Aromatherapy: Art or Science - Continuing Education with Inet CE

17 Pages·2005·0.15 MB·English

by  Linda S Swanson

IInneettCCEE

Volume 8 2004 Number 8

Karen J. MacKinnon, R.Ph. Linda S. Swanson
Editor Copy Editor

Internet Continuing Education (InetCE) provides free, continuing education to pharmacists and other health care
providers for 24 hours a day over the Internet at www.InetCE.com. Since 1997, these home study programs have
assisted in keeping practitioners apprised of treatment-related topics, general pharmacy, and law in the changing
health care environment.

InetCE grew out of a need for relevant, continuing education in health care, and to make it accessible to pharmacy
practitioners in various practice settings. This format provides convenient instruction, on-line testing, evaluation,
and certification. Continuing education examinations are graded automatically and, if successfully passed, the user
can print the statement of credit.

Accreditation
ProCE, Inc. is accredited by the Accreditation Council for Pharmacy Education as
a provider of continuing pharmacy education. ACPE Universal Program Number
221-999-04-095-H01 has been assigned to this home study program (initial release

date December 6, 2004). This program is acceptable for 2.0 contact hours (0.20 CEUs)
in states that recognize ACPE providers. The program is provided at no cost to
participants. Statements of credit will be issued on-line upon successful completion
(> 70% score) of the posttest.

Faculty Disclosure
It is the policy of ProCE, Inc. to ensure balance, independence, objectivity and scientific rigor in all of its continuing
education programs. Faculty must disclose to program participants any significant relationships with companies that
manufacture or market products discussed during their presentation. Drs. Esposito and DeKorte report having no
relationships to disclose.
Please note: The opinions expressed in this program should not be construed as those of the CE provider. The
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Aromatherapy: Art or Science? cancer, dermatologic conditions, and
Highlights of Aromatherapy in Medicine pain.
Today
ABSTRACT: Aromatherapy is categorized
InetCE 221-999-04-095-H01 as a form of complementary and alternative
medicine (CAM), and has been steadily
Tina M. Esposito, Pharm.D. gaining popularity in today’s society.
Resident Aromatherapy has roots that can be traced
George E. Wahlen VA Medical Center back at least 5,000 years to ancient China,
Salt Lake City, Utah India, Persia, and Egypt. The word
aromatherapy is used to describe the use of
Carrie J. DeKorte, Pharm.D., BCPS essential oils for aromatic inhalation,
Director compresses, and topical application through
Pharmacy Education and Training massage. Aromatherapy should not be
George E. Wahlen VA Medical Center confused with aromatology, which is the
Salt Lake City, Utah oral use of essential of oils in addition to the
application of neat (undiluted) oil through
PLEASE NOTE: The content of this the skin. Aromatic oils are categorized by
article was current at the time it was written. differences in how long the scent lingers.
The exam for this article is not valid for CE Those planning self-care with aromatherapy
credit after December 6, 2007. need to use caution when using oils owing to
possible adverse reactions. The consumer
LEARNING OBJECTIVES can easily purchase essential oils on many
1. Discuss the history of aromatherapy Internet sites and in stores. Some colleges
and the theory of application. and universities have academic training
2. Outline the process of producing, programs for those interested in pursuing a
categorizing, purchasing, and career in aromatherapy. Trials using
administering essential oils for aromatherapy have investigated several
aromatherapy. therapeutic uses. Studies have attempted to
3. Identify the potential areas of quantify the comfort and symptom relief of
controversy and adverse effects blended oil aromatherapy in cancer patients.
associated with aromatherapy. Other areas of investigation include the
4. Describe the current literature for the effect on central and autonomic nervous
use of lavender, rosemary, neroli, systems, such as in the case of neroli
and other aromatherapy agents for massage after cardiac surgery. Rosemary
therapy in cognition, dementia, aromatherapy has been studied for its
potential to stimulate attention and improve
cognition. Dermatologic conditions, more established medical therapy.
insomnia, and pain control have also been Traditional health care practitioners
studied. Because of increasing popularity especially hold this view. This view is
and its broad range of use, pharmacists may understandable considering a physician can
be asked questions on aromatherapy and be charged with malpractice if a patient is
should be aware of the potential hazards and referred to an alternative practitioner when
lack of demonstrated efficacy. the condition has a cure with conventional
means.2 It may be claimed that benefits are
ProCE, Inc. is accredited by the derived mostly from the placebo effect or
Accreditation Council for Pharmacy from massage, but some regard
Education as a provider of continuing aromatherapy more for its medicinal
pharmacy education. An on-screen qualities. Regardless, popularity is
statement of credit verifying participation in definitely gaining. The increased use of
0.20 CEUs (2.0 contact hours) will be CAM may be a result of a combination of
displayed for printing to participants who several factors. Over the past decade, access
successfully complete the examination. This to the World Wide Web has increased public
article has been assigned ACPE ID number awareness. The Web, combined with
221-999-04-095-H01. For more commercial advertising promoting disease
information, visit http://www.InetCE.com prevention and healing by unconventional
means, have created a strong appetite for
ancient philosophies.1

