General | September 13, 2014 | Author: The Super Pharmacist
Motion sickness is not really a 'sickness' per se but a normal physiological response to real, perceived, or anticipated movement and can be triggered by the movement of a car, train, airplane or amusement park ride. The symptoms of motion sickness tend to be limited to the duration of the motion experienced and include nausea and vomiting, dizziness, vertigo, cold sweating, disorientation, and fatigue.
Motion sickness can be debilitating and particularly interfere with functioning at work for those whose jobs entail motion. Motion sickness can be visually induced (when there is no real motion) in virtual environments, such as simulators, cinemas, and video games. Motion sickness indiscriminately affects air, sea, road and space travelers. All individuals (humans and animals) possessing an intact vestibular apparatus (inner ear 'balance center') can get motion sickness given the right quality and quantity of provocative stimulation, although there are wide and consistent individual differences in the degree of susceptibility.
Although nausea is the hallmark symptom, motion sickness comprises a much broader syndrome. It includes a wide range of signs and symptoms including cold sweating, pallor of varying degrees, increases in salivation, drowsiness, headache, and even severe pain, as well as nausea and vomiting.
The sensory organs control the body's sense of balance by signaling the brain as to the direction in which the body is pointing or moving, and if it is standing still or turning.
These messages are relayed by:
All incoming sensory information is processed by the brain and spinal cord (central nervous system).
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The cause of motion sickness is complex and not fully understood. Many theories of motion sickness have been proposed over the years.
The evolutionary theory - holds that motion sickness initially evolved as a response to poisoning. The notion is that when a noxious substance was ingested, nausea and vomiting resulted, inactivity would be induced and symptoms would thus be attenuated because of reduced levels of ingested toxins.
The ecological theory - of motion sickness is based on the hypothesis that motion sickness is caused by postural instability or a loss of postural control. The concept is that as postural instability increases, motion sickness will develop.
The sensory conflict theory - of motion sickness is the most widely accepted theory of motion sickness. Nearly all situations that elicit motion sickness involve some form of intersensory conflict. According to this theory, motion sickness results when the brain receives conflicting information about body movements from the visual (eyes) and vestibular receptors (inner ear) and the proprioceptive system (muscle and joint receptors).
An example of this type of intersensory conflict is when someone is reading a book in the back seat of a moving car. The inner ears and skin receptors sense the motion, but the eyes only register the stationary pages of the book.
This conflicting information may cause the usual motion sickness symptoms of dizziness, nausea and vomiting.
Generally, after ending the motion stimulus, motion sickness symptoms rapidly disappears, but in some instances, the sensation of persists. This phenomenon is called Mal de Débarquement syndrome or Disembarkment syndrome.
It most often develops following an ocean cruise or other type of water travel. Symptoms usually begin shortly after the cessation of the motion stimulus and often increase when in an enclosed space or when attempting to be motionless (sitting, lying down, or standing in a stationary position). The motion sensation may seem to disappear when in passive motion such as in a moving car, airplane, or train.
Common symptoms include a persistent sensation of motion such as rocking, swaying, tumbling, and/or bobbing. This sensation is often associated with anxiety, fatigue, difficulty maintaining balance, unsteadiness, and difficulty concentrating.
One facet of motion sickness that often is not recognised is the "sopite syndrome." It refers to the profound drowsiness and persistent fatigue that can follow brief exposures to highly provocative stimulation or prolonged exposures to low-intensity motion stimulation. Yawning has recently been shown to be a potential behavioural marker for onset of the sopite syndrome. The sopite syndrome can persist for hours or even days and when exposure is prolonged, even longer. It is characterised by boredom, apathy, failure of initiative, increased irritability, and even changes in personality. It may be one of the only syndromes that persist when nausea is not elicited or has abated. The sopite syndrome has been attributed to motion-induced drowsiness such as that experienced by a baby when rocked.
Three key factors affect motion sickness development: the person's sensitivity to stimulation, the rate of adaptation to stimulation, and the speed of resolution of elicited symptoms.
The range of sensitivity to motion sickness in the general population varies by about 10 to 1, and the rate of adaption to stimulation also ranges from 10 to 1. By contrast, the speed of symptom resolution varies by 100 to 1.
The significance of these values is that susceptibility to motion sickness in the general population varies by about 10,000 to 1 – a vast range.
Risk factors for the development of motion sickness include:
Behavioural techniques and complementary alternative medicine
Prevention of motion sickness is much more effective than trying to “cure” symptoms once they have started. Both pharmacological and nonpharmacological treatments are more effective if applied before the motion stimulus. Patients should learn to identify situations that will lead to motion sickness and minimise the amount of unpleasant motion to which they are exposed while traveling. For example:
Among alternative therapies, acupressure, wristbands and ginger have been proposed as safe treatments.
Other potential remedies include biofeedback training and relaxation deep breathing techniques, and cognitive-behavioral therapy, modalities that have been tested on airplane pilots and were found to be helpful.
More recently, the use of relaxing and pleasant music has been proposed as a non-invasive and inexpensive counter-measure to visually induced motion sickness. During a visually induced motion sickness experience, persons who listened to music that they self-reported as 'pleasant', showed a significant reduction in motion sickness symptoms, with concomitant improved mood and emotion, compared with those who did not listen to 'pleasant' music.
If nonpharmacological measures are insufficient, the use of pharmacological agents is advised in adults and children over the age of two years. It is generally agreed that infants are highly resistant to motion sickness.
Hyoscine is the most effective drug for the prevention of motion sickness.
Over-the-counter antihistamines are commonly used in the prevention and treatment of motion sickness and are the drugs of choice for motion sickness in children. There is no specific paediatric data for these drugs in motion sickness and dosing has been extrapolated from studies done in adults. In Australia, sedating antihistamines have recently become prescription-only for children less than two years of age. They should be avoided in children with seizure disorders. These medications appear to act by reducing the stimulation of the inner ear. The most common side effect is sedation. The newer non-sedating antihistamines, such as loratidine and cetirizine, do not cross the blood-brain barrier and are not effective against motion sickness. Antihistamines should be taken one hour prior to departure.
Examples of antihistamine medications effective in the prevention of motion sickness include:
A number of sympathomimetic drugs (drugs which mimic the effects of adrenaline and noradrenaline), particularly amphetamine and ephedrine, have been reported to have anti-motion sickness effects alone or in combination with hyoscine or promethazine. These agents are mainly used during space flights. However, sympathomimetic drugs are not used in routine clinical situations and should not be used in children.
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