MD, PhD, FMedSci, FRSB, 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?

26 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.

  • Actually all essential oils can help kill bacteria and viruses, fight infection, relieve allergies and alleviate anxiety, stress, depression, fatigue and poor memory. My favorite is rosemary oil that helps improve my memory, concentration and mental alertness, and help treat headaches and migraines.

    • don’t talk nonsense!
      show us the clinical trials for all or some of these claims.

      • I don’t need a clinical trial to prove that as far as I’m concerned essential oils worked for me. I have had toe nail fungus for some time now but always thought it might just go away on it’s own. It didn’t, instead it got worse. I found a bottle of Nail Fungus treatment on The net called Nail Solution From Dr Organic. Ingredients:
        Prunus amygdalus dulcis (Sweet almond) oil, Oryza sativa (Rice) bran oil, Simmondsia chinensis (Jojoba) seed oil, Melaleuca alternifolia (Tea tree) leaf oil, Undecylenic acid, Tocopherol, Limonene. Appying the application of this oil twice daily has brought remarkable results. The fungus is dying off leaving perfectly healthy nails. It takes time but it is working. Been applying the solution for a month and my toe nails alooking a lot healthier. Clinical trials my arse. It’s results that count. Still I suppose it must be Placebo LOL.

        • bravo
          except this is not aromatherapy

          • I know but it uses aromatherapy oils. So are you saying Aromatherapy oils work when applied directly? It would seem so wouldn’t it?

        • @Barry
          Have you done a superiority trial against turpentine? Like most aromatic oils, which are distilled from plants and trees, it contains a lot of nasty chemicals. Some of the oils that are used by the aromatherapy aficionados are rather repugnant and some smell of turpentine, such as the much acclaimed tea-tree oil.
          The health hazards of turpentine are well known. The list of dangers of “essential” oils is even more frightening.

          Many complain of irritation from these products.
          I have had to leave a room where oils or resins are being used because of severe mucosal irritation. One big problem for me seems to be Frankincense which is a tree-resin. A woman I know is a believer in the purported powers of this tree resin and I cannot stay close to her when she has doused herself in the muck.

          • @Bjorn. Well, what can I say I have had no adverse effects so far. There is very little smell to this mixture. I have been a little to enthusiastic at times and touched flesh with the stuff but so far I have had no adverse effects as of yet and like I say I have been using it a month now. The other option I had of course is that I could have gone yo my GP but I have heard they give you tablets for nail fungus. I am not one for taking tablets unless really necessary so that was thought dispatched ASAP. No all in all I am well pleased with the results Bjorn. My nails are beginning to look good again.

          • My point is Barry, that tea tree oil and other distillates of plants and trees contain a mixture of chemicals, many of which are nasty solvents and irritants and turpentine is such a product too.

            Your application of this chemical mixture on your toenails is like applying any strong stuff on a culture in a Petri-dish, nothing remarkable about it sometimes killing whatever is in that dish, but is it really curing your fungiculture?
            The problem is that if the fungus has infected the root of your nail you will invariably get it back when the nail grows, even if you manage to kill the champignons you can get at.
            You are only applying the muck to the already “dead” part of the nail. If the root is infected you will need to take an antifungal drug by mouth that reaches the root of your nail and you need to take it for months as the nail is slow growing.
            You may be killing off fungus where you apply the oil, but the oil may just be soaking into the porosities in the nail caused by fungus,making the nail appear less opaque and healthier without really killing the fungus. I would stop this mucking about with dubious snake-oil and consult a (real) dermatologist who can take samples from your nail for culture and determine if and what treatment you need.

          • Björn Geir on Wednesday 22 August 2018 at 16:18
            My point is Barry, that tea tree oil and other distillates of plants and trees contain a mixture of chemicals, many of which are nasty solvents and irritants and turpentine is such a product too.

            Your application of this chemical mixture on your toenails is like applying any strong stuff on a culture in a Petri-dish, nothing remarkable about it sometimes killing whatever is in that dish, but is it really curing your fungiculture?
            The problem is that if the fungus has infected the root of your nail you will invariably get it back when the nail grows, even if you manage to kill the champignons you can get at.
            You are only applying the muck to the already “dead” part of the nail. If the root is infected you will need to take an antifungal drug by mouth that reaches the root of your nail and you need to take it for months as the nail is slow growing.
            You may be killing off fungus where you apply the oil, but the oil may just be soaking into the porosities in the nail caused by fungus,making the nail appear less opaque and healthier without really killing the fungus. I would stop this mucking about with dubious snake-oil and consult a (real) dermatologist who can take samples from your nail for culture and determine if and what treatment you need.

            We’ll see Bjorn..

        • @ Barry Trestain,
          Quote: „Clinical trials my arse.”

          Nobody here argues that plant derivatives or other natural compounds can have a biological (in your case antifungal) activity. However, I don´t understand why you seem to oppose the evidence-based, scientific approach, which in your example could look something like this:

          1) Determine which species of fungus you have, because the observed effect could be specific for this fungus.

          2) Analyze the complete chemical composition of the oil you were applying. We have modern analytical methods like e.g. HPLC, GC/MS, etc. to achieve this.

