Topics in PAIN MANAGEMENT Vol. 34, No. 1 Current Concepts and Treatment Strategies August 2018 CONTINUING EDUCATION ACTIVITY Aromatherapy: Does It Make “Scents” as Complementary Therapy in Pain Management? Angela Starkweather, PhD, ACNP-BC, FAAN The purpose of this article is to review evidence about the effectiveness of aromatherapy as a complementary therapy in the treatment of pain. Learning Objectives/Outcomes: After participating in the CME/CNE activity, the provider should be better able to: 1. Define aromatherapy and how it may be used as a complementary therapy. 2. Differentiate the 4 potential mechanisms by which aromatherapy may influence health and well-being. 3. Analyze the evidence on the effectiveness of aromatherapy for reducing pain. Key Words: Aromatherapy, Essential oils, Odor, Pain management romatherapy is the use of concentrated essential oils, psychiatric manifestations, and infection, and integrated into Awhich are volatile liquids extracted by steam distillation spiritual practices and cultural rituals.1 or mechanical expression from flowers, herbs, or trees, to There are many essential oils available for aromatherapy, improve health and well-being. Essential oils have been a part such as bergamot, cedarwood, Roman chamomile, geranium, of the healing practices of most ancient cultures and were ginger, jasmine, lavender, lemon, and tea tree. Each type of used to treat ailments, such as fever, cough, headaches, essential oil has a unique chemical composition that deter- mines its smell, how it is absorbed, and how it affects the Dr. Starkweather is Professor and Director, Center for Advancement in In This Issue Managing Pain, University of Connecticut School of Nursing, 231 CE Article: Aromatherapy: Does It Make “Scents” as Glenbrook Rd, Storrs, CT 06269; E-mail: angela.starkweather@ Complementary Therapy in Pain Management? . .1 uconn.edu. The author, faculty, and staff in a position to control the content of this ICYMI: In Case You Missed It . .9 CME/CNE activity have disclosed that they and their spouses/life partners (if any) have no financial relationships with, or financial CE Quiz . .11 interests in, any commercial organizations pertaining to this educational activity. CME Accreditation Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This CME activity expires on July 31, 2020. CNE Accreditation Lippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Lippincott Professional Development will award 1.0 contact hours for this continuing nursing education activity. Instructions for earning ANCC contact hours are included on page 11 of the newsletter. This CNE activity expires on June 5, 2020. 1 TTPMv34n1.inddPMv34n1.indd 1 004/07/184/07/18 66:58:58 AAMM Topics in Pain Management August 2018 2 CO-EDITORS body. Essential oils can be inhaled, applied topically, or ingested. However, the most common use is for inhalation.1 Elizabeth A.M. Frost, MD Most essential oils have been approved as ingredients in food Professor of Anesthesiology Icahn School of Medicine at Mount Sinai and fragrances and are labeled by the FDA as “generally rec- New York, NY ognized as safe” (GRAS). However, aromatherapy products do not need FDA approval unless there is a claim for treat- ment of specific diseases.3 Angela Starkweather, PhD, ACNP-BC, CNRN, FAAN Professor of Nursing Aromatherapy can be used via inhalation, topical application University of Connecticut School of Nursing with or without massage, or in baths. As the essence oils are Storrs, CT inhaled through the nasal mucosa, the molecules diffuse to receptors on olfactory sensory neurons, which send messages to the brain, where the smell is interpreted. In the limbic sys- ASSOCIATE EDITOR tem, the emotional center of the brain, aromas that are famil- iar can evoke memories and emotions associated with the Anne Haddad Baltimore, MD smell. Aromatic molecules carried to the lungs can enter the bloodstream and travel to other parts of the body. However, the pharmacologic properties of inhaled essence oils have not been verified in humans and many questions remain regard- EDITORIAL BOARD ing the proposed pharmacologic effects.4 Jennifer Bolen, JD Topical application of essential oils is carried out by diluting The Legal Side of Pain, Knoxville, TN the essential oil with a carrier oil (such as sweet almond oil or olive oil). Some of the aromatic oils applied topically have 3 C. Alan Lyles, ScD, MPH, RPh antibacterial, anti-inflammatory, and analgesic effects. University of Baltimore, Baltimore, MD Allergic reactions may occur when essential oils are used and a skin patch test can be performed to test for allergies, espe- cially in patients who have multiple chemical sensitivities, Stephen Silberstein, MD Jefferson Headache Center, Philadelphia, PA seasonal allergies, or a history of topical allergic reactions. Another approach for topical application is to start with a low dilution at 1% or less, with gradual increases of 0.5% if Steven Silverman, MD Michigan Head Pain and Neurological Institute, Ann Arbor, MI The continuing education activity in Topics in Pain Management is intended for clinical and academic physicians from the specialties of anesthesiology, neurology, psychiatry, physical and rehabilitative medicine, and neurosurgery, as well as residents in those fields Sahar Swidan, PharmD, BCPS and other practitioners interested in pain management. Pharmacy Solutions, Ann Arbor, MI Topics in Pain Management (ISSN 0882-5646) is published monthly by Wolters Kluwer Health, Inc. at 14700 Citicorp Drive, Bldg 3, Hagerstown, MD P. Sebastian Thomas, MD 21742. Customer Service: Phone (800) 638-3030, Fax (301) 223-2400, or Email Syracuse, NY [email protected]. Visit our website at lww.com. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Priority postage paid at Hagerstown, MD, and at additional mailing offices. GST registration number: 895524239. POSTMASTER: Send address changes to Topics in Pain Management, Emily Wakefield, PsyD PO Box 1610, Hagerstown, MD 21740. Connecticut Children’s Medical Center, University of Publisher: Randi Davis Connecticut School of Medicine, Hartford, CT Subscription rates: Individual: US $339, international: $467. Institutional: US $768, international $894. In-training: US $148 with no CME, international $168. Single copies: $73. Send bulk pricing requests to Publisher. 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Topics in Pain Management is independent and not affiliated with any organization, vendor Lonnie Zeltzer, MD or company. Opinions expressed do not necessarily reflect the views of the Publisher, Editor, or UCLA School of Medicine, Los Angeles, CA Editorial Board. A mention of products or services does not constitute endorsement. All com- ments are for general guidance only; professional counsel should be sought for specific situa- tions. Editorial matters should be addressed to Anne Haddad, Associate Editor, Topics in Pain Management, 204 E. Lake Avenue, Baltimore, MD, 21212; E-mail: [email protected]. Topics in Pain Management is indexed by SIIC HINARI and Google Scholar. 2 ©2018 Wolters Kluwer Health, Inc. All rights reserved. TTPMv34n1.inddPMv34n1.indd 2 004/07/184/07/18 66:58:58 AAMM Topics in Pain Management August 2018 there are no signs of an allergic reaction. In infants up to the memory of the odor and associations with particular stimuli age of 6 months, the recommended dilution is 1 drop of within the current status and conditions of the individual. essential oil in 20 mL of carrier solution, whereas a 0.5% There is a difference between complementary therapy and dilution should be used for older children, elderly, and expect- alternative therapy. It is important to understand this distinc- ant mothers.5 To create a 1% dilution, it is generally advised tion, and the concept of integrative care. Regardless of to use 6 drops of essential oil per ounce (29.6 mL) of carrier whether aromatherapy produces