aromatherapy mythical magical or medicinal.pdf

7/25/2019 Aromatherapy Mythical Magical or Medicinal.pdf

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Aspen Pub./HNP AS130-02 August 13, 2002 20:14 Char Count= 0

THEME ARTICLES

Aromatherapy: Mythical,Magical, or Medicinal?

Aromatherapy, a branch of herbology, is one of the fastest growing therapies in the world today. Historically,

essential oils are best used in the form of massage or bath oils or inhalations. Frequently, it is reported that

aromatherapy leaves one feeling uplifted, stimulated, invigorated, or rejuvenated, depending on the oil used.

When inhaled, the various aromas penetrate the bloodstream via the lungs causing physiologic changes. In turn,

the limbic system, which controls our emotions and memories, is affected. Some consider aromatherapy as

mystical or magical; others, however, are attempting to validate empirically this ancient therapy as medicinal.

Key words:alternative medicine,aromatherapy,complementary medicine

Deborah V. Thomas, EdD, ARNP, CS

Assistant Professor

School of Nursing

University of Louisville

Louisville, Kentucky

My soul travels on the smell of perfume like the souls

of other men on music.

Charles Baudelaire

Little Poems in Prose:A Hemisphere of Hair(1857)

INTRODUCTION

How does that make you feel? Ah, the

quintessential question of mental health pro-fessionals. Is how we feel complexly re-

lated to or merely subjugated to the simplest

anatomy of the olfactory system? Is aro-

matherapy magical, mythical, or medicinal?

Perhaps the answer will never be clearly de-

fined; however, there are some things we do

know. Specifically, we know that, for many

individuals coming home after a long day

at work, the simple ritual of lighting a can-

dle or two around the house will help to

soothe the soul andcalm thenerves, allowing

the body and mind to relax and reenergize.

The popularity of various complementary

and alternative medicine (CAM) therapies,

including aromatherapy, is on the rise due

Holist Nurs Pract 2002;17(1):816c 2002 Lippincott Williams & Wilkins, Inc.

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Aromatherapy 9

in part to trends in cultural communication,

marketing, and product promotion. Also, it is

reflected in nurses use of aromatherapy. The

three most common CAM therapies used

by nurses are aromatherapy, massage, and

reflexology.1

The practical link between smell, emo-

tions, thoughts, and feelings is obvious to

most of us. We usually associate smells with

a pleasant or unpleasant feeling, hardly ever

a neutral one. This is a powerful indicator

of how smells, via the olfactory nerves, linkup with the limbic system in the brain. The

limbic system is the command central for

our emotional or affective states, and it is

connected to the olfactory bulb.2

This does not preclude or negate the no-

tion that many other sensory inputs could

stimulate equally pleasant thoughts or feel-

ings. While the sense of smell enjoys no par-

ticular advantage when it comes to access-

ing various parts of the brain, neither can

it be ignored. Perception of the experience

is what matters most, not the reality of theexperience, which may not be empirically

supported.

Thus, the value of aromatherapy can-

not be underestimated; this fact in itself con-

tributes to the difficulty in defining empiri-

cal support. There is a great deal of debate

over the efficacy of aromatherapy. Some ar-

gue that claims for therapeutic value or ben-

efit outweigh the scientific evidence.3,4 Re-

gardless of the side of the debate on which

you fall, the use of CAM therapies, of which

aromatherapy is but one, is gaining contin-ued attention from consumers and health

care providers.5 This requires nursing to

move forward with research that will sup-

port claims on either side of the debate re-

garding use and benefit of aromatherapy as

one modality of CAM.

The purpose of this article is to briefly re-

view the definition and history of aromather-

apy, present a summary of current research

related to uses of aromatherapy in various

clinical situations, and discuss ethical impli-

cations for practice.

DEFINITION

Current literature defines aromatherapy as

the use of pure essential oils from various

parts of a plant, including the blossoms,roots, or leaves, to help improve physical

and mental health, quality of life in general,

or just for fun.2,6 Pleasant smelling botanical

oils such as rose, lemon, lavender, and pep-

permint can be added to the bath, massaged

into the skin, inhaled directly, or diffused to

scent an entire room. Thus, aromatherapy

means treatment using scents.

