The Many Sides of Aromatherapy: Pain, Sleep, Stress, and Beyond
Deneene R. Doyker-Booth
What is Aromatherapy? This is a derivative of herbal medicine, which uses essential oils, derived from aromatic plants, in a therapeutic manner, to stimulate the olfactory system (smell receptors in the nose) that then send signals to the brain to the Limbic system, which is the part of the brain that controls emotions. Aromatherapy has also been shown to be beneficial for relaxation, anxiety reduction, improvement of sleep, relief of pain (help with labor pain, reduce post surgical pain), relieve chemotherapy side effects, improve cardiac rehabilitation, and also enhance energy. Saying this, there is little data on the efficacy, and the mechanism of action of how it works continues to be controversial.
This small article will present some data, and hopefully will inspire further questions and research to define how and why aromatherapy works. This is not a foreign concept. For example, since the time of the Ancient Egyptians and Hippocrates, the mechanism of how Aspirin (Willow Bark) provided pain relief, and decreased fever and inflammation was unknown, yet it did, and was used for this purpose. Not until the 18th Century were enough questions asked, was the research done to finally isolate the acetylsalicyclic acid in the late 1800’s that we know and use today.
In 2008, a group of researchers at Ohio State University looked at how aromatherapy affected mood, autonomic, endocrine and immune function. In their research they used the lemon and lavender essential oil as these were widely used oils for stimulation and relaxation respectively. What they found, was that there was no differences in gender in odor responsiveness, although it is known that women have a more acute sense of smell. Unfortunately, in this study, there was no relationship found with aromatherapy and pain, however, there are subsequent studies that will be presented in this article in regards to their positive impact on pain. Keocolt-Glaser et al did find that the lemon oil inhalation did enhance positive mood, and did boost norepinephrine release. They did not find any other physiological or health related benefits from either lemon or lavender oils.
In a study done in 2015 by Mohammad Ali Heidari Gorji et al, lavender 2% aromatherapy was studied in regards to the effectiveness of sternotomy pain intensity after coronary artery bypass. Here, the study measured the pain severity in 4 phases, representing before inhalation, 5 min, 30min and 60min after inhalation. The severity of the pain was decreased in phases 2, 3, and 4 with the greatest decrease in phase 4, which in turn resulted in less opioid medication administration needed. How? The proposed mechanism for this physiological finding according to the researchers was that the aromatherapy affected the patient both physiologically as well as physiologically where the lavender stimulated the receptors in the olfactory system which then signals to the Limbic system in the brain (the center of emotions), which then could theoretically secrete endorphins, encephalin and serotonin in response to the stimulus, which then affects heart rate, blood pressure, respiration, leading to decreased physiological stress response to pain, and decreased pain. It was further proposed by Re et al (2000), that in regards to lavender itself, the Linalool component may act as a sedative (via decreased acetylcholine release), and linalyl acetate had a narcotic-like effect to reduce pain.
There are several other studies that looked at the effects of lavender in regards to labor pain, where it was found to decrease the level of pain in 38% of the cases (Burns et al 2007, Vakilian et al 2012). It was found to decrease pain associated with dysmenorrhea and menstruation ( Han et al 2008). And lastly was found to improve depression and pain in patients with Rheumatoid Arthritis in research done by Kim et al (2005).
Aromatherapy with lavender (Lavandula angustifolia), has also been shown to be effective for sleep when combined with sleep hygiene versus sleep hygiene alone (Lillehei et al 2015), in the study of college students with sleep disturbance. Although the exact mechanism is unknown, nor was one proposed by the research group. Due to the safety profile of the lavender, it was deemed a safe and effective modality as a first-line sleep intervention. This was taken a step further by Kao et al in their 2017 study where this random controlled trial looked at aromatherapy and acupressure massage and the effects on sleep in career women with sleep disturbance. In this study, three inhalation mixes were used, placebo (distilled water), lavender essential oil (Lavandula angustifolia), and a blended essential oil (1:1:1 ratio of Lavandula. angustifolia, Salvia sclarea (Clary Sage), and Origanum majorana (Sweet Manjoram)), all 4 with and without acupressure massage. It was found in this study, the group that had the greatest positive improvement of their sleep was in the group with the blended essential oil and acupressure massage.
And finally there have been several studies reported in regards to the evidence of therapeutic outcomes on palliative and cancer patient populations, where there was a decrease in anxiety, physical and psychological symptoms as well as overall quality of life, with chamomile essential oil and massage as well as a blended essential oil and massage (PDQ Aromatherapy and Essential Oils. Bethesda, MD: National Cancer Institute).
With the above short article, hopefully you have questions in regards to this subset of complementary and alternative medicine therapy. I encourage you to never stop asking questions, or looking for answers……in my journey, it has been quite helpful. I am an anesthesiologist, Pain Management Specialist, and Interventionalist and approach my patients as a whole person, who may have many layers requiring healing (physical and emotional). Although this is not for everyone, it may be just what is needed to improve the quality of life of those who are suffering. They may be your neighbors, your friends, or your family. They are worth asking those questions, and are worth finding the answers.
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