Nausea: a review of pathophysiology and therapeutics

Singh, Prashant; Yoon, Sangmoon; Kuo, Braden

doi:10.1177/1756283x15618131

Cited by 145 publications

(72 citation statements)

References 88 publications

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“…However, the relationship between nausea and vomiting is not simple, and these symptoms likely do not represent points on a continuum. Nausea involves dynamic interactions between the central and autonomic nervous systems as well as gastric dysrhythmias and the endocrine system . Although the use of effective antiemetic agents has resulted in improved control of chemotherapy‐induced vomiting, chemotherapy‐induced nausea (CIN) continues to be a common negative influence on the quality of life of both adult and pediatric patients …”

Section: Introductionmentioning

confidence: 99%

Risk factors for chemotherapy‐induced nausea in pediatric patients receiving highly emetogenic chemotherapy

Dupuis

Tamura

Kelly

et al. 2018

Pediatric Blood & Cancer

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Background Little is known regarding risk factors for chemotherapy‐induced nausea (CIN) in pediatric patients. Procedure A secondary analysis was conducted of a previously published multicenter, prospective, randomized, single‐blind, sham‐controlled trial assessing the efficacy of acupressure in preventing CIN in pediatric patients receiving highly emetogenic chemotherapy. The primary outcome was nausea severity, self‐reported using the Pediatric Nausea Assessment Tool. The relationships between acute and delayed nausea severity and patient‐ (sex, race, age, and cancer diagnosis) and treatment‐related (chemotherapy, antiemetic prophylaxis, CIN, and vomiting control) factors were analyzed by a proportional odds generalized estimating equation approach. The acute phase started with administration of the first and continued for 24 hours after the last chemotherapy dose. The delayed phase started at the end of the acute phase and continued until the next chemotherapy block (maximum seven days). Results In the acute and delayed phases, 165 and 144 patients provided data for analysis, respectively. Nonwhite race was significantly associated with higher acute phase nausea severity (OR, 1.7; 95% CI, 1.1–2.6). Poor CIN control in the acute phase (OR, 16; 95% CI, 4.0–64.6), diagnosis of a cancer other than a central nervous system (CNS) tumor (OR, 2.5; 95% CI, 1.2–5.3), and cisplatin administration (OR, 3.7; 95% CI, 2.1–6.0) were significantly associated with higher delayed phase nausea severity. Conclusion Acute phase CIN was associated with nonwhite race. Delayed phase CIN was associated with poor acute phase CIN control, diagnosis of non‐CNS cancer, and receipt of cisplatin. These findings will inform future antiemetic trial design.

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Section: Introductionmentioning

confidence: 99%

Risk factors for chemotherapy‐induced nausea in pediatric patients receiving highly emetogenic chemotherapy

Dupuis

Tamura

Kelly

et al. 2018

Pediatric Blood & Cancer

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“…Nausea and emesis have a number of etiologies, including motion-related signals that deviate from those expected, administration of toxins, exposure to radiation, migraine, gastrointestinal disease, pregnancy (hormonal changes), and even psychological stimuli (e.g., stress and extreme emotional reactions, as well as classically conditioned smell and taste aversions) (Feyer et al, 2014; Hederos, 1992; Heer et al, 2006; Horn et al, 2014; Kenward et al, 2015; Matthews et al, 2014; Olden et al, 2005; Singh et al, 2016; Sugino et al, 2015; Wiesmann et al, 2015; Yates et al, 2014). There is some evidence that the prodromal signs and symptoms preceding vomiting can vary depending on the emetic trigger.…”

Section: Introductionmentioning

confidence: 99%

What is nausea? A historical analysis of changing views

Balaban

Yates

2017

Autonomic Neuroscience

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The connotation of “nausea” has changed across several millennia. The medical term ‘nausea’ is derived from the classical Greek terms ναυτια and ναυσια, which designated the signs and symptoms of seasickness. In classical texts, nausea referred to a wide range of perceptions and actions, including lethargy and disengagement, headache (migraine), and anorexia, with an awareness that vomiting was imminent only when the condition was severe. However, some recent articles have limited the definition to the sensations that immediately precede emesis. Defining nausea is complicated by the fact that it has many triggers, and can build-up slowly or rapidly, such that the prodromal signs and symptoms can vary. In particular, disengagement responses referred to as the “sopite syndrome” are typically present only when emetic stimuli are moderately provocative, and do not quickly culminate in vomiting or disengagement from the triggering event. This review considers how the definition of “nausea” has evolved over time, and summarizes the physiological changes that occur prior to vomiting that may be indicative of nausea. Also described are differences in the perception of nausea, as well as the accompanying physiological responses, that occur with varying stimuli. This information is synthesized to provide an operational definition of nausea.

