Cancer Treatment induced nausea abated by chiropractic adjustment

Case Study CD 15

Integrative Cancer Treatment:

Cancer Treatment induced nausea abated by chiropractic adjustment

By: Jeffrey A. Sklar, D.C.

ABSTRACT

The following case describes a 60 year-old woman with metastatic breast cancer that began to experience unrelenting nausea soon after beginning a six week regimen of radiation therapy. The patient had been under chiropractic care and other holistic approaches for different cancer treatment related side effects prior to complaining of nausea.  After performing a musculoskeletal examination of the patient, the chiropractor   employed cryotherapy combined CMT of the cervical spine. The patient reported complete abatement of her nausea directly following the treatment. The patient’s last follow up visit was two months after the visit being reviewed. She reported that the nausea never returned. This case suggests chiropractic care as a frontline approach for mild to moderate nausea, as this may ease the physiological and economic pharmaceutical burden that already places great weight on cancer patients and their caregivers.

Keywords: cancer, chiropractic, nausea, pharmaceutical

INTRODUCTION

During the course of cancer treatment, nausea is a frequent symptom that may be triggered from chemotherapy and/or radiation therapy. In fact, approximately one half of cancer patients will experience nausea or vomiting during the course of their disease either because of the cancer itself or because of their treatment (1). Subjective complaints of nausea are typically described as queasy in the stomach that could trigger vomiting.   Other symptoms such as increased heart rate, vertigo and body surface temperature change may also accompany an episode of nausea.  Although the reflex mechanism of emesis can be traced to the brainstem, the mechanism of nausea is more subjective and less understood. However, “the experience of nausea is linked with the urge to vomit (2), but nausea does not always result in emesis (3) and is reported by human patients to be a worse experience and more disabling than the act of vomiting itself.”

The following case describes a patient who suffered from radiation therapy induced nausea.

THE CASE

This is a review of a 60 year old woman with metastatic breast cancer that received four cycles of chemotherapy in the fall of 2017 and began adjuvant radiation therapy January 8, 2018. During the course of radiation treatment, the patient began to experience nausea daily. The patient had already been under chiropractic care as well as other alternative modalities, such as naturopathic medicine and acupuncture for other treatment related side effects including chemotherapy induced neuropathy. These modalities were provided onsite as part of her integrative oncological regimen. The patient reported the nausea to the chiropractor 17 days after beginning XRT.

An evaluation of the cervical spine was performed. The patient demonstrated mildly reduced cervical range of motion in all planes, with hypertonicity of the cervical paraspinal musculature and multiple vertebral articulation restriction noted in the cervical spine.   Upon completion of the evaluation, the patient was placed on the chiropractic adjusting table in the supine position.  Keeping in mind other known symptoms that accompany nausea, specifically temperature changes of skin surface,  a decision was made to place an ice pack on the patient’s abdomen. Prior to the adjustment, the chiropractor attempted to relax the paraspinal and sub-occipital musculature with gentle soft tissue manipulation. Once the soft tissue was felt to have eased from tension, CMT was performed to the cervical spine.

After the CMT, the patient was instructed to stay in the supine position for several minutes. Upon rising from the table, the patient was asked if she was still nauseous. She waited a moment and responded that the nausea was completely gone.

Follow up with this patient occurred several times throughout her radiation therapy and after its completion. The patient enthusiastically reported to other providers that chiropractic treatment had abated her nausea. The patient was last seen approximately two months after the completion of XRT claiming that her nausea states that she never experience additional nausea since the one chiropractic visit resolved the symptom.

It should be noted that in review of EMR chart notes for this patient with other providers, there are at least two references by other providers that noted that patients subjective reporting that her nausea was abated during a chiropractic treatment.

DISCUSSION

Cancer treatments are quite challenging for cancer patients to endure. The cancer treatments and subsequent side effects patients experience often make them feel worse than the disease itself(4).

Nausea is one of the most common side effects that impact quality of life for this heavily medicated patient population. The mechanisms of nausea are complex and the neural pathways are currently poorly understood (5).

Nausea is often referred to as the ‘neglected symptom.’  Improved understanding of the pathophysiological basis of nausea has important implications for exploiting novel mechanisms or developing novel therapies for nausea relief (6). In that light, the physiological effects of nausea, such as skin blood flow, sweating, thermogenesis and thermoregulation(7). may offer insight to a combined holistic approach that utilizes cryotherapy and chiropractic manipulative therapy. In this current case, the reasoning behind placing the ice pack on the patients abdomen was to slow down the neural activity with fibers from the superior gastric plexus that interface with the left vagus nerve (also known as the penumogastric nerve) that interfaces with the parasympathetic nervous system which has controls over the digestive tract. Moreover,   the area postrema, a region of the brain stem responsible for projectile vomiting may offer itself for a role in reducing nausea via CMT.

If one considers the neural pathway of the vagus nerve as it relates to the area postrema,  and the connection to the nucleus of the solitary tract (NTS) and other autonomic control centers in the brainstem(8), the mechanism for this case of abated nausea may offer an interest in further exploration of the visceral afferent impulses (sympathetic and vagal) arising from the gastrointestinal tract, the area postrema and how cooling the pneumogastric nerve along its autonomic pathway combined with reducing vertebral encroachment within the cervical spine.

Conclusion

It is acknowledged that a single case is limited regarding repeatable results. However, the subjective relief experienced by this report’s patient is unparalleled compared to other patients suffering from chronic nausea that must take anti-emetics and other remedies in addition the necessary prescription medications designed to treat their cancer. With the simple technique described above, using an ice pack and skilled chiropractor, a chance exists for a cancer patient suffering with nausea to forego the need to ingest another pill or potion. Finally, an additional consideration is the cost of anti-emetics compared to the cost a visit to the chiropractor.

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6. Therap Adv Gastroenterolv.9(1); 2016 JanPMC4699282
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8. (1990). “Microvascular specializations promoting rapid interstitial solute dispersion in nucleus tractus solitarius”. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology. 259 (6 Pt 2): R1131–8. doi:10.1152/ajpregu.1990.259.6.R1131. PMID 2260724