Monday, July 7, 2014

Behavioral interventions to help motion sickness

- Jennifer Middleton, MD, MPH

When my father tells the story of his parents' second honeymoon, which was a cruise, he relates how my grandmother had a delightful time sailing the seas while my grandfather sat in the cabin feeling irritable and dizzy in between bouts of emesis. (This story inevitably seemed to come up right after my sister had vomited in the car during a family road trip; a recent study estimated the prevalence of motion sickness in cars among children aged 7-12 at 43%.)

For as prevalent as motion sickness is, the recent AFP review article on this topic, Prevention and Treatment of Motion Sickness, reminds us that there is much we can do to help our patients overcome this discomfort. The article reminds us that prevention is the mainstay of treatment, and beyond the multiple pharmacologic options (nicely summarized in Table 3) the authors also point out important behavioral strategies (Table 2).

Two of the cited studies regarding behavioral interventions looked at how music and deep breathing may help. Denise et al investigated the use of controlled breathing as participants were upside-down, rightside-up again, and tilted to the side while watching an asynchronous 180 degree video screen; in all positions, controlled breathing lowered sickness ratings and prolonged participants' tolerance to movement.

In the second study, Sang et al had healthy participants listen "to music audiotape designed to reduce motion sickness symptoms," do breathing exercises, or neither (control group) while undergoing a lab simulation to evoke motion sickness symptoms. The participants began the music or deep breathing after the onset of mild motion sickness symptoms, and both interventions prolonged the development of moderate motion sickness symptoms for about ten minutes compared with placebo. Another just published study found that "pleasant music" reduced motion sickness symptoms overall to participants exposed to symptom-inducing stimuli. While it's unclear in this latter study who decided what "pleasant music" was, it's probably reasonable to extrapolate that "pleasant" is in the ear of the beholder.

Listening to music and controlled breathing exercises are simple, zero-risk interventions that would require only brief counseling in the office to recommend to patients, and they may complement the prescription therapies described in the article.

How do you discuss motion sickness prevention with your patients?