Aromatherapy’s Effects on Pain

November 24, 2023

By Laura Jones CAHP^®/ RMT.

Aromatherapy has been used since 3500 BC and utilized by noted healers including Hippocrates in the 5th century BC. It was termed aromatherapy by Lyon chemist Rene-Maurice Gattefosse in 1928. However, there is still a lot we don’t know and are in the process of learning. Research is being done on the effect of aromatherapy on pain. This is a hard topic to find consistent research on as pain is subjective and there is no universal scale for rating the intensity of the pain. Does aromatherapy reduce the perception of pain; is there a difference in relief between acute and chronic pain; and what role does inhalation as opposed to topical application play?

How does pain work? The first thing to know about pain is that it is subjective. What is intense pain for one person, may be mildly irritating for another. This is not saying the first person is exaggerating, they just perceive their pain differently. Pain comes from nerve endings, which are the pain receptors, designed to let the body know when they are in contact with painful stimulus. The painful stimulus sends a message to the spinal cord through the pain receptor nerves. Primary afferent nociceptors are formed when the nerve ending attaches to the nerve. These nociceptors trigger pain transmission neurons found in the spinal cord. The pain stimulus is then relayed to the thalamus, somatosensory cortex and limbic system. The thalamus and cortex are where the pain perception occurs.

How does olfaction relate to pain perception? Olfaction causes changes in brain activity as it reacts in different parts of the brain, including the amygdala. The limbic region of the brain, where the amygdala is found, is the part that activates the fight or flight response, as well as the sense of smell. Scent therefore, can alter the undesirable effects that occur with pain, such as stress and fear through its emotional transformation and in turn, reduce the pain sensation.. The limbic system is where emotions, memories and behaviours are triggered, A scent that is pleasant will cause the release of serotonin, endorphins and dopamine. These hormones make you feel better, and more relaxed. Aromatherapy is a fast and safe way to use essential oils and allow the scent to reach the olfactory nerves.

One of the effects of pain that aromatherapy can help change is respiratory rate. When inspiration of a scent occurs, the receptors in the olfactory nerve become triggered, activating the olfactory limbic region, which can then cause breathing patterns to change. When someone is in pain, their breathing is generally sped up and possibly uneven, but when a calming aroma is introduced, it can help to slow the breathing so the patient is getting more oxygen. A reduction in blood pressure has also been noted in the studies that have been performed as well as a reduction in pain. A study on pain perception was conducted with the focus being on inhalation aromatherapy. In 79.55% of the cases looked at, there was a reduction in pain perception. A known effect of aromatherapy is that it can improve moods as well as reduce the feeling of depression and anxiety, which can then help a person with pain feel more positivity around the cause of the pain and their future. There are few side effects that occur with inhalation therapy, unlike pain medications; it is an easy method to use; and it is not expensive. However, studies have found that the effect of the aromatherapy wears off quickly after the aromatherapy is removed. It is imperative to understand that aromatherapy is not a cure or a fix for pain, but can help to reduce the amount of pain experienced.

Pain can be broken down into acute pain, and chronic pain. Acute pain is pain that comes from a direct cause, such as surgery, illness, injury, and trauma. This pain will last anywhere from a few minutes to 12 weeks, and is a short term pain. Chronic pain in comparison, is pain that lasts longer than 12 weeks, and does not go away fully with medication. Chronic pain includes back pain, diabetes, fibromyalgia and arthritis. It is important to look at both acute and chronic pain to understand how aromatherapy may help and to what extent.

Acute pain is the type of pain that is experienced through childbirth, as well as after a surgery. It is pain that you know will resolve within 12 weeks. Acute pain can be accompanied by nausea, vomiting, headaches, dizziness and hypertension. These side effects can make the pain worse by adding to the level of discomfort, and medications to treat these often come with additional side effects. A study looking at childbirth found that using essential oils through inhalation can decrease the feelings of nausea, and vomiting, as well as headaches and hypertension. This is beneficial to the patient as well as to the unborn child. Aromatherapy has begun to be requested in the delivery room ro help increase relaxation and decrease the use of pain medication. In a triple blind study (meaning that the study was not revealed to the participants, experimenters or the research analysts) lavender essential oil was administered through inhalation while monitoring post cesarean section pain. This study was completed by Hadi, N, & Hanid, A in 2011 and found that the group that received lavender experienced a reduction in nausea and dizziness over the placebo group as well as an overall 90% satisfaction rate of their treatment, while the placebo group only reported 50% satisfaction.

Another study conducted around knee replacement surgery by Jun, Y. S. & Kang, P. et al. in 2013, found that patients treated with eucalyptus oil inhalation had lower blood pressure and pain levels than the placebo group. Finally, a study by Kim, J. T. & Wajda, M. et al. in 2006 looked at recovery after undergoing a breast biopsy and revealed that the group receiving lavender oil inhalation therapy were substantially more satisfied with their pain management than the control group.

