This Cochrane review assessed the efficacy and safety of aromatherapy for people with dementia. The researchers included randomised controlled trials which compared fragrance from plants in an intervention defined as aromatherapy for people with dementia with placebo aromatherapy or with treatment as usual. All doses, frequencies and fragrances of aromatherapy were considered. Participants in the included studies had a diagnosis of dementia of any subtype and severity.
The investigators included 13 studies with 708 participants. All participants had dementia and in the 12 trials which described the setting, all were resident in institutional care facilities. Nine trials recruited participants because they had significant agitation or other behavioural and psychological symptoms in dementia (BPSD) at baseline. The fragrances used were:
- lavender (eight studies);
- lemon balm (four studies);
- lavender and lemon balm,
- lavender and orange,
- cedar extracts (one study each).
For six trials, assessment of risk of bias and extraction of results was hampered by poor reporting. Four of the other seven trials were at low risk of bias in all domains, but all were small (range 18 to 186 participants; median 66). The primary outcomes were:
- overall behavioural,
- psychological symptoms,
- adverse effects.
Ten trials assessed agitation using various scales. Among the 5 trials for which the confidence in the results was moderate or low, 4 trials reported no significant effect on agitation and one trial reported a significant benefit of aromatherapy. The other 5 trials either reported no useable data or the confidence in the results was very low. Eight trials assessed overall BPSD using the Neuropsychiatric Inventory and there was moderate or low confidence in the results of 5 of them. Of these, 4 reported significant benefit from aromatherapy and one reported no significant effect.
Adverse events were poorly reported or not reported at all in most trials. No more than two trials assessed each of our secondary outcomes of quality of life, mood, sleep, activities of daily living, caregiver burden. There was no evidence of benefit on these outcomes. Three trials assessed cognition: one did not report any data and the other two trials reported no significant effect of aromatherapy on cognition. The confidence in the results of these studies was low.
The authors reached the following conclusions: We have not found any convincing evidence that aromatherapy (or exposure to fragrant plant oils) is beneficial for people with dementia although there are many limitations to the data. Conduct or reporting problems in half of the included studies meant that they could not contribute to the conclusions. Results from the other studies were inconsistent. Harms were very poorly reported in the included studies. In order for clear conclusions to be drawn, better design and reporting and consistency of outcome measurement in future trials would be needed.
This is a thorough review. It makes many of the points that I so often make regarding SCAM research:
- too many of the primary studies are badly designed;
- too many of the primary studies are too small;
- too many of the primary studies are poorly reported;
- too many of the primary studies fail to mention adverse effects thus violating research ethics;
- too many of the primary studies are done by pseudo-scientists who use research for promotion rather than testing hypotheses.
It is time that SCAM researchers, ethic review boards, funders, editors and journal reviewers take these points into serious consideration – if only to avoid clinical research getting a bad reputation and losing the support of patients without which it cannot exist.
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.
In 2012, we evaluated the efficacy/effectiveness of lavender for the reduction of stress/anxiety.
Our systematic review included 15 RCTs. Two trials scored 4 points on the 5-point Jadad scale, the remaining 13 scored two or less. Results from seven trials appeared to favour lavender over controls for at least one relevant outcome. We concluded that methodological issues limit the extent to which any conclusions can be drawn regarding the efficacy/effectiveness of lavender. The best evidence suggests that oral lavender supplements may have some therapeutic effects. However, further independent replications are needed before firm conclusions can be drawn.
Since 2012, more evidence has emerged. The latest study on the subject aimed to investigate the effects of lavender oil on sleep and quality of life of menopausal women through steam inhalation. It was quasi-experimental with pre-test/post-test placebo control groups. It was conducted with 57 women, 27 of whom were subject to aromatherapy and 30 to a placebo. Data were collected using the Questionnaire Form, the Pittsburgh Sleep Quality Index (PSQI) and the Menopause-Specific Quality of Life Questionnaire (MENQOL).
