Nausea and vomiting are very common symptoms that are not specific to any one particular condition or illness. They frequently occur due to a mild infection and inflammation of the stomach (gastroenteritis, or the “stomach flu”), and are also endured by millions of women in the early stages of pregnancy. In addition, nausea and vomiting are common side effects of numerous medications, and can also occur as a result of general anesthesia for surgery. The following is a non-exhaustive list of circumstances and conditions that can lead to nausea and/or vomiting: chemotherapy, migraine, motion sickness, overdose of alcohol or toxic substances, rotavirus infection, vertigo, severe allergic reaction, Crohn’s disease, major depressive disorder, diabetes, food poisoning, generalized anxiety disorder, heart attack, over- or under-active thyroid, irritable bowel syndrome, and radiation therapy.
Fibromyalgia patients can also experience nausea and/or vomiting. Several of the conditions/circumstances listed above are common co-morbid conditions experienced by fibromyalgia patients, including thyroid problems, depression/anxiety, and irritable bowel syndrome. Furthermore, the widespread pain that plagues fibromyalgia patients can also lead to sensations of nausea. Additionally, many of the medications used by fibromyalgia patients carry with them the risk of nausea and/or vomiting as a potential side effect. In particular, most antidepressants in the selective serotonin re=uptake inhibitor (SSRI) and selective norepinephrine re=uptake inhibitor (SNRI) classes almost universally list nausea and/or vomiting as possible side effects of treatment, and the three medications currently approved by the United States Food and Drug Administration (FDA) for the treatment of fibromyalgia – Lyrica, Cymbalta, and Savella – also list nausea as a potential side effect of treatment, which when present, can be frequent and troublesome.
As a result of the non-specific nature of nausea and vomiting, it can be difficult for fibromyalgia patients to determine if these symptoms are the result of a specific treatment, the result of their widespread pain and tenderness, or a side effect of an underlying co-morbid conditions. Situations such as this underscore the importance for diligent and dedicated tracking of all symptoms and treatments. By doing so, patients can better visualize how their treatments and behaviors influence the symptoms they are experiencing, and allow them to make more informed correlations between cause-and-effect. This can help to narrow down the likely causes of a particular symptom, such as nausea, which can lead to more targeted and successful symptom management.
Fortunately, nausea can be effectively treated and prevented by employing a number of strategies. For example, eating small meals throughout the day, as opposed to three large meals, can help by preventing the stomach from emptying completely and exposing it to possible irritation from stomach acid. Eating slowly and not rushing meals can also help by preventing overeating and indigestion. It is also important to eat low-fat, nutritious foods that are easy to digest, rather than heavy, fat-filled fares. Easier digestion means less complications and hopefully, less nausea. In addition, eating foods that are slightly cool or at room temperature can also help to minimize the risk of nausea developing, as they tend to have less of an aroma than hot or warm food. Resting following a meal can also be helpful, but be certain to rest in an upright or slightly-inclined position; laying completely on one’s back or stomach can promote indigestion and lead to feelings of nausea.
Once nausea is present, vomiting can be prevented by drinking small but increasing amounts of clear, slightly sweet liquids. However, avoid acidic liquids such as orange and grapefruit juice. Resting in a sitting position or inclined lying position can also help; activity can worsen the situation so be sure to remain inactive until the nausea has passed. Eating small, dry foods such a few soda crackers, pretzels, or dry un-sweetened cereal may also help to settle the stomach.
From a medication perspective, there are a number of over-the-counter drugs that are helpful to treat nausea when behavioral and dietary remedies have proven ineffective. These drugs are collectively termed antiemetic medications, and include things such as Kaopectate and Pepto-Bismol. Additionally, antihistamine medications such as Dramamine may also help. All of these medications carry with them the risk of certain side effects, including drowsiness, constipation, and ringing in the ears, and as with any medication, allergic reaction is also possible.
There are a number of natural medicines that have been studied for their use in treating nausea following surgery, as well as pregnancy-related nausea. These include acupuncture, ginger, and pyridoxine (also known as vitamin B6) (Ezzo et al., 2006; Chaiyakunapruk et al., 2006; ACOG, 2004; Pimentel et al., 2001).
1. Ezzo JM, Richardson MA, Vickers A, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev. 2006;(2):CD002285.
2. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, et al. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol. 2006;194:95-99.
3. ACOG (American College of Obstetrics and Gynecology) Practice Bulletin #52: Nausea and vomiting of pregnancy. Obstet Gynecol.2004;103:803-815.
Pimentel M, Bonorris GG, Chow EJ, Lin HC. Peppermint oil improves the manometric findings in diffuse esophageal spasm. J Clin Gastroenterol.2001;33:27-31.