Clinical Briefs-With Comments from John La Puma, MD, FACP
Aromatherapy: Evidence-Based Medical Care?
February 2001; Volume 4; 24
Source: Cooke B, Ernst E. Aromatherapy: A systematic review. Br J Gen Pract 2000;50:493-496.
"Aromatherapy is becoming increasingly popular; however, there are few clear indications for its use. To systematically review the literature on aromatherapy in order to discover whether any clinical indication may be recommended for its use, computerized literature searches were performed to retrieve all randomized controlled trials of aromatherapy from the following databases: MEDLINE, EMBASE, British Nursing Index, CISCOM, and AMED. The methodological quality of the trials was assessed using the Jadad score. All trials were evaluated independently by both authors and data were extracted in a pre-defined, standardized fashion. Twelve trials were located: six of them had no independent replication; six related to the relaxing effects of aromatherapy combined with massage. These studies suggest that aromatherapy massage has a mild, transient anxiolytic effect. Based on a critical assessment of the six studies relating to relaxation, the effects of aromatherapy probably are 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."
COMMENT
Another report from the most prolific and one of the most principled and evidence-based shops in alternative medicine evaluation located at the University of Exeter, this critical assessment is unlikely to turn the cosmetics, spa, and beauty businesses on their heads. It does, however, suggest that the scientific basis for aromatherapy is yet to be developed.
Concentrated essential oils are aromatic plant extracts massaged into (or at least, on to) the skin. Whether inhaled essential essences are at work on the limbic system, or its the magic hands of a therapist that calms clients, or both, no one knows.
Ten of the 12 randomized clinical trials were positive, though there was wide variance in their interventions, frequency, duration, and indication. Six studies were identified for reduction of anxiety and improvement in well-being. Follow-up was minimal, and only one trial of these latter six was double-blind (though blinding here would be tough).
The introduction of aromatherapy in cancer care, palliative care, and midwifery begs the question of whether aromatherapy is a medical intervention or just a relaxing, safe way to spend 15 minutes to an hour. Whether employers will want to include aromatherapy as a covered benefit will determine whether their employees (our patients) will be able to access it regularly and readily in a doctor’s office or in a day spa.
Aromatherapy does improve anxiety, at least temporarily. It makes people feel better, giving them something alluring to smell and offering hands-on, paid-for, personal attention. Is that medicine? Yes, if it is therapeutic, and though the data are soft, it appears to be for that indication. But is it evidence-based medical care? You decide.
Recommendation
Should you recommend rosemary- or lavender-containing neck pillows, microwaved for two minutes, for tension headache sufferers, instead of two beers or a prescription anxiolytic? If it appeals to your patient, and if she can microwave safely and can afford the pillow at the drugstore—yes, absolutely.
February 2001; Volume 4; 24
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