Aromatherapy’s roots can be traced back at

least 5000 years to ancient China, India,

Persia and Egypt, where the ancients used

the oils for massage, medicine, religion,
AROMATHERAPY: ART OR
food preparation and preservation, and
SCIENCE? HIGHLIGHTS OF
embalming.3 The term aromatherapy was
AROMATHERAPY IN MEDICINE
not used until the 1920s, when a French
TODAY
cosmetic chemist, Gattefosse, who worked

in a perfumery, noticed the antiseptic
Introduction
qualities of many oils. Historically, oils
Aromatherapy falls into the category of
were administered by inhalation, as washes
complementary and alternative medicine
for the mouth and throat, as compresses, and
(CAM) that may be defined as a vast group
taken internally. The internal administration
of practices and products that are not
of oils more closely describes
considered part of conventional medicine.
“aromatology,” which uses oils internally
Some other examples of CAM are
but more commonly uses undiluted oil,
homeopathic medicine, acupuncture, and
termed neat oil, applied through the skin.
therapeutic touch. In 1997, the number of
Aromatology uses plant extract to stimulate
visits to alternative care practitioners
circulation, lymph flow, and detoxification
exceeded the visits to primary care
and is more extensively involved compared
physicians in the United States (U.S.), and in
with aromatherapy.4 Oils are selected by the
2000, it was estimated that at least 50% of
effect they exert on a particular organ, and
the U.S. population used some form of
alternative therapy.1 Many view may be used undiluted and delivered per
rectum or vagina.5 There is only one college
aromatherapy as only a complement to a
offering training in aromatology.6 It purchase, how to purchase, and the proper
consists of an intensive 2-year program storage of essential oils. At the end of this
designed for those who are already licensed article, names of books and websites are
as therapists or in medicine. The term provided that may be useful. Information
“aromatherapy” applies to the use of can also be found on each oil’s use and for
essential oils for aromatic inhalation and homemade formulas, with suggestions of
topical application that can be through how to mix them together based on their
massage and should not be confused with characteristics. Many people find it
the term “aromatology.6 enjoyable to mix the essential oils in creams
and lotions creating their own personal
Aromatherapy Basics scents. It is important for those planning
Oils from the plants are extracted from self-use to be aware that chemical
flowers, twigs, leaves, bark, or from a fruit’s constituents of essential oils can be skin
rind. For example, sandalwood oils are irritants especially if used in concentrations
from the wood, rose oils from the flowers, exceeding 5%. Sometimes irritation can
and some basil oils from the leaves. 7 occur even from just overusing the same
Several methods of oils can be extracted oil.9 Ketones and phenolic ethers may be
from the plant material. The most common present in some oils, and can be damaging
method is steam distillation. Some others causing neurotoxicity and hepatotoxicity
include hydrodiffusion, mechanical when used incorrectly and over a long time
expression or pressing, enfleurage (using be attributable to systemic absorption.5
fixed oil or fats to absorb aromatic volatile Clove and cinnamon have been known to
oils), and solvent extraction.8 Whatever the cause a dermatitis-type reaction in about 5%
method, the yield is generally small with of the population.9 Tea tree oil or melaleuca
sometimes as much as 500 pounds to a ton oil has been known to cause contact
of plant material consumed to produce a dermatitis in some people.10,11 In addition,
quart of oil.3 The oils are properly termed some scents that are relaxing can cause
“essential oils.” They are very concentrated stimulation if used in higher concentrations,
and are generally diluted to a concentration such as lavender. 5 For pregnant women,
not greater than 5% volume in volume (v/v) babies and children, those who are sick, and
prior to use. 5 As one can guess, essential also the elderly, essential oils should
