Care at the Close of Life: Evidence and Experience
Stephen J. McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz
Part B Symptom Management
Chapter 7. Management of Intractable Nausea and Vomiting in Patients at the End of Life: “I Was Feeling Nauseous All of the Time…Nothing Was Working”
Gordon J. Wood, MD, Joseph W. Shega, MD, Beth Lynch, NP, Jamie H. Von Roenn, MD
Table 7-2 Common Clinical Scenarios Associated With Nausea and Vomiting at the End of Life
Topics Discussed:
5-ht3 receptor antagonist, antiemetic agent, autonomic dysfunction, chemotherapy sickness, chlorpromazine, drug interactions, drug-induced nausea and vomiting, haloperidol, intestinal obstruction, motion sickness, nausea and vomiting, opioid-related disorder, palliative care, polypharmacy, practice guidelines, summarizing the evidence
Excerpt:
"Thoughtful evaluation to determine both the cause of the symptoms
and the pathophysiologic mechanism by which they are triggered allows
directed therapy to begin. Therapy should include not only antiemetics
but also measures to alleviate the cause of the symptoms, such as
the proton pump inhibitor for Mr Q.Nonpharmacologic therapy is an important first consideration
in the management of intractable nausea. Simple recommendations
such as avoiding strong smells or other nausea triggers, eating small,
frequent meals, and limiting oral intake during periods of extreme
emesis are helpful.37,38 Psychological techniques,
especially those that promote relaxation, can be helpful.39,40 Acupuncture
and acupressure may provide some benefit in the setting of chemotherapy
or surgery. A systematic review found benefit to P6 stimulation
(just above the wrist) in 11 of 12 randomized, placebo-controlled
trials.41 Emerging evidence from randomized trials
suggests that acupressure wrist bands may also be effective.42,43 Medical
devices, including gastric electrical stimulation44 and
transcutaneous electrical nerve stimulation units,45 are
currently under investigation, but a lack of convincing evidence
and substantial cost currently limit their use...."
Log in to read the full chapter:
Get full access to JAMAevidence two ways:
Subscribe to JAMAevidence
JAMAevidence is a subscription-
based website dedicated to the learning, teaching, and practicing of evidence-based medicine.
Pay Per View
Timed access to all of JAMAevidence
24 hours for $29.95
48 hours for $49.95