There are about 150 essential oils. Table 1

provides a sampling of these and their var-

ied effects. Most essential oils have anti-

septic properties; some are antiviral, anti-inflammatory, pain relieving, antidepressant,

or expectorant. Those who use aromathera-

pies may take advantage of other properties

of essential oils such as stimulation, relax-

ation, and digestion improvement as well as

their diuretic properties.

HISTORY

Aromatherapy datesback over 6,000 years

to ancient Egypt,the FarEast, China,and Re-

naissance Europe. Ayurveda is Indias tradi-tional, natural system of medicine that has

been practiced for more than 5,000 years.

Ayurveda is a Sanskrit word that, literally

translated, means science of life; it in-

cludes the use of aromatic oils in rejuvenat-

ing and healing recipes.


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10 HOLISTICNURSINGPRACTICE/OCTOBER2002

Table 1. Essential oils and effects

Essential oil Effect

Basil Uplifting, refreshing, clarifying, aiding concentration

Bergamot Refreshing, uplifting

Chamomile Refreshing, relaxing, calming, soothing, balancing

Cedarwood Sedating, calming, soothing, strengthening

Clary sage Warming, relaxing, uplifting, calming, causing euphoria

Cypress Relaxing, refreshing, providing astringent qualities

Eucalyptus Head clearing, providing antiseptic and decongestant properties, invigorating

Fennel Providing carminative properties, easing wind and indigestion

Frankincense Relaxing, rejuvenating, easing breathing, dispelling fears

Geranium Refreshing, relaxing, balancing, harmonizingHyssop Providing decongestant properties

Jasmine Relaxing, soothing, building confidence

Juniper Refreshing, stimulating, relaxing, promoting diuresis

Lavender Refreshing, relaxing, providing therapeutic qualities, calming, soothing

Lemon Refreshing, stimulating, uplifting, motivating

Lemongrass Toning, refreshing, fortifying

Marjoram Warming, fortifying, sedating

Melissa Uplifting, refreshing

Myrrh Toning, strengthening, rejuvenating, providing expectorant properties

Neroli Relaxing, dispelling fears

Orange Refreshing, relaxing

Patchouli Relaxing, enhancing to sensuality

Peppermint Cooling, refreshing, head clearing

Petitgrain Refreshing, relaxingPine Refreshing, providing antiseptic properties, invigorating, stimulating

Rose Relaxing, soothing, enhancing to sensuality, building confidence

Rosemary Invigorating, refreshing, stimulating, clarifying

Sandalwood Relaxing, warming, building confidence, grounding

Tea tree Acting as antiseptic, strengthening to immune system

Thyme Acting as antiseptic, refreshing, strengthening to immune system

Ylang ylang Relaxing, soothing, enhancing to sensuality

The medieval physician Avicenna is

credited with determining the methods for

extracting essential oils from plants.3 Theancient Egyptians used aromatherapy for

religious and medicinal purposes and in

incense, embalming, perfumes, and cosmet-

ics. Wigs often were scented with oils to

mask the stench of unsanitary streets and

bodies. Hippocrates, the father of modern

medicine, used aromatherapy baths and

scented massage. He also used aromatic

fumigations to rid Athens of the plague.In France, hospitals often burned rosemary

and lavender for fumigation.

In the 1930s the term aromatherapy

was coined when French chemist Rene

Maurice Gattefosse discovered the benefits

of lavender oil when it healed his burned


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Aromatherapy 11

hand without leaving scars. He then started

investigating the effects of other essential

oils for healing.7 During World War I,

French army surgeon Dr Jean Valnet ex-

perimented on wounded soldiers and found

that essential oils were excellent antiseptics

that detoxified. Later, Madame Marguerite

Maury elevated aromatherapy as a holistic

therapy. She started prescribing essential

oils as remedies for her patients ailments.

She also is credited with the modern use of

essential oils in massage.7

Today, essential oils are very potent,

complex, highly fragrant, and volatile sub-

stances. Essential oils consist of chemical

compounds that contain hydrogen, carbon,

and oxygen. The primary functional groups

of the essential oils used in aromatherapy are

monoterpenes, esters, aldehydes, ketones,

alcohols, phenols, and oxides.8

Current aromatherapy products are avail-

able as ointments, lotions, creams, soaps,

shampoos, bath salts, massage oils, com-

presses, vaporizers, personal mists, roomdiffusers, room mists, incense, and candles.