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“…; Singh et al . ), it is interesting to also find a concomitant autonomic association to this network, wherein greater connectivity corresponded both to greater nausea severity and resting sympathetic tone. We have already discussed some of these brain regions and their known role in autonomic regulation, though in this network we additionally implicate the thalamus, cingulate cortex and nucleus accumbens, all of which are known to have a role in sympathetic neuro‐regulation, or a sympathetic response to events meriting emotional arousal (such as nausea or pain) (Critchley & Harrison, ; Ruffle et al .…”

Section: Discussionmentioning

confidence: 89%

Functional brain networks and neuroanatomy underpinning nausea severity can predict nausea susceptibility using machine learning

Ruffle

Patel

Giampietro

et al. 2019

The Journal of Physiology

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Key points Nausea is an adverse experience characterised by alterations in autonomic and cerebral function. Susceptibility to nausea is difficult to predict, but machine learning has yet to be applied to this field of study. The severity of nausea that individuals experience is related to the underlying morphology (shape) of the subcortex, namely of the amygdala, caudate and putamen; a functional brain network related to nausea severity was identified, which included the thalamus, cingulate cortices (anterior, mid‐ and posterior), caudate nucleus and nucleus accumbens. Sympathetic nervous system function and sympathovagal balance, by heart rate variability, was closely related to both this nausea‐associated anatomical variation and the functional connectivity network, and machine learning accurately predicted susceptibility or resistance to nausea. These novel anatomical and functional brain biomarkers for nausea severity may permit objective identification of individuals susceptible to nausea, using artificial intelligence/machine learning; brain data may be useful to identify individuals more susceptible to nausea. Abstract Nausea is a highly individual and variable experience. The central processing of nausea remains poorly understood, although numerous influential factors have been proposed, including brain structure and function, as well as autonomic nervous system (ANS) activity. We investigated the role of these factors in nausea severity and if susceptibility to nausea could be predicted using machine learning. Twenty‐eight healthy participants (15 males; mean age 24 years) underwent quantification of resting sympathetic and parasympathetic nervous system activity by heart rate variability. All were exposed to a 10‐min motion‐sickness video during fMRI. Neuroanatomical shape differences of the subcortex and functional brain networks associated with the severity of nausea were investigated. A machine learning neural network was trained to predict nausea susceptibility, or resistance, using resting ANS data and detected brain features. Increasing nausea scores positively correlated with shape variation of the left amygdala, right caudate and bilateral putamen (corrected P = 0.05). A functional brain network linked to increasing nausea severity was identified implicating the thalamus, anterior, middle and posterior cingulate cortices, caudate nucleus and nucleus accumbens (corrected P = 0.043). Both neuroanatomical differences and the functional nausea‐brain network were closely related to sympathetic nervous system activity. Using these data, a machine learning model predicted susceptibility to nausea with an overall accuracy of 82.1%. Nausea severity relates to underlying subcortical morphology and a functional brain network; both measures are potential biomarkers in trials of anti‐nausea therapies. The use of machine learning should be further investigated as an objective means to develop models predicting nausea susceptibility.

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Nausea: a review of pathophysiology and therapeutics

Cited by 145 publications

References 88 publications

Risk factors for chemotherapy‐induced nausea in pediatric patients receiving highly emetogenic chemotherapy

Risk factors for chemotherapy‐induced nausea in pediatric patients receiving highly emetogenic chemotherapy

What is nausea? A historical analysis of changing views

Functional brain networks and neuroanatomy underpinning nausea severity can predict nausea susceptibility using machine learning

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