For the intervention group, the PSQI median scores after the administration of aromatherapy were found to be significantly lower than those before the administration (p < 0.001) and those of the placebo group (p < 0.001). Similarly, for the intervention group, the total median MENQOL scores after the administration of the aromatherapy were found to be significantly lower than the scores prior to the administration (p < 0.001) as well as the scores of the placebo group (p < 0.001).
The authors of the new study concluded that that aromatherapy involving lavender-scented steam inhalation increased sleep quality and quality of life in women with sleep deprivation problems during menopause.
Hurray, this seems to be a decent trial with a positive result for SCAM!
And why not? It is not at all implausible that lavender has hypnotic effects. There are now quite a few reasonably sound trials that suggest it works. Moreover, it is safe and not very expensive (or even free, if you can grow it yourself).
I for one am more than happy to report a positive finding for a SCAM and merely regret that I cannot do so more often.
My ‘Corona-Virus Quackery Club’ (CVQC) is getting rather popular. The current members,
are now thinking of admitting the essential oil salesmen. It seems that many of them find it impossible to resist the chance to make a fast buck on the fear many consumers currently have. Take this website for instance:
If you have a breathing aid or respiratory device, use it to reduce breathing difficulties. Alternatively, you can use a breathing ointment like Breathe and Focus Oil. Formulated with menthol, eucalyptus, rosemary and thyme essential oils, this phyto-aromatherapy ointment helps ease breathing difficulties commonly associated with cold, flu, cough, asthma and pneumonia. Gently massage a few drops of Breathe and Focus Oil to your chest and apply 1 to 2 drops to a tissue or handkerchief then inhale the aroma. Repeat as often as necessary.
Studies showed that eucalyptus essential oil contains cineole that helps reduce inflammation and infection in the lungs. Eucalyptus Radiata essential oil has antiviral effects against coronavirus SARS. Rosemary essential oil has been shown to be effective against Klebsiella pneumoniae, a bacteria which causes pneumonia in humans and animals. Thyme essential oil has been shown to have antiviral activities against Influenza A virus (H1N1), while menthol with its cooling-effect has also been shown to reduce breathing difficulties. These essential oils may help you dealing with Covid-19 disease.
Another website even has the promising title ‘What can you try to cure from coronavirus ….’ and it tells us that:
Black cumin can boost immunity, especially in patients with impaired immune systems. According to research, 1 gram Seed capsules, twice daily for four weeks can improve T-cell ratio between positive and negative up to 72%. Increased immunity plays an important role in the healing of colds, influenza, AIDS, and other diseases related to the immune system.
But there is more – so much more that I can here only present a very small selection of that is on offer.
- Cinnamon bark
- Clove bud
- Eucalyptus globulus/radiata
- Lemon myrtle
- Tea tree
- Thyme thymol & linalool
Yet another website includes the claim: “The most powerful anti-virus essential oils to provide defence (sic) against coronavirus include:
- Cedarwood Virginian
- Clove Bud
- Eucalyptus Globulus, Radiata and Smithii
- Juniper Berry
- Lavender Spike
- Laurel leaf
- Tea Tree
- Thyme Sweet Thyme White.”
I know, this is confusing! I do sympathise with the difficulty of choosing between all these recommendation; therefore, let me help you. Here is the full list of essential oils proven to prevent or treat a corona-virus infection:
Yes, that’s right: NO ESSENTIAL OIL HAS EVER BEEN FOUND TO BE EFFECTIVE AGAINST THIS OR ANY OTHER VIRUS INFECTION!
The FDA agree and have therefore sent out letters to seven US companies warning them to stop selling products that claim to cure or prevent COVID-19 infections, stating that such products are a threat to public health because they might prompt consumers to stop or delay appropriate medical treatment.
WELCOME TO THE CVQC, ESSENTIAL OIL SALESMEN!
The Internet is full of complete nonsense about alternative medicine, as we all know. Much of it could be funny – if it was not so extremely dangerous. Misinformation on health can (and I am afraid does) kill people. One of the worst BS I have seen for a long time is this article entitled ‘Here’s What Oncologists Won’t Tell You About Essential Oils’.
