By David Kiefer, MD
Clinical Assistant Professor, Department of Family Medicine, University of Wisconsin (Madison); Clinical Assistant Professor of Medicine, Arizona Center for Integrative Medicine, University of Arizona, Tucson
Dr. Kiefer reports no financial relationships relevant to this field of study.
• Sixty-six people, in a controlled trial comparing lavender aromatherapy, placebo, and a control group, showed benefits during and after trigger point injection only for the aromatherapy group.
SYNOPSIS: In people with myofascial pain syndrome receiving a trigger point injection, aromatherapy with lavender oil helped to decrease pain and anxiety and improve comfort.
SOURCE: Kasar KS, Yildirim Y, Aykar FS, et al. Effect of inhalation aromatherapy on pain, anxiety, comfort, and cortisol levels during trigger point injection. Holist Nurs Pract 2020;34:57-64.
There is no lack to the purported effects of essential oils on human health and disease; analgesic and calming are two that most clinicians would attest are commonly mentioned by patients who are proponents of these plant extracts. Most evidence steers essential oil use to aromatherapy for such diagnoses as insomnia or anxiety,1 and topically for pain conditions.2,3 This study attempted to show multi-symptom benefits from aromatherapy for patients undergoing an otherwise uncomfortable/painful procedure — trigger point injection.
The study took place in Turkey and involved 66 patients receiving trigger point injections for the first time for myofascial pain syndrome. There were exclusion criteria, such as a lavender allergy, “psychiatric disease” (it wasn’t described whether anxiety or insomnia were included), steroid treatments, and pulmonary conditions, among others.
The 66 study participants were randomly divided into three groups with 22 participants in each one: an aromatherapy group, a placebo group, and a control group. For each group, demographic information was collected, as was information about prior pain-related diagnoses and treatments, current symptoms (Visual Analog Scale [VAS] for pain, completed pre-, mid-, and post-trigger point injection), comfort (General Comfort Questionnaire [GCQ], 48-items, 4-point Likert for each), and anxiety (State-Trait Anxiety Index containing 20 items). In addition, saliva was collected before and after each trigger point injection and tested for cortisol. The aromatherapy group had five drops of 100% lavender essential oil placed in a diffuser and run during the trigger point injection; the placebo group also had a diffuser in the room, but only used an organic baby oil, and the control group didn’t use any diffuser device during the trigger point injection.
Between the groups, demographics were statistically similar, and the mean age was 49 years for the entire cohort. With respect to pain, as per the VAS, the three groups started at levels that were statistically similar, whereas only the aromatherapy group showed an improvement in pain around the time of the procedure; the other two groups had worsening pain. (See Table 1.)
Table 1. Changes in Pain as per the VAS
|
| |
Aromatherapy group
|
Placebo group
|
Control group
|
Inter-group P value
|
|
VAS at baseline
|
6.05
|
6.68
|
6.09
|
0.926
|
|
VAS mid-procedure
|
5.23
|
8.05
|
8.23
|
0.000
|
|
VAS post-procedure
|
3.86* **
|
7.41
|
7.64
|
0.000
|
|
VAS: Visual Analog Scale
* P value post compared to baseline = 0.005
** P value post compared to mid < 0.001
|
Anxiety also improved in the aromatherapy group to a level below the baseline median scores for the three groups; in the placebo group and control group, anxiety scores actually increased from baseline. With respect to comfort (as per the GCQ), the aromatherapy group improved to 146 from 120, whereas the other two groups worsened pre-injection vs. post-injection (to 112 from 116, and to 104 from 113, in the placebo and control groups, respectively). Salivary cortisol levels were not statistically significantly different among the groups.
The results presented here are striking, seemingly showing a marked effect of lavender aromatherapy on the stress and anxiety that can occur with trigger point injections. This benefit stands out of this study, as does the results on the placebo and control groups; essentially, doing nothing (control) or nothing physiologically (placebo), these first-time recipients of trigger point treatments for myofascial pain syndrome do worse. It really makes a compelling case to do something!
Cooling our jets a bit, it is important to note that the researchers do not comment on blinding, which would be difficult to do using aromatherapy; nonetheless, it would have been good to document participants’ responses to the query about what group they thought they were in. Also, we should have been given some data about adverse effects, which always happen, even in placebo or control groups. Safety data helps clinicians to make informed decisions about using a treatment in their practice.
It is impressive that all 66 people completed all survey instruments, essentially a 0% dropout rate. It would have been good to learn about their technique for data gathering, which may have included research assistants. Some participants were described as “illiterate,” so somebody was needed to help them with the surveys.
If the researchers used more of a convenience sampling technique, essentially only including the people for whom they had complete data, that also should have been mentioned, as it has its own biases that could affect generalizability of the research findings.
But on face value, this study should offer clinicians an approach to lessening pain and anxiety during difficult procedures, since long as this treatment can be shown to be safe and adverse effects specified. The next step(s) would be to see if the use of lavender aromatherapy can be applied to other ages, demographics, procedures, and diagnoses.
REFERENCES
- Generoso MB, Soares A, Taiar IT, et al. Lavender oil preparation (Silexan) for treating anxiety: An updated meta-analysis. J Clin Psychopharmacol 2017; 37:115-117.
- Sritoomma N, Moyle W, Cooke M, O’Dwyer S. The effectiveness of Swedish massage with aromatic ginger oil in treating chronic low back pain in older adults: A randomized controlled trial. Complement Ther Med 2014;22:26-33.
- Ou MC, Lee YF, Li CC, Wu SK. The effectiveness of essential oils for patients with neck pain: A randomized controlled study. J Altern Complement Med 2014;20:771-779.
