochlorperazine buccal 6 mg, in each case by the buccal route, 1 h prior to anaesthesia with further doses at 6, 18, 30 and 42 h, respectively. Symptom scores in respect of nausea, pain and sedation, the number without nausea, the number without vomiting and the requirement for rescue anti-emetic therapy were noted for each 4-h period during the 48-h study. Morphine utilization and taste associated with the study material were recorded. Data for 21 patients in the placebo group and 25 patients in the prochlorperazine buccal group were available for analysis. Patients in the prochlorperazine buccal group showed significantly lower mean nausea scores at 4-8 h (placebo group: mean nausea score 0.95; prochlorperazine buccal group: mean nausea score 0.36; P < 0.05) and at 16-20 h (placebo group: mean nausea score 1.24; prochlorperazine buccal group: mean nausea score 0.48; P < 0.05). Furthermore, the prochlorperazine buccal group showed significantly more patients without nausea at 4-8 h (placebo group: 11 patients out of 21; prochlorperazine buccal group: 20 patients out of 25; P < 0.05) and at 16-20 h (placebo group: nine patients out of 21; prochlorperazine buccal group: 18 patients out of 25; P < 0.05). The prochlorperazine buccal group showed a significantly higher number of patients rating the taste as unsatisfactory (placebo group: two patients out of 21; prochlorperazine buccal group: nine patients out of 25; P < 0.05). Intravenous droperidol is the current gold standard prophylactic anti-emetic in post-operative nausea and vomiting associated with intravenous patient controlled analgesia with morphine usage. This study has demonstrated a peri-operative prochlorperazine buccal regimen to be effective in post-operative nausea and vomiting prophylaxis in the use of intravenous patient controlled analgesia with morphine. Prochlorperazine buccal should be considered as an effective, inexpensive option for the prevention of post-operative nausea and vomiting in post-operative intravenous patient controlled analgesia with morphine administration.

Administration, Buccal↗
PubMed2001

Effect of rizatriptan and other triptans on the nausea symptom of migraine: a post hoc analysis.

OBJECTIVE: To compare the effects of oral rizatriptan, sumatriptan, naratriptan, and zolmitriptan on the relief and emergence of nausea during a migraine attack. METHODS: Data from five randomized, placebo-controlled, double-blind clinical trials in which oral rizatriptan 10 mg was directly compared with oral sumatriptan 100 mg (N = 772), 50 mg (N = 1168), 25 mg (N = 1180), naratriptan 2.5 mg (N = 406), or zolmitriptan 2.5 mg (N = 571) for the acute treatment of a migraine attack were retrospectively analyzed. Migraine was diagnosed according to International Headache Society criteria. Presence or absence of nausea was recorded at baseline and at 0.5, 1, 1.5, and 2 hours after dosing. The end points analyzed were relief of nausea in those who had it at baseline and emergence of nausea in those who were free of it at baseline. Treatments were compared using odds ratios estimated from logistic regression models at 2 hours, and averaged odds ratios for the first 2 hours posttreatment. RESULTS: Approximately 60% of patients in each treatment group had nausea at baseline. In those patients with nausea at baseline, significantly more patients treated with rizatriptan 10 mg were free of nausea at 2 hours compared with sumatriptan 100 mg (66% versus 58%, P =.043), sumatriptan 50 mg (68% versus 57%, P =.010), sumatriptan 25 mg (68% versus 59%, P =.017), and naratriptan 2.5 mg (59% versus 45%, P =.014). Averaging over the four posttreatment time points in the first 2 hours, significantly more patients treated with rizatriptan 10 mg were free of nausea compared with sumatriptan 100 mg (P =.004), sumatriptan 50 mg (P =.001), and naratriptan 2.5 mg (P =.015). No significant differences in nausea relief were seen between rizatriptan 10 mg and zolmitriptan 2.5 mg, either at 2 hours (65% versus 61%, P =.210) or over the first 2 hours (P =.781). Rates of treatment-emergent nausea at 2 hours ranged from 11% to 18% with placebo, from 5% to 13% with rizatriptan 10 mg, and from 10% to 20% with other comparator triptans. CONCLUSIONS: Oral rizatriptan 10 mg was more effective than oral sumatriptan and naratriptan at eliminating nausea within 2 hours in patients who had it at baseline. Rates of emergent nausea in patients who were free of it at baseline were low, and no consistent differences were observed between active treatments.

