Preparation May Help Patients Cope With Nausea
June 22, 2006
Patients undergoing difficult medical procedures may benefit from getting
advance detailed information about how unpleasant they might feel, according to
researchers from Wake Forest University School of Medicine and colleagues.
"A person's expectations can strongly affect how they respond to adversity
- both subjectively and physiologically," said lead author Max E. Levine,
Ph.D. "Being prepared for difficulty can benefit people greatly."
The study, designed to determine how expectations affect symptoms of nausea and
motion sickness, found that participants who were led to expect considerable
nausea actually fared better than those who weren't. The results are reported in
the current issue of Psychosomatic Medicine.
Participants were 75 healthy college students who were assigned to one of three
groups. All groups were given placebo, or "dummy" pills. One group was
led to believe that the pill would protect them against the development of
nausea and motion sickness. A second group was told that the pills would make
their nausea worse. And, a third group was told that the pills were placebos and
would have no effect whatsoever.
Participants sat on a stool inside a drum marked with vertical stripes - viewing
the drum's rotation induced the illusion of self-motion. The drum was rotated at
a constant speed for 16 minutes, unless participants asked that it be stopped
early.
While the drum was rotating, an intercom system was used to ask participants
about symptoms of nausea and motion sickness, including warmth, dizziness and
drowsiness. Based on the reported severity of symptoms, a score was calculated
for each participant. In addition, three electrodes placed on the surface of
their abdomens detected the presence of any of the abnormal stomach activity
that typically accompanies nausea.
The nausea scores of the "placebo-control group," those participants
who were told the pills would have no effect, were about 2.5 times higher than
the group that was warned the experience would be particularly unpleasant. In
addition, the abnormal stomach activity that typically accompanies nausea was 30
percent higher in the control group.
"Surprisingly, symptoms of nausea and motion sickness were least severe
among participants told their experience would be made more unpleasant by the
drug," said Levine, an assistant professor of gastroenterology.
The authors hypothesize that once the drum began to rotate, the group that was
told they should anticipate a sickening experience may have experienced
something far more innocuous than they had expected.
"Those who unnecessarily braced themselves for a torturous ordeal may have
been calmed or relaxed by what they experienced," wrote the authors.
Levine said the findings have implications for patients who experience nausea as
part of an illness or treatment.
"Being prepared to experience a negative reaction to the drum was
associated with less nausea and more normal stomach activity, suggesting that
how patients are prepared for potentially adverse events can meaningfully affect
their responses to them," he said. "If patients are informed about
what they will likely be going through over the course of an illness or
treatment, it may influence their ability to cope with the symptoms once they
develop."
Levine said that if further research can demonstrate that expectations regarding
the development of nausea can control the unpleasantness of the symptoms that
develop, there could be profound implications for the treatment of people whose
illness or treatment involves nausea.
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Co-researchers were Robert M. Stern, Ph.D., with the Pennsylvania State
University, and Kenneth L. Koch, M.D., with Wake Forest.
About Wake Forest University Baptist Medical Center: Wake Forest Baptist is an
academic health system comprised of North Carolina Baptist Hospital and Wake
Forest University Health Sciences, which operates the university's School of
Medicine. The system comprises 1,282 acute care, psychiatric, rehabilitation and
long-term care beds and is consistently ranked as one of "America's Best
Hospitals" by U.S. News and World Report.
Contact: Karen Richardson
Wake Forest University Baptist
Medical Center
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