oils can be expensive. Some oils may cost probably not be used because of lack of data
around 30 dollars for one-half ounce; displaying safety.
however, a couple drops will go a long way.
Less expensive oils are available, though Aromatic oils fall into “note” categories of
often they are not the best of quality. Some an aromatic orchestra. These notes carry
suppliers may not verify the purity of their degrees of volatility rates or differences in
oils, but questions are almost always met the time the scent lasts.8 There are top notes
with a positive assurance of quality.9 Some whose scents are light and sweet such as
signs of adulteration are when oils all have citrus oils, basil, sage, and eucalyptus, to
the same price or that a label does not name a few. 7 Top notes generally linger for
indicate that the product is an “essential 3 to 24 hours.7 There are others called
oil.”9 middle notes that provide the character of
the blend and last 2 to 3 days.8, 7 Some
There are several web sites and books middle notes are chamomile, lavender, and
available that have information on where to rosemary. 7 Lastly, there are the base or
bottom notes. These scents are deep and examined the challenges in designing a
strong and linger the longest, up to a week. 7 randomized control trial for aromatherapy
Common base notes are myrrh, patchouli, massage. Most patients were reported to be
and sandalwood.7 unwilling to participate in the study.14 Also,
from examining the scientific literature cited
When essential oils are used for massage, in this article, a limited number of essential
they are diluted with “carrier oils” such as oils were studied, with one of the most
almond, apricot kernel, grapeseed, avocado, popular being lavender, followed by
wheat germ, evening primrose, and coconut chamomile.
oils. 7,12 Almond oil is absorbed easily from
the skin and is beneficial if the skin is dry. Trials using aromatherapy have investigated
Apricot kernel oil is very light and is best several medical conditions such as patients
for facial application.7 Grapeseed oil is the with cancer and dementia, pain during and
least expensive and is also light, which is post labor, arthritis, skin conditions like
good for people with oily skin. 7 Avocado oil alopecia areata and psoriasis, cognition,
is for dry, flaking, and aging skin.12 Wheat anxiety, and insomnia. Some additional
germ oil contains vitamin E, and may help areas of investigation but not discussed in
to prevent scar tissue.12 Evening primrose this article are postoperative nausea, chronic
contains gammalinolenic acid, and may be obstructive lung disease, and asthma.15, 16
useful to prevent aging.12 Coconut oil has Data is even available on the use of essential
claims in moisturizing the scalp.12 oils as an ingredient in mouthwashes.
Essential oils have been found to contain
Controversy Today anti-plaque properties and to prevent
Current medical standards use evidence- gingivitis. 17 The American Dental
based medicine from well-controlled, Association has endorsed essential oil use as
double-blind trials to guide therapy; oral-hygiene adjuncts, and they can be found
however, this is generally lacking when it in everyday products such as Listerine.17
comes to aromatic therapies. One reason is Owing to increasing popularity and its broad
the difficulty of devising a sound study range of uses, it would not be unreasonable
design. Perhaps another is attributable to the to say that pharmacists may receive
current attitude of the scientific community questions on aromatherapy regarding its
and the skepticism in which CAM therapies p lace in medicine.
are received. Most support for Autonomic Nervous System and Anxiety
aromatherapy comes from anecdotal When aromatherapy is mentioned, one may
evidence and case reports. Many published tend to think of its effects on the mind and
studies do fall short for several reasons. body. Thoughts of calmness or relaxation
Some do not include a control group, others and reduced anxiety tend to almost define
do not record baseline measurements, and/or the word for many people. Some essential