Most aromatherapy products are delivered

to the body via massage or inhalation. His-

torically, aromatherapy must be acknowl-

edged as a timeless intervention, growing

and evolving as practitioners use scientific

rigor to explore its effects.

RESEARCH

A review of the literature suggests ma-

jor gaps in the knowledge related to theclinical application of aromatherapy in re-

lation to issues of dosage, methods of ad-

ministration, and therapeutic effects.9 There

is a paucity in both quantitative and quali-

tative studies pertinent to aromatherapy as

a specific modality of complementary ther-

apy. There are many peripherally relevant

articles that address anecdotal practice stan-

dards, opinions, or philosophical beliefs as

they relate to the practice of complemen-

tary or alternative therapies. No randomized,

controlled, double-blind studies were found.

One problem encountered with this litera-

ture review is that there appeared to be many

studies related to aromatherapy. However,on

further examination most of these studies ac-

tually were looking at alternative medicine

as a whole and most often reported researchrelated to the use of herbs. The following are

examples of the types of studies currently

reported in the literature on aromatherapy in

clinical settings.

Walsh and Wilson10 randomly as-

signed severely disabled participants in an

extended-stay neurology unit to receive

five hourly sessions of one of four of the

following treatment regimens: relaxation,

aromatherapy, reflexology, or aromatherapy

and reflexology combined. Treatments

occurred weekly for 5 weeks. Daily recordsof perceived problems, pain, and mood

were maintained throughout the study.

Results indicated that patients daily mood

ratings were highest when aromatherapy

and reflexology were combined.

Using the General Health Questionnaire,

results suggest a positive reduction in re-

ports of psychological distress by these

patients. Methodological flaws were pre-

empted by use of visual analog scales and

semi-structured interviews using psychome-

trically valid measures of mental healthand personal adjustment. In addition, nurses

were unaware of which type of therapy

was being administered to participants un-

til completion of the study. As a result

of this study, regular baseline assessments

for all new patients and post-intervention


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evaluations have been implemented as stan-

dard practice.10

Tate11 attempted to establish efficacy of

peppermint oil as treatment for postoper-

ative nausea. There were no statistically

significant differences between subjects or

variables. In this three-condition design,

peppermint oil was the independent variable

and nausea was the dependent variable.

Sample size was 18 patients who underwent

gynecologic surgery.

Subjects were randomly assigned to ei-ther a control group (no treatment), group 2

(placebo), or group 3 (peppermint oil). All

patients were in single rooms on two wings

to eliminate cross-contamination. Results of

this study indicate there is some evidence

to suggest that peppermint oil may im-

prove postoperative nausea in gynecologic

patients.11 Further studies with varied post-

operative patients need to be performed.

In a study by Dunn and associates,12

122 patients admitted to a general intensive

care unit (ICU) were randomly chosen to re-ceive massage, aromatherapy using essential

oil of lavender, or a period of bed rest. As-

sessments before and after included phys-

iologic stress indicators and patients self-

report of anxiety levels, mood, and ability to

cope with the ICU experience.

Of the 122 initial participants, 77% were

able to complete subjective assessments. Re-

sults suggest that patients who received aro-

matherapy reported significantly greater im-

Patients who received aromatherapy

reported significantly greater

improvement in their mood and

perceived level of anxiety.

provement in their mood and perceived level

of anxiety. These participants also felt less

anxious and more positive immediately fol-

lowing the therapy, although this effect was

not sustained or cumulative.12 The results

of this study cannot be generalized; how-

ever, thefindings raise a numberof important

points for health care providers to consider

when planning for the care of patients.

Blanc and coworkers5 conducted a ran-

dom population telephone sample of adults

aged 18 to 50 with a self-report of a physi-cian diagnosis of asthma or rhinosinusi-

tis. The study objective was to determine

prevalence of specific CAM use, includ-

ing aromatherapy. Structured telephone in-

terviews inquired about CAM use in the past

12 months. Results indicated that, in this

population, herbal use was reported by 24%

of participants. However, there were no sta-

tistical differences in the frequency of herbal

use, overall or by subcategory, among those

with asthma compared with those with rhi-

nosinusitis. This also was true for acupunc-ture, aromatherapy, and various forms of

massage.