These studies show that inhalation aromatherapy in acute pain situations affects how patients perceive their pain with the majority of people in these studies having better overall satisfaction with their treatment as well as better pain and side effect management.

Chronic pain is pain that has been dealt with for over 12 weeks with little to no resolution. Chronic pain is harder to manage as there are often underlying conditions such as anxiety and depression to deal with as well. The first study I looked at was conducted by Horwath, A. L. & Freshwater, D. in 2004. Its focus was on patients with Multiple Sclerosis and how aromatherapy massage worked as a pain reliever. Fifty MS patients had aromatherapy massage once a month for a duration of four months. 78% of the patients reported feeling better and wanting to continue to receive massage after the study was through. 88% of the group of fifty found that their overall sense of well being was improved and 91% of the fifty said it helped them relax. As well, 55% of the group reported that they slept better. When pain relief was looked at, there was an overall reduction of 7% less medication used. Most of the people studied found a benefit in having aromatherapy massage, with a generalized sense of improved well being. The issue with this particular study was that there should have been a control group just receiving massage without aromatherapy and there wasn’t, so that makes it difficult to tell if the improvements were due to the massage, or the aromatherapy portion.

Another study I looked at involved older adults that are living in nursing homes. For the aging population, the majority of seniors live with some type of chronic pain. Chronic pain is more complex than acute pain as the pain may have a comorbidity, meaning there may be more than one underlying condition, including if the person is feeling stressed, or having a hard time coping with persistent pain. This then leads to poor sleep, depression, anxiety and an overall decrease in their quality of life. This particular study by Cino, K. in 2014, looked at a group of older adults that had a variety of other conditions such as high blood pressure, diabetes, depression, arthritis and dementia and most of them took daily medication to manage their symptoms. As well, half of them were also on anti-depressants. The participants were divided into three groups with one group receiving a daily hand massage with unscented lotion, one group receiving daily hand massage with lavender oil, and the last group received daily visits from a nurse, but not receiving massage. The two groups that received massage reported that they had lower levels of pain than the group that did not receive massage, However, there was no real difference between the groups that received lavender and the group that received unscented lotion. This result was thought to be partially due to the fact that seniors often have a reduced sense of smell.

Finally, I looked at chronic back pain. Back pain is one of the top five reasons people seek health care and yet less than 15% of back pain has a diagnosable cause. Lower back pain in particular leads to a decreased quality of life, a decrease in physical activity and this leads to a lost work time. In a randomized, controlled study by Yip, Y. B. & Tse S. H. M. in 2004, they wanted to see the effectiveness of relaxation acupressure as well as having aromatic lavender oil for non-specific low back pain. Participants were studied for three weeks and received eight treatments. These participants felt that there was a significant reduction in pain and an improvement in measurable physical functions such as lateral spine flexion and the amount of time they were able to walk. The results of this study were promising in proving that lavender oil as well as acupressure massage was beneficial in helping pain reduction, however, the study was not repeated with a control group that just received the acupressure. The researchers concluded that the combination of acupressure and lavender oil are useful along with medical intervention to reduce lower back pain. In a separate randomized study on back pain by Stritooma, N. & Moyle, W. in 2014 looked at back pain and divided the group into two test groups. The first group received Swedish massage with ginger essential oil, while the second group received Thai massage over the clothes, without any oil. Participants were asked fifteen months after receiving treatment how they felt as the study wanted to see the long term effects. Both of the groups experienced better mobility and a reduction in pain, but the group that received the ginger oil experienced better results across all categories for a longer period of time.

Chronic pain can be debilitating for a lot of people, especially when comorbidities such as high blood pressure, diabetes, anxiety and depression are also present. While lifestyle changes are sometimes required, adding in essential oils can help to reduce the amount of pain medication needed as well as reduce some of the comorbidity side effects they are experiencing. Whether the pain reduction is due to aromatherapy is hard to measure as a lot of the time, aromatherapy has been responsible for relieving feelings of anxiety and depression around an acute or chronic issue which then causes the subject to feel better, without necessarily a reduction in pain. More studies need to be done around this with a wider range of participants to know for certain how the aromatherapy portion is helping.

It must also be considered if there is a difference between inhalation aromatherapy and topical aromatherapy when looking at pain reduction. Inhalation aromatherapy can help to relax the entire body, which in turn helps to reduce the amount of pain that is felt. Using aromatherapy topically can help with both inflammation and pain relief, as well as make your recovery faster as the oils are being absorbed into the skin and the massage is working on the sore, stiff muscles, or adhesions and trigger points. Touch and the sensation that is associated with massage have a large impact on clients' well being, as well as the client’s reaction to the pleasant scent of aromatherapy. Therefore, the client's needs must be considered first when deciding on whether to use inhalation therapy or topical therapy as well as what condition(s) you are hoping to treat.