A few excerpts might be of interest:
START OF QUOTES
…The human body resonates at a frequency of 62-78 MHz and scientists believe that diseases start at 58 MHz. Many studies have shown that negative thoughts can reduce our frequency by 12 MHz, while positive thinking raises it by 10.
This means that there are many things that can affect our health in ways we can’t imagine.
According to the latest studies, essential oils can fight cancer thanks to their antibacterial properties and their ability to change the frequency we resonate at.
One of the scientists involved in the study, Bruce Tainio, developed a special Calibrated Frequency Monitor that measures the frequency of essential oils and how they affect us. M. Suhail, an immunologist, says that cancer develops when the DNA in our cells’ nucleus is corrupted.
Essential oils can correct this and repair the code, effectively improving our chances against the terrible disease…
In his book “The Body Electric”, R. O. Becker said that our bodies’ electronic frequency determines our health.
Even Nikola Tesla said that removing outside frequencies can make us more resistant against ailments, while Dr. Otto Warburg discovered over a century ago that our cells have a specific electrical voltage that can drop due to a various factors and trigger diseases such as cancer.
However, science has now discovered that essential oils with higher frequencies can destroy diseases with lower frequencies.
Here’s a list of some of the oils used in the research and their electrical frequencies:
- Juniper – 98 Mhz
- Angelica – 85 Mhz
- Frankincense – 147 MHz
- Rose – 320 Mhz.
- Sandalwood – 96 Mhz
- Helichrysum – 181 MHz
- Peppermint – 78 Mhz
- Lavender – 118 Mhz
In the study, cinnamon, thyme, jasmine and chamomile oils had the best results when put up against breast cancer cells. Chamomile destroyed 93% of the cells in vitro, while thyme destroyed 97% of the cells…
11 oils were examined in total including bitter and sweet fennel, winter savory, peppermint, sage, lavender, chamomile and thyme.
According to Suhail, frankincense oil can divide the nucleus of cancer cells from the cytoplasm and prevent it from reproducing. The oil works thanks to the presence of the so-called monoterpenes which have the ability to kill cancer cells.
Frankincense oil works in all stages of cancer and is cytotoxic, meaning it doesn’t destroy healthy cells.
End-stage liver cancer patient
In the study, a patient with end-stage liver cancer was given only a few months left to live. The tumor was inoperable due to the large size, so having nothing to lose, the man decided to try frankincense oil.
He applied a bit under his tongue and topically on the area of the liver, and on his next doctor visit, the tumor has already reduced in size. The patient continued using frankincense oil, and it eventually reduced just enough to be operable. His tumor was later removed and the man is now happily enjoying his life free of cancer.
A child with brain cancer
One of the toughest cases among all the patients in the study was a little girl aged 5 with brain cancer. After exhausting all other options, the parents decided to give the girl a mixture of frankincense and sandalwood oil.
They rubbed the mixture on her feet while also rubbing a bit of lavender on her wrist. After a few months, the cancer was completely defeated!
Bladder cancer patient
Jackie Hogan is a woman suffering from bladder cancer who needed to undergo a surgery for bladder removal due to the cancer.
However, she decided to try using essential oils in her condition and after a few months of applying a mixture of sandalwood and frankincense oil topically on the area, she is cancer-free.
Stage-4 cancer patient
One woman in the research was diagnosed with stage-4 lung cancer which has already spread to other organs in her body.
Instead of agreeing to chemo and surgery, the woman started applying a bit of frankincense oil topically on the affected areas of her body every 2-3 hours and she was completely healthy in 7 months.
Breast cancer patient
A woman diagnosed with advanced breast cancer used a mixture of frankincense and lemongrass oil (topically and under the tongue) to defeat the disease in only a few months.
Cervical cancer patient
A woman with cervical cancer was given only a few months left to live, but thanks to the powers of frankincense oil, she managed to defeat the diseases in a couple of months.