have not used qualified massage therapists.13 oils such as lavender (Lavandula spp.) are
Since the definition of aromatherapy can thought to have a sedating effect. One
include the use of essential oils with proposed mechanism is owing to an effect
massage, this variable should be consistent. on the autonomic nervous system (ANS).18
In addition, most studies have a small If aromatherapy affects the ANS, then it
sample size. The recruitment of patients may help to reduce anxiety as well.
was the most challenging problem reported The effect of aromatherapy on heart and
by Westcombe in his 2003 study that respiratory rates, blood pressure, and blood
flow has been investigated mainly with decline was seen after the footbath for the
lavender oil, which is known for its relaxing aromatherapy condition.18
and calming qualities. Trials using a
footbath and another using inhalation have Romine et al. studied the effects of lavender
evaluated the effects lavender oil has on the (species unknown) on exercise recovery
ANS, and both displayed a trend toward measured by diastolic and systolic blood
lowered parameters.18,19 It should be noted pressures, mean arterial pressure, pulse
that these studies displayed a trend but they pressure, and heart rate.19 Twenty
lacked an adequate number of patients undergraduate men walked briskly for 2
(n = 10,20), so if there was a difference it minutes. Afterwards, subjects were divided
might not have been detectable. The study into 2 groups. One, a control, and the other
performed by Saeki et al. investigated the received lavender inhalation via an electric
physiologic effects of a footbath with and potpourri device for 10 minutes. The oil
without the addition of lavender oil concentration used was 10 drops in 500 mL
(Lavender angustifolia) on the ANS of water. Measurements were recorded pre-
measured by respiratory rate, exercise, immediately postexercise, and 10
electrocardiogram results converted into minutes postexercise. There was a greater
heart rate variability (HRV), and blood flow reduction in all measured parameters for the
of the palmar side of the fingertips. Ten treatment group but the difference was not
female subjects were chosen (aged 19-21). statistically significant. A randomized study
Four drops of lavender oil per 4L of hot was performed but subject baseline
water were used as a concentration. Three characteristics were not mentioned and,
different conditions were established with thus, no baseline data comparisons were
each participant experiencing each treatment made. In contrast, a randomized, controlled
condition. The 3 treatment conditions study evaluating aromatherapy massage with
consisted of no footbath and with a footbath lavender oil in 122 intensive care unit (ICU)
either with or without lavender oil. The patients found no difference even though it
control condition was first and the duration was powered to 90% (n = 105) to detect a
was for 10 minutes. Next, 5 subjects difference of 30%.20 There was no
received the footbath without the oil and 5 difference in blood pressure, heart rate, or
subjects received the footbath with the oil respiratory rate between groups. Patients
for 10 minutes. After the first treatment, 60 were randomized to undisturbed rest, body
minutes passed before the footbaths were massage, and body massage with 1%
reversed. Data collection was 3 minutes lavender (Lavendula vera) in grapeseed oil.
prior, 10 minutes during, and 7 minutes after Massages were given for 15-30 minutes. A
each footbath. A significant difference was minimum of one and a maximum of 3
seen for both footbaths for fingertip blood sessions were done based on length of ICU
flow. No significant differences were seen stay and were separated at least 24 hours
between conditions for respiratory rate apart. Nurses were trained to administer
overall, but a trend toward a decrease was massage for the study. It should be noted,
seen in both footbath conditions with however, that there was a significant
slightly greater effects in the aromatherapy difference in the patient’s perceived anxiety
