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Managing Nausea from Chemotherapy & Pain Medications  

Is there anything I can do to help with the nausea and vomiting associated with chemotherapy and pain medications?

Yes. Certain types of chemotherapy and some pain medications can cause the side effect of nausea (i.e., feeling like you are going to throw up) and vomiting (i.e., throwing up the contents inside your stomach).

The likelihood that a particular chemotherapy drug or pain medication will cause nausea and vomiting is categorized as mildly, moderately, or highly probable to cause these side effects.[1] Many cancer patients receive combinations of chemotherapy drugs or a combination of a chemotherapy drug and a pain medication, making it more likely that the patient may experience the side effects of nausea and vomiting. To understand why chemotherapy and pain medications can cause nausea and vomiting, see our Q&A called, " Why does chemotherapy and pain medications cause nausea and vomiting?"

One of the most important things you can do is to learn the symptoms of each type of nausea, so you will be better equipped to manage nausea. The following types of nausea and vomiting can occur due to chemotherapy:[1, 2]

Acute onset nausea and vomiting, which occurs within the first 24 hours after chemotherapy. Usually acute onset nausea and vomiting starts a few minutes to several hours (peaking at more than 5 to 6 hours) after the chemotherapy is given and ends about 24 hours after treatment.

Delayed onset vomiting, which occurs more than 24 hours following chemotherapy. The timing and duration of delayed vomiting depend on the particular chemotherapy drug (e.g., cisplatin, carboplatin, cyclophosphamide, and doxorubicin) used and the dose given. For example, cisplatin-related vomiting usually will be at its worst from 48 to 72 hours following chemotherapy and can last for 6 to 7 days.

Anticipatory nausea and vomiting, which is an uncommon side effect that has been established psychologically and physiologically from previous unpleasant experiences with nausea and vomiting due to chemotherapy. Anticipatory nausea and vomiting occurs after the patient has experienced nausea and vomiting from past treatment with chemotherapy and prior to additional treatment with chemotherapy. Due to a conditioned response of the nausea/vomiting side effect from chemotherapy, the patient anticipates that nausea/vomiting will occur as it did before and experiences nausea and vomiting at the time of preparation for the next dose or cycle of treatment with chemotherapy.

Breakthrough vomiting, which occurs despite the use of anti-emetic (anti-nausea and anti-vomiting drugs) treatment to prevent or control nausea and vomiting. Therefore, breakthrough vomiting requires additional treatment with anti-nausea/anti-vomiting medications.

Refractory vomiting, which occurs after one or several chemotherapy treatments, even though the patient is being treated with anti-emetic medications to prevent or control nausea and vomiting. As the treatment with the particular anti-emetic medication is no longer effective, the patient has become "refractory" (is no longer responding) to the particular medication for prevention and control of nausea and vomiting.

Depending on the type of nausea/vomiting you are experiencing from chemotherapy and/or pain medications, your oncologist may prescribe an anti-emetic, an anti-nausea medication. Some anti-emetics belong to a class of drugs called serotonin antagonists that act on the parts of the brain that trigger a feeling of nausea and the part of the gastrointestinal tract that signals vomiting. Many different anti-emetic drugs are available.

Also, various types of medications called gastric acid inhibitors can assist in the control of acid reflux, stomach ulcers, and stomach pain that can be associated with nausea and vomiting caused by chemotherapy.

In addition to taking anti-emetic medications and gastric acid inhibitors, there are several other things you can do to help avoid nausea, including modifying your eating and drinking habits and using self-care and alternative medicine methods:[2-4]

Try to keep yourself well hydrated. It is more important to drink plenty of liquid, than it is to eat three meals a day. Sip cool water or ginger ale through a straw throughout the day. You also may find that sucking on ice chips helps keep you refreshed.

Eat the types of foods (such as bland foods) that were easier for you to digest and that made you feel better in the past when you were nauseated, ill with the flu, or had morning sickness.

When you feel nauseated, do not eat your favorite types of foods, as you might later associate these foods with the nausea.

Eat cold foods or foods served at room temperature, which have less of an aroma that could make you feel nauseated.

Avoid eating sweets.

Avoid fatty, fried foods and spicy foods, all of which are hard to digest and can irritate your gastrointestinal tract.

Eat dry foods like toast, crackers or dry cereal.

If recommended for maintaining good nutrition by your oncologist, oncology nurse, or nutritionist, drink nutritional shakes or other liquid nutitional supplements.

If you are experiencing nausea and vomiting as a side effect of pain medications, take your pain medications with food.

Avoid heavy meals before chemotherapy. Do not eat for 1 or 2 hours before or after your chemotherapy treatments. Try eating 5 or 6 small meals per day, rather than 3 big meals.

When you do not feel nauseated, cook and freeze several meals in advance that can be reheated and eaten if you feel nauseated later.

If you feel nauseated and find it difficult to prepare food, have another person prepare your meal.

Avoid strong odors that might trigger feelings of nausea.

Drink the types of beverages that made you feel better in the past when you were nauseated, ill with the flu, or had morning sickness.

Avoid coffee and other caffeinated products that might dehydrate you. Alcohol also should be avoided, as it can dehydrate you.

Try sipping ginger or peppermint teas, both of which help with nausea and will help you feel refreshed.

If you are feeling sick, many patients find that taking a short walk before a meal can help.

You may find that the best time to try to eat is after you have vomited. Sucking on an antacid tablet may prevent the acidic burning sensation that follows vomiting.

If you experience anticipatory nausea, try using another strong, but pleasant taste (such as lemon) to block a taste sensation that otherwise might stimulate nausea and vomiting.

To maintain good oral hygiene, brush your teeth at least two times a day and rinse your mouth frequently.

Rest after eating.

Breathe through your mouth if you are nauseated.

Consider using alternative medicine methods, such as acupuncture, to help control nausea and vomiting.

If you experience anticipatory nausea, use relaxation techniques, guided imagery, and biofeedback methods to decrease anxiety, make you feel more in control, and help reduce nausea and vomiting.

REFERENCES
1. Managing nausea and vomiting. Accessed at www.chemotherapy.com.
2. The National Comprehensive Cancer Network. Accessed at www.nccn.org/patients/patient_gls/_english/_nausea_and
_vomiting/index.htm.
3. Royal Marsden Hospital. Patient information: coping with nausea and vomiting. 2001. Accessed at www.royalmarsden.com.
4. Managing pain. Accessed at www.chemotherapy.com.


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