In a small pilot study by Komori and

colleagues,13 12 depressed men were ex-

posed to citrus fragrance in the air and com-

pared with 8 patients not exposed to the fra-

grance. Both groups were taking prescribed

antidepressants. It was reported that the dose

of antidepressants in the experimental group

could be significantly reduced. However, the

study was not randomized and included a

small number of participants with varyingdose and type of antidepressants. Accord-

ing to this study, it is not possible to draw

any clear conclusions about the value of aro-

matherapy for depression.

Using a quasi-experimental design with a

convenience samplingmethod, Brownfield14


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Aromatherapy 13

selected nine patients diagnosed with

rheumatoid arthritis. Each participant was

placed in one of three groups. The con-

trol group completed pre- and posttests only.

Group 2 completed pretests and were mas-

saged for two nights with no oil, then com-

pleted the posttest, followed by two nights

of massage with lavender oil. Group 3 did

the reverse of group 2. The variables being

investigated were pain perception, sleep, and

well-being.

Quantitative results about pain, generatedfrom the Visual Analog Scale (VAS), did

not reveal any reduction in pain levels fol-

lowing massage or aromatherapy massage.

However, data generated by interview re-

vealed that those patients receiving the mas-

sage with lavender oil were able to decrease

intake of analgesia due to perceived reduc-

tion in pain perception. Investigators report

this contradictory finding may be due to pa-

tients with rheumatoid arthritis having diffi-

culty distinguishing pain from stiffness, and

patients may define pain differently at differ-ent times.

No improvement in sleep was noted in the

VAS recordings. Once again, the interview

responses showed that the use of massage

with lavender oil affected sleep patterns in a

positive manner.

The VAS data suggest that perceptions of

the massage containing lavender oil showed

enhanced perception of well-being. Thisalso

was reflected in the interviews.14 A ma-

jority of respondents in this study (83%,

n= 5) expressed a desire to receive fur-ther massage containing lavender oil if the

treatment was to be available to them in

the hospital. An obvious limitation to this

study is the study sample size and the inher-

ent limitations using a quasi-experimental

design.

In a study conducted by Hay and

associates,15 the efficacy of aromatherapy

in the treatment of patients with alopecia

areata was examined using a randomized,

double-blind, controlled trial of 7 months

duration, with follow-up at 3 and 7 months.

The study was conducted in a dermatology

outpatient department. There were 86 invited

participants, all diagnosed as having alope-

cia areata. The 86 patients were randomized

into two groups. The active group massaged

essential oils (thyme, rosemary, lavender,and cedarwood) in a mixture of carrier oils

(jojoba and grapeseed) into their scalp daily.

The control group used only carrier oils for

their daily scalp massage.

Two dermatologists independently eval-

uated treatment success using sequential

photographs. Likewise, degree of improve-

ment was measured by two methods: a

6-point scale and computerized analysis of

traced areas of alopecia. Results indicated

that 19 (44%) of 43 patients in the active

group showed improvement compared with6 (15%) of 41 patients in the control group.

An alopecia scale was applied by blinded ob-

servers on sequential photographs and was

shown to be reproducible with good interob-

server agreement(kappa=0.84). The degree

of improvement on photographic assessment

was significant (p= .05). Demographic anal-

ysis showed that the two groups were well

matched for prognostic factors. Results sug-

gest aromatherapy is a safe and effective

treatment for alopecia areata.

Hay and coworkers15 reported that treat-ment with these essential oils was signif-

icantly more effective than treatment with

the carrier oil alone. A potential limitation

to this study lies in the fact that the investi-

gators did not clearly delineate their process

for randomization.


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While all of the research studies discussed

indicate encouraging information about the

use and potential benefits of aromatherapy,

there must be considerable effort to conduct

experimental research to further the fund

of knowledge needed for evidence-based

practice.

IMPLICATIONS FOR PRACTICE

AND ETHICAL CONSIDERATIONS

Even though aromatherapy is widely prac-ticed, as well as other forms of complemen-

tary or alternative therapies, there still exists

a lacunae of empirical support on which to

base practice. Existing evidence is mainly

based on anecdotal claims in the absence

of well-designed case studies or randomized

control trials.12,16 Nurses must continue to

evaluate the benefit, or lack thereof, of CAM

techniques (such as aromatherapy), ensuring

sound evidence-based practice that will hold

up to rigorous scrutiny and not be rebuffed

as the trend or therapy of the month.Norton17 suggests that nurses must con-

sider incorporating or facilitating various

complementary therapies to benefit patients.

