Lavender Aromatherapy for Chronic Pain
Lavender Aromatherapy for Chronic Pain
By Jane Buckle, RN, MA
Chronic pain costs the u.s. economy approximately $70 billion annually and affects nearly 80 million Americans.1 During the last five years there has been a 2,700% increase in the numbers of social security disability claims paid for chronic back pain2 and the emergence of specialized pain clinics.3 Pain is one of the most common symptoms in clinical settings and is one of the main reasons patients seek alternatives.4
With symptoms that include anxiety, depression, irritability, insomnia, loss of appetite, and immobility, chronic pain is a complex emotional, social, and physical dysfunction.5 Conventional treatment for chronic pain generally includes a mixture of opioid and non-opioid drugs. There is evidence that tricyclics or benzodiazepines (more commonly known for their antidepressant properties) inhibit the action of nociceptor neurotransmitters.6 These drugs are used as analgesics (at doses less than those given for depression) and are particularly relevant in the treatment of neuropathic pain.
Recently, aromatherapy has emerged as part of an integrated, multidisciplinary approach to pain management. Aromatherapy is thought to enhance the parasympathetic response through the effects of touch and smell,7 and to encourage deep relaxation which has been shown to alter perceptions of pain.8 Several State Nursing Boards now accept aromatherapy as part of holistic nursing care.9
Definitions
Aromatherapy is the controlled, therapeutic use of essential oils.7 When essential oils are used by nurses for therapeutic purposes, aromatherapy becomes clinical.10 Clinical aromatherapy requires significant training. Nurses wishing to use essential oils clinically should be conversant with potential drug interactions and contraindications before they begin using aromatherapy with patients. For example, there are three different species of lavender: One is a sedative, one is a stimulant, and the other can be neurotoxic in large doses but is effective against pseudomonas.11 Inhaled Lavandula angustifolia (true lavender) has calming effects that are comparable to diazepam;12 it can potentiate the use of hypnotics;13 and used topically (1-5% dilution), it can enhance healing in burns and wounds.14 Clinical aromatherapy is common practice among nurses in many parts of the world, including the United Kingdom, Australia, South Africa, Germany, and Switzerland.15
Only pure essential oils are used in aromatherapy. (See Table 1 for the different methods of administration.) Essential oils are the "volatile, organic constituents of fragrant plant matter"16 (in this context, volatile means evaporates easily). Essential oils should be 100% pure and are up to 100 times more highly concentrated than the plant. Allergic reactions to the pure essential oils used in aromatherapy are uncommon; however, using essential oils that are not pure may cause adverse effects due to the contaminant.
| Table 1-Aromatherapy: Methods of administration | ||||
| Inhalation: Useful for depression, insomnia, sinusitis, upper respiratory tract infection. Inhale directly from tissue or float two drops on steaming bowl of water. | ||||
| Topical: Useful for pain, contusions, skin complaints, muscle strain, and scar tissue. Compresses, baths, and massage. | ||||
| Vaginal: Useful for yeast infections or cystitis. Use diluted in carrier oil on tampon. Only use essential oils high in alcohols, such as tea tree. | ||||
Mechanism of Action
Essential oils are highly complex and are made up of many different chemical components, or molecules. These molecules travel via the nose to the olfactory bulb and on to the limbic system of the brain, an inner complex ring of brain structures below the cerebral cortex, arranged into 53 regions and 35 associated tracts.17
Both touch and smell affect the parasympathetic nervous system and can have instant effects at physical, psychological, and molecular levels.18 The analgesic effects of aromatherapy are thought to be caused by several factors:7
• The effect of a complex mixture of volatile chemicals on the pleasure memory sites within the brain
• The effects of certain analgesic components within the essential oil on the neurotransmitters dopamine, serotonin, and noradrenaline at receptor sites in the brain stem
• The interaction of touch with sensory fibers in the skin and the transmission of referred pain
• The rubefacient effect of baths or friction on the skin