There are many more patients who have managed to defeat different types of cancer using the remarkable powers of various essential oils…
END OF QUOTES
I managed to find 4 of the studies this article seems to refer to:
Differential effects of selective frankincense (Ru Xiang) essential oil versus non-selective sandalwood (Tan Xiang) essential oil on cultured bladder cancer cells: a microarray and bioinformatics study.
Dozmorov MG, Yang Q, Wu W, Wren J, Suhail MM, Woolley CL, Young DG, Fung KM, Lin HK.
Chin Med. 2014 Jul 2;9:18. doi: 10.1186/1749-8546-9-18. eCollection 2014.
Ni X, Suhail MM, Yang Q, Cao A, Fung KM, Postier RG, Woolley C, Young G, Zhang J, Lin HK.
BMC Complement Altern Med. 2012 Dec 13;12:253. doi: 10.1186/1472-6882-12-253.
Woolley CL, Suhail MM, Smith BL, Boren KE, Taylor LC, Schreuder MF, Chai JK, Casabianca H, Haq S, Lin HK, Al-Shahri AA, Al-Hatmi S, Young DG.
J Chromatogr A. 2012 Oct 26;1261:158-63. doi: 10.1016/j.chroma.2012.06.073. Epub 2012 Jun 28.
Suhail MM, Wu W, Cao A, Mondalek FG, Fung KM, Shih PT, Fang YT, Woolley C, Young G, Lin HK.
BMC Complement Altern Med. 2011 Dec 15;11:129. doi: 10.1186/1472-6882-11-129.
I do not think that these papers actually show what is claimed above. Specifically, none of the 4 articles refers to clinical effects of essential oil on cancer patients. In fact, according to a 2014 review, and a 2013 paper (the most recent summaries I found) there are no clinical trials of essential oil as a cure for cancer.
The conclusion therefore must be this: Essential oils might be an interesting area of research, yet one has to tell consumers and patients very clearly:
there is no evidence to suggest that using essential oils will change the natural history of any type of cancer.
This week, I find it hard to decide where to focus; with all the fuzz about ‘Homeopathy Awareness Week’ it is easy to forget that our friends, the chiros are celebrating Chiropractic Awareness Week (9-15 April). On this occasion, the British Chiropractic Association (BCA), for instance, want people to keep moving to make a positive impact on managing and preventing back and neck pain.
Good advice! In a recent post, I even have concluded that people should “walk (slowly and cautiously) to the office of their preferred therapist, have a little rest there (say hello to the staff perhaps) and then walk straight back home.” The reason for my advice is based on the fact that there is precious little evidence that the spinal manipulations of chiropractors make much difference plus some worrying indications that they may cause serious damage.
It seems to me that, by focussing their PR away from spinal manipulations and towards the many other things chiropractors sometimes do – they often call this ‘adjunctive therapies’ – there is a tacit admission here that the hallmark intervention of chiros (spinal manipulation) is of dubious value.
A recent article entitled ‘Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative’ seems to confirm this impression. Its objective was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The specific aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.
The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a non-pharmacological intervention. The panel updated the search strategies in Medline and assessed admissible systematic reviews and randomized controlled trials. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee.
For patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises).
The authors concluded that a multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.
I find this paper most interesting and revealing. Considering that it originates from the ‘Canadian Chiropractic Guideline Initiative’, it is remarkably shy about recommending SMT – after all their vision is “To enhance the health of Canadians by fostering excellence in chiropractic care.” They are thus not likely to be overly critical of the treatment chiropractors use most, i. e. SMT.
Perhaps this is also the reason why, in their conclusion, they seem to have rather a large blind spot, namely the risks of SMT. I have commented on this issue more often than I care to remember. Most recently, I posted this:
The reason why my stance, as expressed on this blog and elsewhere, is often critical about certain alternative therapies is thus obvious and transparent. For none of them (except for massage) is the risk/benefit balance positive. And for spinal manipulation, it even turns out to be negative. It goes almost without saying that responsible advice must be to avoid treatments for which the benefits do not demonstrably outweigh the risks.
HAPPY CHIROPRACTIC AWARENESS WEEK EVERYONE!
