MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Aromatherapy is currently one of the most popular of all alternative therapies. It consists of the use of essential oils for medicinal purposes. Aromatherapy usually involves the application of diluted essential oils via a gentle massage of the body surface. Less frequently, the essential oils are applied via inhalation. The chemist Rene-Maurice Gattefosse (1881-1950) coined the term ‘aromatherapy’ after experiencing that lavender oil helped to cure a serious burn. In 1937, he published a book on the subject: Aromathérapie: Les Huiles Essentielles, Hormones Végétales. Later, the French surgeon Jean Valnet used essential oils to help heal soldiers’ wounds in World War II.

This Iranian study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on pain and anxiety in burn patients. This three group clinical trial was conducted on 120 patients with burns less than 30% of total body surface area (TBSA). The patients were randomly allocated into three groups, aromatherapy damask rose essence, placebo, and control. The pain intensity was assessed using visual analogue scale prior to intervention, immediately before, and 15 min after dressing. Anxiety was measured using Spielberger Inventory at before intervention and 15 min after dressing, also the prolonged effect of intervention on pain was assessed by number of the analgesics drugs received for four hours after dressing change. The intervention included inhalation of 6 drops of 40% damask rose essential oil in the damask group, and six drops of distilled water in placebo group one hour before dressing change. The control group received no additional intervention. All groups also received standard care.

Baseline state-trait anxiety and pain intensity were similar in these three groups. A significant reduction was found in pain intensity immediately before and after dressing and state anxiety after dressing in the damask group compared to the placebo and control groups. The researchers found no significant difference between the placebo and control groups in terms of these variables at these times. No significant difference was noted among the three groups in frequency of analgesics drugs and trait anxiety after intervention.

The authors concluded that inhaled aromatherapy with Damask rose essence reduces subjective pain intensity and state anxiety in burned patients. Therefore, it is recommended considering use of damask rose essence, as an easy and affordable method along with other treatments.

These are interesting findings for sure. Aromatherapy is far less implausible than many other so-called alternative medicines (SCAMs). It furthermore has the advantages of being safe and inexpensive.

I have no reason to doubt the validity of the study. Yet, I nevertheless think it is prudent to insist on an independent replication before issuing a general recommendation.

19 Responses to Aromatherapy Improves Pain Intensity and Anxiety in Burned Patients

  • The abstract doesn’t mention blinding, and I can’t see how the study could have been blinded. Water doesn’t even look like oil.

    • the way I understand it, only the clinicians evaluating the outcome were blinded.
      this of course means that patients’ expectation could have caused part or all of the effects.

      • When the primary outcome depends on a subjective measure like pain, blinding the assessor would not work. They will just write down what the patient says, and that will be affected by knowing whether they have smelled something nice. This isn’t to say that nice smells might not be clinically useful. It might be interesting to investigate the interactions between pain receptors and smell receptors. I’m not convinced this study adds much to our knowledge.

    • @Les

      The paper states:

      The current study was a randomized three-group single- blinded clinical trial, repeatedly measuring pain intensity, and assessing patients’ anxiety before and after intervention. Due to the use of damask rose essence and its distinctive odor, it was not possible to blind the main researcher and the patients, so, due to this reason, one of the unit nurses also participated as an assistant. She received necessary training in this field and did not know about the intervention and groups’ assignment. Her nose was covered with an aromatic mask. Accordingly, she assessed the pain intensity and recorded number of receive analgesic drugs, and also provided anxiety questionnaire to the samples.

      But they say absolutely nothing about whether they gauged whether the nurse’s blinding was effective: if it was not 100% then she could easily have biased the results.

      Also, if they blinded the assessor, why not the researcher?

  • “I have seen roses damask’d, red and white,
    But no such roses see I in her cheeks;
    And in some perfumes is there more delight
    Than in the breath that from my mistress reeks”.

    Sorry. I am becoming tangential….

    • The Society of Apothecaries use Rose water dabbed behind the ear after a fine dinner to aid digestion.
      Trust me, it works! (Stimulates afferent pathways.)

      I am sure essential oils are nice to experience, but if claims are made about clinical effects then plausible clinical evidence must be produced to support those claims.

      One problem in discussion is that ‘Les Huiles Essentielles’ means ‘essences of oils’ – oils when they are distilled.

      Many English speakers think the meaning is that the oil is ‘essential’ in the sense that there are ‘essential amino acids’, that is, these oils are essential for health.
      Not so.

      Most aromatherapists do not understand this distinction – and blithly think they are ‘doing good work’ when all they are doing is make patients feel good.
      Which is beneficial, but needs proper understanding if patients are not to be misled.

      Moi? Je prefere Eau Sauvage de Dior.

  • Smelling something nice can be a pleasant experience. Who knew?

    • I remember becoming sceptical about the whole aromatherapy thing many years ago, when looking at charts saying which aroma was good for which mood; thinking, who decided this, who allocated which adjectives to which oils, and on what basis? And how do you decide which mood or combination of moods or attributes you have, or want? It struck me as being somewhat in the territory of phrenology, in which attributes were assigned, with conviction but without science, to cranial bumps. (Even Arthur Conan Doyle’s Sherlock Holmes fell for phrenology somewhat – he remarked on Professor Moriarty’s skull, as I recall).

  • The problem I have had in talking with ‘aromatherapists’ is that they claim (and perhaps, believe, how do we know?) that they are true ‘therapists’ – that they are treating some condition or another, and using aromata to do it. Akin to physiotherapists.

    Dr. Doyle had Holmes use phrenological insights, but as a science, the idea died out over forty years leaving only the scamists and gullible public to be interested, and serious psychologists/neuroscientists who advanced evidenced-based concepts of the brain having discrete functional areas.

    Even so, public demand for a head reading was so high that con-men were quick to take advantage. They realised that no formal training in phrenology was actually necessary to set themselves up as a phrenology head reader. The fact that people couldn’t tell the difference between these con-men and a professional seriously undermined even practical phrenology.

    This principle applies to all SCAMS: If the work and practice of a scamist cannot be distinguished from a ‘true’ practitioner (by critical examination of outcomes), we must remain confident that in time all will follow phrenology, astrology, alchemy – to the fringe.

    When homeopathy was reviewed by the House of Commons Science and Technology Committee in 2009-10, one homeopath was asked how a homeopathic remedy might be distinguished from a placebo. He answered: “Only by the label.”

    This Principle of Distinction should be applied to all who claim they are “Therapists”.

  • Smell To Get Well..

    • sounds like a new therapy where you have to pass as much wind as possible to enhance your chi

      • I’m wondering if this ‘aromatherapy’ would work just as well with, say, the scent of old underwear.

        Cuz seems to me what it might be doing is distracting the patient, thus the reduced perception of pain.

        If you release a mighty stench and the patient gets up from their sickbed and runs away with nose-aclamp, it can be declared a cure-all.

    • Smellness is the new wellness 😀

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