condition during the first 5 minutes. HRV compared with rest for the first session.
changes were not significant between the Besides lavender, neroli or orange blossom
conditions overall; however, a greater (Citrus aurantium ssp. auantium) has also
been studied for its effects on the ANS.
Stevensen et al. in 1994 studied the promising, no statistical analysis were done.
physiologic and psychologic effects of In addition, the species of lavender and the
neroli on patients recovering from cardiac concentration were not mentioned nor were
surgery.21 One hundred patients were randomization and blinding performed, thus
divided into 4 groups. Group one received a making conclusions from this study difficult
20-minute foot massage with apricot kernel to draw.
oil. Group 2 received a 20-minute foot
massage with 2.5% neroli oil. Of the The perceived association of aromatherapy
remaining 2 groups, group 3 received 20 with a reduction in anxiety has sparked
minutes of verbal communication and group investigations into the use of aromatherapy
4 had no intervention. On day one in patients undergoing medical procedures.
postoperatively, there was a significant Clarke in 1999 investigated the effects of
psychologic benefit in both groups receiving aromatherapy on stress reduction in patients
massage compared with control in terms of receiving hemodialysis.23 Twenty-one
anxiety and tension. However, statistically patients who received hemodialysis 3 times
significant physiologic differences were weekly for one week received vaporized
limited to respiratory rate as an immediate essential oil combinations such as lavender,
effect of massage with or without the orange, and lemon in different combinations
essential oil. A further follow-up or a combination of cedarwood and
questionnaire on day 5 postoperatively rosewood. No control group was used and,
showed a trend toward greater and longer therefore, all 21 patients experienced the
lasting psychologic benefits from the same therapy. Stress reduction was
massage with the neroli oil compared with measured by identifying the use and display
plain apricot kernel oil. Patients not of stress coping mechanisms and behaviors
receiving massage were not asked to with the social readjustment rating scale
complete the questionnaire, which asked (SRRS) completed by patients, a self-rated
questions to evaluate psychologic benefits as questionnaire completed by patients,
done on day one, as well as duration of the behavior observed by colleagues, and
benefits, if any. At the end of the journal entries from patients. At the end of
questionnaire, patients commented that they each dialysis session, a notation was made in
did enjoy the massage but did not mention the journal and the SRRS and questionnaire
any greater benefits from the addition of were given to patients to complete and
aromatherapy massage with neroli oil. return at the start of the next treatment
session. In addition, a section of the
Woolfson and Hewitt studied the effects of questionnaire was given one month after the
lavender foot massage on intensive and trial for a summative evaluation. After
coronary care patients.22 This study analyzing the results, symptoms of stress
consisted of a foot massage given twice were reduced by 6% when compared with
weekly for 5 weeks. Thirty-six patients baseline, but statistical analysis was not
were divided into 3 groups: lavender in mentioned. Also, journal entries made by
almond oil foot massage, almond oil foot patients noted an increase in interactions
massage, and a control. There was a trend with staff and other patients, and that the
toward lowered heart rate, respiratory rate, experience was calming and helped them to
and systolic blood pressure for both massage relax. Interestingly, after the trial, both
groups, with the lavender group being patients and staff voted to continue the
slightly lower.22 Although the were aromatherapy sessions at the center, even
though the benefits appeared to be was thought to allow participants to
attributable to increased attention given by concentrate better, leading to math score
staff members verses aromatherapy.23 improvement.26