It has been reported that ‘Boots the Chemist’ have filed several legal complaints against The Guardian in relation to articles published by the paper in relation to its April 2016 investigation. The Guardian articles in question alleged that Boots, the UK’s largest pharmacy chain, had placed undue pressure on its pharmacists to perform medicines use reviews so that it could claim the maximum payments possible from the NHS. In other words, The Guardian implied that Boots was trying to get more money from our NHS than might have been due.
Personally, I am always uneasy when I hear that someone takes legal action on such matters. I think that legal complaints of such a nature can turn out to be counter-productive, both in general and in this particular instance.
There could be several reasons. For instance, such actions might give someone the idea of filing complaints against Boots. I am sure it is not difficult to find reasons for that.
In the realm of alternative medicine, for example, someone might question whether selling homeopathic remedies in Boot’s section ‘pharmacy and health’ is not misleading. These remedies might be seen by a naïve customer as masquerading as medicines. As readers of this blog know all too well, they do not, in fact, contain anything (other than lactose) that has any pharmacological activity. Therefore Boots should best market them in the category of ‘confectionary’.
One might even suspect that Boots are fully aware of all this. After all, a spokesperson for the company stated years ago during a parliamentary inquiry: “I have no evidence to suggest that they [homeopathic remedies sold by Boots] are efficacious …”
And it is also not the first time that Boots have been challenged for selling products they know to be placebos. This is what The Guardian reported in 2008 about the issue: “Ernst accuses the company [Boots] of breaching ethical guidelines drawn up by the Royal Pharmaceutical Society of Great Britain, by failing to tell customers that its homeopathic medicines contain no active ingredients and are ineffective in clinical trials.”
A similar void of evidence also applies to Boot’s wide range of Bach Flower Remedies and aromatherapy oils.
Or am I wrong?
Perhaps Boots want to post links to the evidence in the comment section below?
I am always keen to learn and only too happy to change my mind in view of new, compelling evidence!
Boots also sell a very wide range of herbal medicines, and here the situation is quite different: herbal medicines actually contain molecules that might have pharmacological effects, i. e. they might heal or might harm you. And many of these products imply indications for which they should be taken. I will pick just one example to explain: HERBAL SLIM AID.
Yes, you are absolutely correct – this product is (according to its name) not for gaining weight, it’s for reducing it. Each coated tablet contains 45 mg of extract (as dry extract) from Bladderwrack thallus (Fucus vesiculosus L.) (5:1) (equivalent to 225 mg of Fucus) Extraction solvent: water, ,30 mg Dandelion Root (Taraxacum officinale Weber ex Wigg), 27 mg of extract (as dry extract) from Boldo leaf (Peumus boldus Molina) (4-6:1) (equivalent to 108-162 mg of Boldo leaf) Extraction solvent: Methanol 70% v/v, 10 mg Butternut Bark (Juglans cinerea L.).
Now, I thought I know quite a bit about herbal slimming aids, after all, we had a research focus on this topic for several years and have published about a dozen papers on the subject. But oddly, I cannot remember that this mixture of herbs has been shown to reduce body weight.
Perhaps Boots want to post evidence for the efficacy and safety of this product as well?
I certainly hope so, and I would instantly withdraw any hint of a suspicion that Boots are selling unproven or disproven medicines.
Where is all this going?
I have to admit that am not entirely sure myself.
I suppose all I wanted to express was that it might be unwise to throw stones when one is sitting in a glass-house – a cliché, I know, but it’s true nevertheless.
CONFLICTS OF INTEREST:
None [except I don’t like those who easily take legal action against others]
AROMATHERAPY is one of the most popular alternative therapies. The experience is usually pleasant enough, but what are the risks? None!!! At least this is what the therapists would claim. But is this true? Perhaps not. According to a recent press-release, the risks might be considerable.