Within the brain, the amygdala and the hippocampus are of particular importance in the processing of aromas. Lavandula angustifolia (true lavender) is a common essential oil used topically to relieve pain and also appears to enhance the effect of conventional pain medication.19,20 The physiological response to lavender has been "mapped" with a computerized topographical EEG.21 Like diazepam (Valium®), Lavandula angustifolia is thought to reduce the effect of external emotional stimuli by increasing g-aminobutyric acid (GABA)-containing inhibitory neurons in the amygdala.10 This is interesting as tricyclics and benzodiazepines, which are commonly used by conventional medicine to treat chronic pain, also inhibit the action of nocioceptor neurotransmitters.6
Clinical Studies
In a study of 20 hospitalized children with HIV (aged three months and older), nurses used aromatherapy to provide comfort and pain relief.22 This was a descriptive study and no method of measuring pain was given; however, the nurses reported less discomfort in children who had spasm due to encephalopathy, resulting in decreased analgesic use. Chronic chest pain (that had been unresponsive to regular analgesia) was eased and painful peripheral neuropathy was alleviated almost completely. The nurses found the following essential oils useful: true lavender (Lavandula angustifolia); Roman chamomile (Chamaemelum nobile); neroli (Citrus aurantium); mandarin (Citrus reticulata); sandalwood (Santalum album); and palma rosa (Cymbopogon martinii).
A study using lavender (Lavandula angustifolia) cites a 50% reduction in pain perception as recorded by patients in a critical care setting.23 Thirty-six patients were divided into three groups of 12: One group received massage plus lavender (Group A), one group received massage without lavender (Group B), and the control group received no treatment. Treatment consisted of a 20-minute foot massage twice a week for five weeks. The study was not randomized or blinded as smell and touch are impossible to hide.
Investigators completed questionnaires documenting pain, wakefulness, heart rate, and systolic blood pressure, which limited the validity of the study. Observations were taken before and immediately following the intervention and up to half an hour later. This was an interesting study as 50% of the patients were artificially ventilated and, therefore, the effects of the essential oil could not be from inhalation. The most striking difference between Group A and Group B was in the effect upon heart rate. Among Group A patients, 90% showed a reduction of 11-15 beats/min whereas only 58% of Group B showed any reduction, and it was consistently less. Only 41% of the control group showed any reduction. The study gives no formal statistics or analysis.
Brownfield studied the effects of aromatherapy and massage on nine inpatients with rheumatoid arthritis (RA) in a quasi-experimental design.24 This randomized, controlled study used a visual analog scale as the measurement tool. Intervention was a 10-minute upper neck and shoulder massage, with or without Lavandula angustifolia, carried out on two consecutive evenings. Inclusion criteria were diagnosis of RA in accordance with the American Rheumatism Association, 18 years of age or older, and disease duration more than two years.
Quantitative results did not reveal any reduction in pain levels following massage with or without lavender. However, the interviews showed that those patients receiving massage with lavender oil were able to reduce their intake of analgesia. The author concludes that the apparent contradictory findings could be because many patients with RA "have difficulty distinguishing pain from stiffness." Patients also reported that they slept better or were able to roll over in bed and six patients expressed a desire to continue aromatherapy treatment. This study is limited because of the small patient population and the possibility that researchers may have biased subjects to approve of the treatment. However, it does highlight that idea that perception plays an important role in pain and that this perception can be affected by touch and smell.
Conclusion
It is not yet known whether aromatherapy achieves its clinical efficacy as a result of the placebo response, the effect of touch and smell on the parasympathetic nervous system, the learned memory of aroma, the pharmacokinetic potentiation of orthodox drugs by essential oils, or because the pharmacologically active ingredients within the essential oils have analgesic effects. Although future clinical studies are needed to precisely determine the effects of aromatherapy, these studies suggest that aromatherapy may play a role in chronic pain relief.
Ms. Buckle is an adjunct faculty member in the holistic nursing department at The College of New Rochelle, New Rochelle, NY, and in the department of botanical medicine, psychology, and spirituality at Bastyr University, Seattle, WA.
References
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