Whenever the word nausea is mentioned, it is frequently assumed to be with reference to two possibilities.
On the one hand, it is a well-known symptom experienced by many women during pregnancy and is often labeled as morning sickness, although it can occur at any time of the day.
On the other hand, it represents a response to a variety of conditions that might include heartburn, a gut infection, an ulcer, or in reaction to certain types of food. Nausea can also be brought on by motion sickness or seasickness.
This executive summary will deal specifically with functional nausea and the potential for hypnotherapy for functional nausea to help treat the condition and alleviate the symptoms.
What is functional nausea? It is a chronic condition that is common among children suffering from functional gastrointestinal disorders (FGIDs). Research suggests that it is more prevalent in those individuals with a range of existing physical and mental illnesses or comorbidities.
The term “functional” refers to the fact that the condition interrupts communication between the brain and the gut, thereby disrupting normal functionality.
Some experts point out that functional nausea can be diagnosed with only minimal testing. Others disagree, however, highlighting the fact that nausea may be a symptom in about 66% of childhood functional abdominal pain disorders.
The Problem With Functional Nausea
Functional nausea is difficult to investigate or report because there are no objective tools with which to measure the condition. Neither are there any standard guidelines for treatment or procedures for diagnosis.
Part of the problem lies in the fact that the condition is multifactorial, a biopsychosocial model involving autonomic, central, and gastrointestinal pathways combined with the aforementioned comorbidities.
Statistics highlight the prevalence of chronic nausea among school children in the United States and parts of Central and South America, noting that:
- 15 to 23% suffer from chronic or intermittent nausea and most have functional nausea
- Nausea occurs especially in children with pain-associated disorders and functional constipation
- Nausea is more common in girls and in private school students
Higher levels of nausea can result in missed school days and in an inability to do school-related work at home.
It is estimated that approximately 0.7% of all children suffer from the condition, which is also an indicator of other illnesses such as abdominal migraines, cyclic vomiting syndrome (CVS) and postural orthostatic tachycardia syndrome (POTS).
Diagnosis is further hampered by the fact that many patients with chronic nausea also experience a range of related symptoms including headaches, dizziness, fatigue and difficulty sleeping.
Sufferers seem predisposed to experience anxiety, which occurs in 70% of affected girls. Anxiety disorders in general are believed to contribute to the onset of the condition, with nausea symptoms normally peaking in the morning.
Nausea can also be caused by gastric dysfunction when brain-gut signals get distorted or miscommunicated. Studies suggest that these signals appear to be regulated by the limbic system which is the part of the brain responsible for emotions, memory and olfaction.
Research And Diagnosis Potential For Functional Nausea
Diagnosis of functional nausea is particularly tricky in relation to gastric dysfunction. Studies have looked at how symptoms present in adults and children with findings that are inconclusive at best.
There are several reasons for this. Nausea can occur as the result of gastroparesis when the stomach does not empty in the normal way. However it can also come about as a symptom of functional dyspepsia, that is indigestion that seems to have no specific cause.
Studies that examine gastric emptying are difficult to interpret. It is also easy for patients and their families to label a symptom based on any abnormal occurrences after a solid meal, leading potentially to a misdiagnosis.
The problem here is that a diagnosis of gastroparesis could lead to treatments that may not benefit or alleviate the nausea. There is also evidence that nausea can occur as a result of rapid gastric emptying, making it almost impossible to arrive at an accurate cause-and-effect scenario.
Other research has looked at what may be the underlying causes of nausea, such as a high mast cell count or eosinophilia, a high white blood cell count. In such patients it could be that their immune systems are overactive, releasing chemicals that upset the nerves in the intestinal tract.
As yet it is unclear whether these findings pinpoint the cause of nausea or are simply related to too much stress and anxiety. For instance, evidence shows that long-term exposure to stress can lead to mucosal inflammation in patients with irritable bowel syndrome.
There is also a link between constipation and gastric dysfunction. Unfortunately, constipation is often over diagnosed when patients present with a colon filled with stools. A stool-filled colon is perfectly normal, however, and therefore does not even imply constipation, let alone have any firm relation to nausea.
>>Related Article: Gut-Directed Hypnotherapy For IBS Neurogastroenterology Research Reveals Effectiveness
Reports indicate that nausea may be associated with orthostatic intolerance and that some benefit may be gained from using the head-up tilt test to diagnose POTS in patients suspected of ANS dysregulation (autonomic nervous system). However, there is no conclusive evidence that the treatment of POTS will help alleviate functional nausea.
Functional nausea is classed as one of the disorders of gut-brain interaction (DGBI). Researchers have found a link between joint hypermobility, POTS, mast cells activation syndrome (MAS) and many DGBI. Unfortunately, the combination of dyspepsia, POTS and MAS is challenging to treat successfully.
Patients can struggle under the weight of diagnoses and come to believe that any treatment is likely to fail. Naturally, this pessimistic outlook means recovery is more difficult and far from guaranteed.
