Autogenic‐Feedback Training Exercise Is Superior to Promethazine for Control of Motion Sickness Symptoms

Abstract

Motion sickness symptoms affect approximately 50% of the crew during space travel and are commonly treated with intramuscular injections of promethazine. The purpose of this paper is to compare the effectiveness of three treatments for motion sickness: intramuscular injections (IM) of promethazine, a physiological training method (autogenic‐feedback training exercise [AFTE]), and a no‐treatment control. An earlier study tested the effects of promethazine on cognitive and psychomotor performance and motion sickness tolerance in a rotating chair. For the present paper, motion sickness tolerance, symptom reports, and physiological responses of these subjects were compared to matched subjects selected from an existing database who received either AFTE or no treatment. Three groups of 11 men, between the ages of 33 and 40 years, were matched on the number of rotations tolerated during their initial rotating‐chair motion sickness test. The motion sickness test procedures and the 7‐day interval between tests were the same for all subjects. The drug group was tested under four treatment conditions: baseline (no injections), a 25 mg dose of promethazine, a 50 mg dose of promethazine, and a placebo of sterile saline. AFTE subjects were given four 30‐minute AFTE sessions before their second, third, and fourth motion sickness tests (6 hours total). The no‐treatment control subjects were only given the four rotating‐chair tests. Motion sickness tolerance was significantly increased after 4 hours of AFTE when compared to either 25 mg (p < 0.00003) or 50 mg (p < 0.00001) of promethazine. The control and promethazine groups did not differ. AFTE subjects reported fewer or no symptoms at higher rotational velocities than subjects in the control or promethazine groups. The primary physiological effect of promethazine was an inhibition of skin conductance level. The AFTE group showed significantly less heart rate and skin conductance variability during motion sickness tests administered after training.

Nutritional and Behavioral Countermeasures as Medication Approaches to Relieve Motion Sickness: A Comprehensive Review

“…Despite existing medications being prescribed widely for MS mitigation in a real environment, such as a car, boat, plane, or train, they have not been used in VR and simulators due to potential side effects. Therefore, research efforts have been increased recently toward identifying appropriate approaches to alleviate MS without the side effects of currently available medications [ 187 , 188 ].…”

“…Promethazine is typically administered by injection, either intravenously or intramuscularly. However, due to the nature of its administration, it may not be suitable for all populations and groups of people [ 85 , 86 ].…”

“…In order to compare the anti-MS efficiency of AFT and pharmacologic treatment (promethazine), a rotating chair for thirty minutes (four days per week for three weeks in a row) was applied to the AFT group. Their outcomes showed a lower incidence of MS in the AFT group compared to the promethazine group, and the AFT program increased the onset of MS about 2–3 times more than the promethazine condition [ 86 ]. This AFT method was based on decreasing the activity of the sympathetic nerve system [ 178 ].…”

“…It has been suggested that the Aquaporin-1 protein could be an endogenic MS sensitivity regulator, and it is connected to the habituation process of MS [ 184 ]. A study conducted by Cowings and Toscano [ 86 ] showed that 30–40% of neophyte pilots experienced airsickness on their first air flight, but most of them adjusted after their third or fourth flight experiences. Similarly, a study of four consecutive trips was conducted by Nunes et al [ 157 ], and a significant reduction in total MS score was observed from the second trip to the fourth trip, compared to the first trip.…”

“…This confirmed the habituation occurrence during repeated trips. Habituation is preferred to anti-MS drugs by the military service’s programs as it is free of side effects, whereas anti-MS medicine is contraindicated for pilots due to their unwanted side effects, such as blurred vision and drowsiness [ 86 ]. The success rate of habituation programs exceeds 85% [ 185 ]; however, they can be extremely time-consuming and costly [ 185 , 186 ].…”