A double-blind, placebo-controlled, Rosemary and lavender may affect memory
randomized trial investigated the efficacy of and mood.28 Moss et al. randomized a total
aromatherapy in reducing anxiety in 66 of 144 healthy adults (undergraduate
women waiting for surgical abortion using students and the public) to one of 3
inhalation of either the oils of vetivert, independent groups. Subjects performed the
bergamot, and geranium or hair conditioner Cognitive Drug Research (CDR)
as a placebo control.24 Anxiety was assessed computerized cognitive assessment battery
using a verbal anxiety scale and went from in a cubicle containing either the odor
zero to 10, with zero being no anxiety. This lavender (Lavandula angustifolia), rosemary
scale was administered to the women before (Rosmarlnus officinalis), or no odor
and after smelling the scents for 10 minutes. (control). The CDR battery is accepted
The results found a significant reduction in worldwide as an assessment of changes in
anxiety for both the treatment and the cognitive function. The Bond-Lader visual
placebo group, with no difference between analogue scales were used to assess mood.28
groups. The authors concluded that the The subjects who received rosemary by
reduction was probably because of a inhalation were found to have significant
distraction, a pleasant smell, and/or sitting increases in alertness, memory, and
down and probably not because of the contentedness, but impairment in memory
effects of the aromatherapy. However, they speed compared with controls. Lavender
saw no reason to discourage the use of aroma had a significant negative effect on
aromatherapy.24 memory, memory speed, and contentedness
compared with controls. No significant
Cognition, Alertness, and Mood differences in calmness were reported
There is some supporting evidence that between the groups. Rosemary was found to
aromatherapy can positively affect mood, have significant enhancements in memory
alertness, and cognition.25, 26 Effects on compared with lavender. Although the
alertness and relaxation have been noted by results of this study were promising, it
electroencephalogram (EEG) patterns in should be noted that a baseline comparison
some studies.26,27 The changes in EEG between groups was not done. This
patterns may be associated with enhanced comparison would have assured continuity
cognitive function as noted with math in cognitive function, especially since
computation scores.26 A total of 40 adults subjects consisted of members of the public
were administered lavender or rosemary by and undergraduates.
3-minute inhalations with baseline
measurements taken prior to the Some patients have received benefit from
administration. EEG readings showed an aromatherapy for reducing behavioral
increase in drowsiness for lavender and disturbances associated with dementia.
increased alertness for the rosemary group. Sixty percent of 72 patients with severe
Math computations after aromatherapy were dementia experienced a 30% reduction in
faster in both groups but accuracy was agitation from baseline assessed by Cohen-
slightly better in the lavender group only. Mansfield Agitation Inventory (CMAI)
The relaxation induced from the lavender compared with 14% of the control group
(P < 0.0001).29 Patients were randomly act as his own control.31 Each patient
assigned by nursing home locations (8 received 8 to 12 sessions of each treatment
homes) to either aromatherapy with Melissa condition over 3 months.31 Treatment
(lemon balm) or sunflower oil (placebo).29 groups consisted of the following: no
The oils were added to a lotion and applied treatment, aromatherapy by inhalation with
to the patient’s faces and arms twice daily lavender oil, massage, and aromatherapy
for 4 weeks. 29 No differences in patient with massage.31 Observations were made
characteristics were found among the 8 every minute for an hour following
sights (P = 0.51).29 It was also noted that treatment.31
quality of life was improved in the treatment
group, which was measured with Sleep
subcategories of the Neuropsychiatry Limited information is available on the
Inventory (NPI): (1) percent of time spent effects of aromatherapy on insomnia. A
socially withdrawn (P = 0.005) and (2) small preliminary study was conducted on 4
engaged in constructive activities psychogeriatric patients to see if lavender oil
(P = 0.001).29 could replace drug treatment.32 Three of
these patients were using sedating
Another placebo-controlled study done by medications for sleep (temazepam,
Holmes et al. demonstrated a statistically promazine, chlormethiazole) for a range of 7
significant reduction in agitated behavior months to 3 years.32 Hours of sleep were
measured with the Pittsburgh Agitation measured for 6 weeks total.32 Two weeks
Scale (PAS) in patients with severe while on medication, 2 weeks after
dementia. This study enrolled 15 patients medication was withdrawn, and 2 weeks
with severe dementia and agitated behavior while lavender was diffused into their
who received 3 diffused aroma streams of ward.32 During the last 2 weeks, sleep times
either lavender 2% or water (placebo) over 2 returned to the level prior to the medication