Medical opinion suggests that patients with chronic nausea should not undergo testing unless their symptoms are accompanied by other warning signs, such as:
- Unexplained weight loss
- Intense pain
- Bilious vomiting
In fact, upper endoscopies of patients with nausea prove to be useless in 98% of cases, as does laboratory testing. With patients in the right age and gender categories, chronic nausea might point to the need for a pregnancy test.
The general agreement is that testing for the sake of testing does little to solve the problem. Furthermore, it is expensive and may result in the discovery of other minor and unrelated conditions that would only serve to muddy the waters by undermining the physician’s diagnosis while potentially leading to even more costly tests.
Effective Ways To Manage: Hypnotherapy For Functional Nausea
Most respected sources agree that the very best and most beneficial way to help treat functional nausea is by using hypnotherapy. This belief is bolstered by the evidence from a recent trial undertaken in 2021.
The trial looked at large numbers of children who suffered from functional dyspepsia or functional nausea and compared the effectiveness of hypnotherapy to standard medical treatment (SMT).
For the hypnotherapy element, children were given six sessions each lasting approximately one hour over the space of 3 months under the supervision of a qualified hypnotherapist. The randomized SMT group were asked to visit their pediatrician 6 times during a similar 3-month period.
For the SMT group, pediatricians were requested to follow a specific stepwise approach involving changes in diet and lifestyle. They were also asked to dispense a variety of medications, also in a specific order.
Because subjects in the hypnotherapy group spent more time with their therapist, those in the SMT group were given six sessions of 30-minute support therapy to even things out.
The results showed that both hypnotherapy and SMT were equally successful in reducing the symptoms of chronic nausea. Hypnotherapy was more effective during the first six months after treatment, particularly for those children with functional nausea.
This is the latest in a long list of studies showing how such treatments can prove efficacious in relieving pediatric DGBI. Future treatments for these and other pediatric functional disorders recommend a multidisciplinary approach that emphasizes the following:
- Educating the whole family on gut-brain interactions
- The role played by stress and anxiety in triggering symptoms
- Offering interventions that do not involve medicine or drugs
- Providing coping strategies that allow for near-normal functioning
- Involving a psychologist from the beginning of the treatment
While these recommendations are likely to solicit the best outcomes, other treatments are available. These include antiemetics such as ondansetron, although there is little evidence that such medications will benefit children suffering from functional nausea.
Herbal supplements can help both children and adults with functional dyspepsia. These are often more acceptable for parents who prefer not to give their children medicine unless absolutely necessary.
Other alternative treatments include wrist acupuncture, with devices available and marketed directly at nausea during pregnancy or those suffering from motion sickness.
Various drugs do exist that offer relief to children from abdominal pain and nausea, such as cyproheptadine. This drug stimulates appetite and can be useful in cases where nausea makes children want to stop eating, which inevitably causes weight loss and subsequent related issues.
Where gastroparesis is a problem, prokinetics can prove effective. These may help relieve acid reflux and are known to encourage stomach emptying. Erythromycin is one example, although long-term use is not recommended.
Other pharmacological solutions exist, although many of these are frowned upon due to the potential for serious adverse effects. Transdermal scopolamine patches have proven to be effective in treating nausea as a result of chemotherapy, post-operative nausea, and motion sickness. They have also been used in the treatment of chronic nausea in adolescents.
Further research is needed to find suitable methods for preventing and treating nausea, while the chronic condition is thought to benefit from increased hydration, better sleep and regular exercise.
>> If you’re interested in hypnotherapy or want to improve your practice, check out our live and online hypnosis training events.
Conclusion
Figures suggest that the rate of functional nausea is growing among both children and adults. As many as 0.7% of children suffer from the condition, which is often associated with and indicative of other illnesses.
Functional nausea affects up to 23% of school children in the United States, is more common in girls and in private school students, and frequently results in missed school days and an inability to complete work at home.
One of the problems with diagnosis concerns the fact that there are no objective tools with which to measure the condition. Nor are there any set guidelines for treatment.
Science is playing catch up to try and establish appropriate procedures and effective diagnostic tools. In the meantime, certain facts can be stated without fear of controversy:
- Functional nausea exists
- Testing is not necessary except when more serious comorbidities are present
- The condition makes it difficult to participate in age-appropriate activities
- Upper endoscopy is not a useful tool for diagnosis
- Symptoms can be made worse if there is constipation
- There is an obvious link to excess stress and potential anxiety disorder
The most beneficial form of treatment at present calls for a multidisciplinary approach that includes help and support with diet, exercise and sleep management. Results show that while both hypnotherapy and standard medical treatment are successful in reducing the symptoms of chronic nausea, hypnotherapy is more effective in the long term.
>> If you’re interested in hypnotherapy or want to improve your practice, check out our live and online hypnosis training events.
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