Officials with the Tennessee Poison Control Center (TPC) are warning that they are seeing an increasing number of toxic exposures, mostly involving children, to essential oils used in aromatherapy. The TPC says the number of essential oil exposures doubled between 2011 and 2015, and 80 percent of those cases involved children. The primary route of poisoning is by ingestion, but also occurs with excessive or inappropriate application to the skin. Children are at risk because their skin easily absorbs oils and because they may try to ingest essential oils from the container.
“Tea tree oil is commonly cited, and most of those cases are accidental ingestions by children.” said Justin Loden, PharmD, certified specialist in Poison Information (CSPI) at TPC. Most essential oils have a pleasant smell but bitter taste, so children easily choke on them and aspirate the oil to their lungs, Loden said.
Several essential oils such as camphor, clove, lavender, eucalyptus, thyme, tea tree, and wintergreen oils are highly toxic. All of the oils produce oral and throat irritation, nausea, and vomiting when ingested. Most essential oils either produce central nervous system (CNS) stimulation, which results in agitation, hallucinations, delirium, and seizures or CNS depression, which results in lethargy and coma. Other toxic effects include painless chemical burns, hypotension, acute respiratory distress syndrome, acute liver failure, severe metabolic acidosis, and cerebral edema depending on which essential oil is in question.
Tennessee Poison Center Tips for using essential oils
- Safely using and storing essential oils is extremely important
- Use essential oil products ONLY for their intended purpose.
- Use only the amount stated on the label/guide.
- Do not swallow an essential oil unless the label says to do so.
- Do not use a product on the skin unless the label says to do so.
- Do not leave the product out (i.e. as a pesticide) unless the label says to do so.
- If you have bottles of essential oils at home, keep them locked up, out of sight and reach of children and pet at all times. Children act fast, so do poisons.
Many will think that this is alarmist – but I don’t. In fact, in 2012, I published a systematic review aimed at critically evaluating the evidence regarding the adverse effects associated with aromatherapy. No, it was not funded by ‘BIG PHARMA’ but by THE ROYAL COLLEGE OF PHYSICIANS, LONDON.
Five electronic databases were searched to identify all relevant case reports and case series. Forty two primary reports met our inclusion criteria. In total, 71 patients experienced adverse effects of aromatherapy. Adverse effects ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil and ylang-ylang were the most common essential oils responsible for adverse effects.
At the time, we concluded 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.
I might add – before the therapists start making comments – that, yes, aromatherapy is still dimensions safer than many conventional treatments. But remember: the value of a therapy is not determined by its safety but by the risk/benefit balance! And what are the proven benefits of aromatherapy, I ask you.
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:
- Why did this review focus on such a small time-frame? (Systematic reviews should include all the available evidence of a pre-defined quality.)
- The quality of the included studies was often very poor, and therefore the overall conclusion cannot be definitive.
- 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.
- It seems uncertain which essential oil is best suited for this indication.
- 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.
- 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.
My aim with this blog is to eventually cover most of the 400 or so different alternative therapies and diagnostic techniques. So far, I have focused on some of the most popular modalities; and this means, I have neglected many others. Today, it is time, I think, to discuss aromatherapy, after all, it is one of the most popular forms of alternative medicine in the UK.
Aromatherapists use essential oils, and this is where the confusion starts. They are called “essential” not because humans cannot do without them, like essential nutrients, for instance; they are called “essential” because they are made of flower ESSENCES. The man who ‘discovered’ aromatherapy was a chemist who accidentally had burnt his hand and put some lavender essence on the burn. It healed very quickly, and he thus concluded that essential oils can be useful therapeutics.
Today’s aromatherapists would rarely use the pure essential oil; they dilute it in an inert carrier oil and usually apply it via a very gentle massage to the skin. They believe that specific oils have specific effects for specific conditions. As these oils contain pharmacologically active ingredients, some of these assumptions might even be correct. The question, however, is one of concentration. Do these ingredients reach the target organ in sufficient quantities? Are they absorbed through the skin at all? Does smelling them have a sufficiently large effect to produce the claimed benefit?
