MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Of all alternative treatments, aromatherapy (i.e. the application of essential oils to the body, usually by gentle massage or simply inhalation) seems to be the most popular. This is perhaps understandable because it certainly is an agreeable form of ‘pampering’ for someone in need of come TLC. But is aromatherapy more than that? Is it truly a ‘THERAPY’?

A recent systematic review was aimed at evaluating the existing data on aromatherapy interventions as a means of improving the quality of sleep. Electronic literature searches were performed to identify relevant studies published between 2000 and August 2013. Randomized controlled and quasi-experimental trials that included aromatherapy for the improvement of sleep quality were considered for inclusion. Of the 245 publications identified, 13 studies met the inclusion criteria, and 12 studies could be used for a meta-analysis.

The meta-analysis of the 12 studies revealed that the use of aromatherapy was effective in improving sleep quality. Subgroup analysis showed that inhalation aromatherapy was more effective than aromatherapy applied via massage.

The authors concluded that readily available aromatherapy treatments appear to be effective and promote sleep. Thus, it is essential to develop specific guidelines for the efficient use of aromatherapy.

Perfect! Let’s all rush out and get some essential oils for inhalation to improve our sleep (remarkably, the results imply that aroma therapists are redundant!).

Not so fast! As I see it, there are several important caveats we might want to consider before spending our money this way:

  1. Why did this review focus on such a small time-frame? (Systematic reviews should include all the available evidence of a pre-defined quality.)
  2. The quality of the included studies was often very poor, and therefore the overall conclusion cannot be definitive.
  3. The effect size of armoatherapy is small. In 2000, we published a similar review and concluded that aromatherapy has a mild, transient anxiolytic effect. Based on a critical assessment of the six studies relating to relaxation, the effects of aromatherapy are probably not strong enough for it to be considered for the treatment of anxiety. The hypothesis that it is effective for any other indication is not supported by the findings of rigorous clinical trials.
  4. It seems uncertain which essential oil is best suited for this indication.
  5. Aromatherapy is not always entirely free of risks. Another of our reviews showed that aromatherapy has the potential to cause adverse effects some of which are serious. Their frequency remains unknown. Lack of sufficiently convincing evidence regarding the effectiveness of aromatherapy combined with its potential to cause adverse effects questions the usefulness of this modality in any condition.
  6. There are several effective ways for improving sleep when needed; we need to know how aromatherapy compares to established treatments for that indication.

All in all, I think stronger evidence is required that aromatherapy is more that pampering.

ENOUGH SAID?

5 Responses to Aromatherapy: trick or treat or treatment?

  • This points to a problem with testing in general. “Real” treatments are tested initially against placebo to see if there is an effect present other than killing the patient. It is only later that they might be tested against other effective treatments for a comparison of relative benefit. This is expensive and the results might be less useful for marketing of the less effective agent. Even when there are such studies we have to look for bias and spin. Being a skilled reader of studies does not come easily. Thank you for helping others with developing those skills.

    • One of the biggest problems that I can see (I have been thinking about how would be the best way to set up a trial to see how well aromatherapy works that would be more or less foolproof so results could be duplicated) is that for setting up a placebo you have to note how it is being used. If you are using it merely as something a person smells, then if the observed effect is psychological then a fragrant oil with the right smell but not being an essential oil would have the same effect as a real one. With direct application it would be a little easier since a fragrant oil wouldn’t have the same chemical constituents as an essential oil. For example, I am doing a case study with a person that suffers from anxiety attacks. She is noticing some improvement but the way we are doing it (associated response, so basically a conditioned reflex) means that it might be the oils that are helping her or it might just be an association that we could have made with any generic perfume substance.

  • Talking of risks, as a desperate insomniac I occasionally tried heating a few drops of lavender oil mixed with water in an oil burner on my bedside table. One night I fell asleep quickly but woke again soon afterwards feeling groggy but very thirsty. Still in the dark, I reached for the glass of water I always kept on my bedside table, took a swig and gulped it down before realising I’d picked up the oil burner by mistake and drank from that instead. Don’t laugh.

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