hours on alternate days. 30 Each patient being withdrawn.32 The authors concluded
received 5 streams of each producing 10 that lavender oil may provide a temporary
PAS scores for each patient.30 A blinded relief from insomnia medication.32 From the
rater who was unaware of the study design limited information presented, however, it is
assessed individual behavior, and 60% difficult to draw a conclusion. The benefits
showed an improvement in agitation derived may be attributable to the original
(P = 0.016) compared with 33% with no cause of the insomnia being resolved.
change and 7% with worsening symptoms.30
A subanalysis found that patients with In another small study, an attempt to reduce
Alzheimer’s disease and vascular dementia nighttime sedation in 10 hospitalized
benefited most compared with Lewy body patients over 70 years of age was
and fronto-temporal lobe dementia.30 conducted.33 Nurses trained to administer
aromatherapy used vaporization and a 5-
Another small study involving only 4 minute massage.33 At the end of 2 weeks of
patients with severe dementia showed one aromatherapy treatment, patients reported a
patient benefited from both aroma alone and good night’s sleep 97% of the time versus
massage alone.31 In this small study, 73% prior to the therapy, and nightly
agitation was measured using an sedation was reduced by 49%.33 This study
individualized scale made from observing was limited by a lack of a control group,
each patient so that each participant would however, so improvements may be because
of the passing of time instead of aromatic was conducted.35 Six hundred thirty-five
therapy. women were blinded, randomized, and
divided into 3 groups. The women either
Pain received lavender essential oil, synthetic
Pain relief during or after childbirth using lavender oil, or aromatic placebo. Six drops
aromatherapy has been investigated. Burns of the oils were added to bath water for 10
et al. conducted a 6-month pilot study to days after delivery. Analysis of daily
evaluate aromatherapy in 585 women during discomfort scores revealed no statistical
their labor. Attending midwives trained in differences among groups; however, there
aromatherapy selected the women while was a trend in the lavender essential oil
they were in labor based on whether or not group to have lower pain scores between
the women had known allergies, wanted days 3 and and 5. In addition, the decrease
aromatherapy, and gave verbal consent.34 in discomfort was not faster in any group.
The midwives selected essential oils and the
method of administration.34 The choice of Brownfield conducted a small, quasi-
oils were lavender, clary sage, peppermint, experimental study of 9 patients with
eucalyptus, chamomile, frankincense, rheumatoid arthritis. Patients were divided
jasmine, rose, lemon, and mandarin.34 into 3 groups.36 One group served as a
Several methods of administration were control, one group received massage for 2
available, such as spraying a solution of 100 consecutive nights with lavender oil then
mL with 2 drops of oil onto a cloth object, a massage for 2 consecutive nights without
drop onto an absorbent card, and massage lavender oil. The other group received
with 2 drops per 50 mL of almond oil.34 massage for 4 evenings, but first without
Peppermint could be dropped directly on the lavender oil for 2 nights then with lavender
forehead and frankincense could be oil for 2 nights.36 The massages were
administered by a drop on the palm.34 performed for 10 minutes on the upper neck
Thirteen percent of the women used no other and shoulders of each patient for each
form of pain relief and 67% used the oils night.36 Visual Analogue Scales (VAS) were
prior to other analgesia; however, it was not used to measure the patient’s perception of
known at what point analgesia was given.34 pain, sleep, and well-being.36 The author
The other 20% used analgesia prior to using hypothesized that people who slept better
essential oils. The most popular oils chosen were better able to cope with pain, and that
for analgesia were lavender, clary sage, and one’s perception of well-being has a direct
chamomile.34 Midwives and mothers relationship to pain.36 Measurements were
reported the effects of the oils after birth and taken prior to massages and again after the
prior to transfer from the delivery room.34 A second consecutive night of massage.36
total of 62% of women described the After the fourth night, an interview of the
essential oils as being “effective,” 12% patient was done to explore subjective
reported the oils as being “not effective,” perceptions of the procedures.36 Patient
17% were undecided, and 9% did not record interviews revealed a positive effect on pain,
a decision. Other parameters besides pain sleep, and well-being and patients reported
were evaluated but were not included in this taking fewer analgesics.36 However, VAS
discussion. scores did not show improvements for pain
and sleep after massages, which was
A randomized trial using lavender essential contradictory to the patient interviews.36
oil in a bath to relieve perineal discomfort The author concluded that patients with