The ‘acid test’ for any therapeutic claim is, as always, the clinical trial. As it happens a new paper has just become available. The aim of this randomised study was to determine the effects of inhalation aromatherapy on pregnant women. Essential oils with high linalool and linalyl acetate content were selected and among these the one preferred by the participant was used. Thirteen pregnant women in week 28 of a single pregnancy were randomly assigned into an aromatherapy and a control group. The main outcome measures were several validated scores to assess mood and the heart-rate variability. The results showed significant differences in the Tension-Anxiety score and the Anger-Hostility score after aromatherapy. Heart rate variability changes indicated that the parasympathetic nerve activity increased significantly in the verum group. The authors concluded that aromatherapy inhalation was effective and suggest that more research is warranted.
I have several reasons for mentioning this study here.
1st research into aromatherapy is rare and therefore any new trial of this popular treatment might be important.
2nd aromatherapy is mostly (but not in this study) used in conjunction with a gentle, soothing massage; any outcome of such an intervention is difficult to interpret: we cannot then know whether it was the massage or the oil that produced the observed effect. The present trial is different and might allow conclusions specifically about the effects of the essential oils.
3rd the study displays several classic methodological mistakes which are common in trials of alternative medicine. By exposing them, I hope that they might become less frequent in future.
The most obvious flaw is its tiny sample size. What is an adequate size, people often ask. This question is unfortunately unanswerable. To determine the adequate sample size, it is best to conduct a pilot study or use published data to calculate the required number of patients needed for the specific trial you are planning. Any statistician will be able to help you with this.
The second equally obvious flaw relates to the fact that the results and the conclusions of this study were based on comparing the outcome measures before with those after the interventions within one intervention group. The main reason for taking the trouble of running a control group in a clinical trial is that the findings from the experimental group are compared to those of the control group. Only such inter-group comparisons can tell us whether the results were actually caused by the intervention and not by other factors such as the passage of time, a placebo-effect etc.
In the present study, the authors seem to be aware of their mistake and mention that there were no significant differences in outcomes when the two groups were compared. Yet they fail to draw the right conclusion from this fact. It means that their study demonstrated that aromatherapy inhalation had no effect on the outcomes studied.
So, what does the reliable trial evidence on aromatherapy tell us?
A clinical trial in which I was involved failed to show that it improves the mood or quality of life of cancer patients. But one swallow does not make a summer; what do systematic reviews of all available trials indicate?
The first systematic review was probably the one we published in 2000. We then located 12 randomised clinical trials: six of them had no independent replication; six related to the relaxing effects of aromatherapy combined with massage. These 6 studies collectively suggested that aromatherapy massage has a mild but short-lasting anxiolytic effect. These effects of aromatherapy are probably not strong enough for it to be considered for the treatment of anxiety. We concluded that the hypothesis that it is effective for any other indication is not supported by the findings of rigorous clinical trials.
Since then several other systematic reviews have emerged. We therefore decided to summarise their findings in an overview of all available reviews. We searched 12 electronic databases and our departmental files without restrictions of time or language. The methodological quality of all systematic reviews was evaluated independently by two authors. Of 201 potentially relevant publications, 10 met our inclusion criteria. Most of the systematic reviews were of poor methodological quality. The clinical subject areas were hypertension, depression, anxiety, pain relief, and dementia. For none of the conditions was the evidence convincing. Our conclusions therefore had to be cautious: due to a number of caveats, the evidence is not sufficiently convincing that aromatherapy is an effective therapy for any condition.
Finally, we also investigated the safety of aromatherapy by assessing all published data regarding adverse effects. Forty two primary reports met our inclusion criteria. In total, 71 patients had experienced adverse effects after aromatherapy which ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil and ylang-ylang were the most common essential oils responsible for adverse effects. We concluded that aromatherapy has the potential to cause adverse effects some of which are serious. Their frequency remains unknown.
And what is the conclusion of all this? To me, it seems fairly straight forward: Aromatherapy is not demonstrably effective for any condition. It also is not entirely free of risks. Its risk/benefit profile is thus not positive which can only mean that it is not a useful or recommendable treatment for anybody who is ill.