Along with this responsibility comes an ac-

countability to ensure an appropriate, sound

knowledgebase and clinical savvy.

Trends in modern medicine have been re-

ductionistic in nature and have assumed that

patients seek only to be cured. This has

occurred slowly over time and is increas-

ing due to a highly technological approach,

which often emphasizes interventions suchas surgery and medication. It is beyond the

scope of this article to discuss the impact of

insuranceand managed care on the increased

focus on curing versus caring. However,

this is a powerfulcontributingfactor andcan-

not be ignored.

Some may argue that nursing, in contrast,

focuses on a caring approach using compas-

sionate caring skills to help move a patient to

a healthier state of mind, body, and spirit.18

Watsons19 caring theory of nursing main-

tains that caring is one of the intrinsic factors

needed to guide holistic nursing practice that

truly integrates the physical, psychosocial,

and spiritual needs of the patient. Many

of the nursing theorists, such as Levine,

Neuman and Roy, support this and reflect

the importance of a holistic approach.While it may be simple to choose one

or the other of these philosophical leanings

toward the medical or nursing model (re-

gardless of professional discipline), if we

are truly dedicated to the benefit and well-

being of our patients, we may opt to em-

brace both. As we move away from the

traditional paternalistic model of health care

where provider knows best, perhaps we

can truly begin to demonstrate uncondi-

tional respect for and encourage the auton-

omy of our patients within the health caresystem.

For practitioners using various functions

or applications of aromatherapy, patient suf-

fering may seem to diminish. Relief, if only

briefly, is often welcomed by those suffering

from physiologic or emotional pain and suf-

fering. Frequently, modern health care prac-

titioners sacrifice contact with patients in the

name of efficiency. Sadly, this lack of con-

nection or contact hurts both the patient and

the practitioner.

The most powerful therapeutic or seem-ingly magical cures occur due to the time

a practitioner and patient are able to spend

getting to know each other.20 Often, the sub-

tleties that occur during seemingly unim-

portant conversation can hold the key to

therapeutic interventions.


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Aromatherapy 15

If you do not connect with your patients

they may never tell you the simple things

that work for them, such as an herbal bath,

a scented candle, or a massage with laven-

der oil. While these things may not, in and of

themselves, cure, they may certainly make

someone feel better. Often the most effica-

cious therapy is one that is not quickly dis-

cernible to the researcher. It is reasonable to

consider that this may be in part due to the

neurobiologic foundation of aromatherapy,

which is not easily studied in live humans.Comfort or relief from sufferingmay be so

subtly induced it is not measurable by labo-

ratory tests or brain waves. Maybe it is only

measurable by report of our patients. Maybe

this is what we should listen to most. Isnt

that why we do what we do as nurses?

CONCLUSION

Currently there is a lack of sound evidence

regarding the appropriate use of aromather-

apy in a variety of health care settings. Anec-dotal accounts are plentiful, however, they

are not supportedby randomized, controlled,

double-blind studies. In fact, such studies

have not been performed. Part of the rea-

son may be the lack of available funding

for this area of research as opposed to the

vast resources available to pharmaceutical

companies. Thus, in order to practice in a

manner that is morally and ethically respon-

sible, nursing must systematically evaluate

any new therapeutic modalities such as aro-

matherapy that have the potential to do harm

as well as good.

With this in mind, perhaps the question

initially posed in the article title is not yet

readily answered. It may well depend on

the practitioner or the patient, the day, themood, the scent, or even the intentionality

of the provider. Maybe the enigma of the

essence of aromatherapy serves as a guiding

premise to the answer. To some, it is myth,

because there is no real empirical evidence

in the volumes necessary to be counted. For

others, perhaps the magic is thebelief or faith

that it will work. Yet, for others, it may be

clear and simple: a medicinal approach to

distress, illness, or health promotion. It is

clear that clinical studies must be conducted

to garner support for effectiveness as wellas determine potential dangers to patients. It

seems that whatever argument we use to an-

swer this question, the end result will vary in

degree by circumstance, context, and inher-

ent belief of individuals.

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