Pathophysiology of nausea and vomiting in palliative medicine

Nausea/vomiting remains a significant problem in medicine, especially in patients with chronic illnesses. The incidence and patient distress level from nausea and vomiting are underestimated by health care providers. A thorough patient evaluation followed by rational polypharmacy and a multimodal treatment approach may minimize the occurrence and intensity of nausea/vomiting. Utilizing new techniques (e.g., PET imaging of the CNS with novel radiotracers, functional Magnetic Resonance Imaging), clinicians could have a greater chance to elucidate which receptors may be contributing to an individual’s experience of nausea and vomiting and the relative importance of each. Future research into assessing precise mechanisms of nausea and vomiting in particular patients may enable clinicians to design the most appropriate combinations of antiemetics in efforts to achieve the most effective therapy with the least side effects. Individually-tailored antiemetic “cocktails,” based on patient specific pathophysiology, may lead to optimal treatment outcomes.