          3) Isolate the active, antifungal component(s) in the oil to optimize the effectiveness of the remedy, since we would like to avoid any unnecessary compounds that could potentially have unwanted side-effects.

          4) After we found the active chemical substance(s), we would test the pure substance in several steps of pre-clinical and finally clinical trials to identify the compound-specific effectiveness (we need to “substract” the unspecific effects, such as natural progression, which could occur in some people) and also find out about potential unwanted side effects, to be able to evaluate the risk vs. benefit balance. I assume that you would agree that it would not be advisable to use a compound that kills the fungus, but also strongly increases the chance to develop skin cancer.

          5) After all steps are completed and the risk/benefit balance is positive, the remedy could be produced in large scale and sold.

          Such an evidence-based procedure is very logical and straightforward in my mind. So what exactly is your problem with it?! What is that you do not agree with?!

          • It’s working and that’s all I need to know. I would think that if there was any danger in using this stuff someone, somewhere would have written about it.

          • Quote#1:
            “It’s working and that’s all I need to know.”

            This seems to be a big difference between you and a scientific person: Apparently, you don´t mind to be ignorant regarding HOW things work. For me, it is extremely interesting to understand at least the basic principle of the mode of action of a remedy. Since I have studied biology, I am in the fortunate position to understand at least some of the molecular aspects behind the effects that you observe. Really fascinating stuff, I can assure you!
            E.g. in case of nail fungus, I would prefer an amorolfine-containing remedy, where the mode of action has been identified on a molecular basis. Basically, this chemical blocks the fungus from being able to build its cell membrane (which is different from human cell membranes).
            https://en.wikipedia.org/wiki/Amorolfine
            It is a quite typical strategy when trying to find antimicrobial chemicals to focus on differences between the human cells and the microbe cells, in order to avoid side-effects to the human cells.

            Quote#2: „I would think that if there was any danger in using this stuff someone, somewhere would have written about it.”

            I would be very careful with this somewhat negligent attitude towards your own health.
            As long as the mode of action for a remedy is not identified and no proper trials have been conducted, you could expose yourself to more risk than benefit (maybe not in the case of this “nail oil”, but certainly in other cases).
            And to find out about risk and benefit, we need to look at more persons than just you, I´m afraid, because we cannot draw general conclusions from just one case example. Like it or not, randomized controlled trial with an adequate number of patients is currently the best way that we have in this regard.

          • The product Barry Trestain is using is billed as pure ‘Tea tree oil’ on the Holland & Barrett website. In common with many essential oils, Tea tree oil contains a lot of different terpenes and terpenoids, which confer antimicrobial properties in vitro. You can view the full composition of potentially pharmacoactive compounds in Tea tree oil here. (Search for ‘Melaleuca alternifolia’.)

            Tea tree oil has been researched particularly for its antifungal (mainly anti-Candida) effects in vitro and it shows activity against several Trichophyton spp. — common causes of toenail onychomycosis. A clinical study from 1994 compared Tea tree oil with clotrimazole for topical treatment of onychomycosis and the abstract showed comparable activity for the two products, with 60% full or partial clinical improvement in both treated groups after 6 months of treatment. Sadly, the original paper with the details seems not to be currently available on line.

            I have no special reason to doubt that Tea tree oil appears to be working for Barry Trestain’s toenail fungal infection, but his “Clinical trials my arse” attitude reveals a deficit in his critical thinking. At the very least, well designed clinical trials will reveal what proportion of people treated with something show a response, and what proportion experience side-effects. If Barry goes around recommending his Tea tree oil product to his friends he might be surprised to discover a few of them don’t share his positive experience.

            As Jashak already pointed out, the normal course of action with a natural product should be to determine the main active component and research it fully, but Tea tree oil advocates seem to be determined not to do this, and to keep their oil in its natural form (which, of course, may vary from preparation to preparation).

            Barry said: “I would think that if there was any danger in using this stuff someone, somewhere would have written about it.” He might take a look at Holland & Barrett’s website where someone has written: “Advisory information: Skin patch test is recommended for those with sensitive skin. If irritation occurs, discontinue use. For external use only. Avoid contact with eyes. Keep out of reach of children.”

  • “I don’t need a clinical trial to prove that as far as I’m concerned….” wow, now THAT is profound! And stated in perfect gibberish as well.

  • Edzard posted.

    see also here:
    https://www.ncbi.nlm.nih.gov/pubmed/10800248

    So, I guess I can keep using it as it works on fungus apparently.

  • I love essential oils and use them daily. Essential oils became a part of my life! I do feel better with it! Why I need clinical trials so?

    • I love champagne and use it daily. Champagne became a part of my life! I do feel better with it! Why I need clinical trials so?
      NO, BUT IF I MADE MEDICAL CALIMS FOR IT, I WOULD!

    • I’m with Upton Sinclair here:

      It is difficult to get a man to understand something, when his salary depends upon his not understanding it!

      __________
      I, Candidate for Governor: And How I Got Licked (1935), ISBN 0-520-08198-6; repr. University of California Press, 1994, p. 109.

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