Administration, Oral↗
PubMed1993

Conditioned nausea after cancer chemotherapy and autonomic nervous system conditionability.

There are marked individual differences in conditioned nausea after cancer chemotherapy. To examine if part of this variation is associated with individual differences in autonomic nervous system conditionability, the present study addressed whether patients with conditioned nausea acquired conditioned heart rate and electrodermal responses at a different rate than patients without conditioned nausea. Of 28 relapse-free patients who had completed cisplatinum treatment for testicular cancer between 1981 and 1986, 10 reported persistent conditioned nausea, 8 extinguished conditioned nausea and 10 no conditioned nausea. These three groups were subjected to a differential conditioning paradigm with 8 sec pictorial stimuli (circles and triangles) serving as conditioned stimuli for an unconditioned electric shock while heart rate and electrodermal activity was monitored. There were 4 habituation, 8 acquisition and 8 extinction trials with each of the two cues. Analyses of variance using nausea status as the independent variable and physiological responses as the dependent lended some support to the notion that conditioned heart rate deceleration developed in response to the reinforced compared to the nonreinforced cue during acquisition in the two groups with persistent or extinguished conditioned nausea but not in the group with no conditioned nausea. In addition, patients that displayed good, as compared to poor heart rate conditionability during acquisition, were more likely to have persistent conditioned nausea, whereas those who showed poor heart rate conditioning mostly were those without conditioned nausea. Electrodermal variables revealed no systematic differences between groups. This tentatively supports that individual differences in parasympathetic but not sympathetic nervous system conditionability may be associated with individual differences in conditioned nausea resulting from cancer chemotherapy.

Adult↗
PubMed1984

Methodology in behavioral and psychosocial cancer research. The assessment of nausea and vomiting. Past problems, current issues and suggestions for future research.

Given the diversity of assessment methodologies in previous studies, and given the increasing attention being shown in studies in which nausea and vomiting are used as outcome measures, it is reasonable to expect that there are more questions on the assessment of nausea and emesis than there are answers. There is little consensus on the efficacy of various approaches used to help control chemotherapy-induced nausea and emesis. There is also little consensus on the appropriate assessment techniques for their measurement. While there is room for much controlled experimentation and study of the ways to assess nausea and emesis, a review of past studies indicates several guidelines that should be kept in mind. The first of these is that nausea is a subjective phenomenon. It exists only insofar as it is defined by the patient. The clinical reality is that patients' decisions to delay or terminate chemotherapy are based on their subjective evaluations of the side effects, not on evaluations made by a clinician or others. With this in mind, a self-report approach to the assessment of nausea appears the most reasonable at this time. On the other hand, while vomiting does have subjective aspects, it represents a behavior that may be reliably observed by others. Thus, it is appropriate that observer ratings be obtained whenever feasible. The use of such indirect measures of nausea and vomiting as time to food intake, appetite change, and other measures of patient well-being should be considered whenever feasible. As with all measures, the cost in patient time needs to be balanced against the scientific needs of any study quantifying nausea and vomiting. While direct, physiologic measures would provide an important external reference to the assessment of nausea and vomiting, at the present time, these appear useful only in animal studies. The fact that nausea and vomiting can occur independently points to the validity of their assessment as separate behaviors. It is also important to note that their frequency, severity, and duration are separable phenomena. A complete assessment of nausea and vomiting responses should include separate measures of frequency, severity, and duration. Anticipatory nausea and vomiting are clinical phenomena that appear to occur with a reasonable enough frequency so that their measurement would be important in clinical studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