Finally, it’s important to look at the individual oils to see what effects they have on certain conditions. The oils can be used individually, or combined to make a blend for the conditions being treated. For ease of reference, they will be broken down into categories around what they are helpful in treating.

Oils for pain, tension and swelling that can be used topically:

Helichrysum	relieves muscle spasms, inflammation and pain
Marjoram	relaxes muscle spasms and tension as well as easing pain and inflammation
Peppermint-	peppermint contains menthol which has a cooling effect on the body and sore muscles as well as being an analgesic, antispasmodic and anti-inflammatory oil

OIls for pain and swelling that can be used topically:

Eucalyptus	has a cooling effect on sore muscles as well as relieving pain and inflammation
Lavender	helps the body relax as well as relieving pain and inflammation
Roman and German chamomile	help with pain and inflammation as well as soothing muscle tension and reducing spasms
Rosemary	known to ease pain as well as inflammation
Yarrow oil	used to relieve pain and inflammation

Oils for tension and swelling that can be used topically:

Cypress	calms and relaxes muscle spasms as well as reduces inflammation
Sandalwood	relieves tension, muscle spasms and inflammation

Oils for pain relief that can be used topically:

Black pepper	has a warming effect on the body and helps to alleviate pain
Clove	has a warming effect on sore muscles helping to relieve pain
Ginger	ginger has a warming effect on the muscles which helps relieve pain

Oils for tension that can be used topically:

Clary Sage	alleviates tension and muscle spasms as well as promoting relaxation
Juniper	alleviates tension and eliminates muscle spasms

Oils for headache relief that can be inhaled:

Lavender	has a soft, relaxing scent that helps to calm the thoughts and alter the perception of pain that you are feeling
Geranium	has the ability to relieve anxiety and stress and this helps in relieving the pain from a headache
Peppermint	has a cooling scent and can help relieve tension headaches

Oils for nerve pain that can be inhaled:

Bergamot	reduces neuropathic pain
Eucalyptus	reduces nerve pain and acts as an analgesic
Frankincense	has the ability to ease pain and discomfort as well as act on nerve pain
Juniper Berry	helps to reduce pain and continued use can strengthen the nervous system allowing it to react better to nerve pain

Oils that can be used to promote sleep and relaxation through inhalation:

Clary Sage	helps with anxiety and is a relaxing scent
Geranium	helps to relax the mind and is a calming scent
Lavender	well known for its gentle, relaxing scent and calming ability
Roman Chamomile	helps with pain relief and promotes a restful sleep

The above oils are not a comprehensive list as there are many oils that work well for these conditions. These are just some of the more recognizable oils. As well, oils should never be used topically without dilution and you should be extra cautious if you have asthma, allergies, epilepsy, hypertensive or any skin conditions that are not diagnosed.

The use of essential oil to assist with pain relief is a valid resource. Whether or not it actually reduces pain needs to be further studied, as pain is a hard thing to measure as there is no universal measurement and everyone feels pain differently. However, one can draw the conclusion that it helps with the perception of pain. As well, it can be seen that by using essential oils to reduce some of the symptoms and comorbidities of pain such as anxiety and depression, the patient will begin to feel more optimistic about the future and their quality of life. Essential oils are less likely to produce adverse effects such as the side effects that medication can produce and aromatherapy is a cost effective treatment. Aromatherapy is very effective at reducing the perception of pain that is from an acute injury, and shows improvements in patients quality of life when used by patients with chronic pain as well as underlying comorbidities. As well, it seems to be effective for both topical applications and inhalation applications, but there needs to be more studies on whether the topical effect is from the aromatherapy, the massage or both. While there needs to be more research conducted to further the use of essential oils in the treatment of pain, a conclusion can be drawn that there is enough research that shows there are promising results when using aromatherapy to combat pain.

Photo credit: by Canva

References

Chappell, M. M., & Davis, J. Aromatherapy for Arthritis Relief. https://www.arthritis.org/health-wellness/treatment/complementary-therapies/natural-therapies/aromatherapy-for-arthritis-relief

Cherney, K. (2019, May 23). 9 Essential Oils for Back Pain and How to Use Them. https://www.healthline.com/health/essential-oils-for-back-pain

Cino K. (2014). Aromatherapy hand massage for older adults with chronic pain living in long-term care. Journal of Holistic Nursing. http://dx.doi.org/10.1177/0898010114528378

Cronkleton, E. (2019, May 15). 18 Essential Oils for Sore Muscles, Pain Relief and Swelling. https://www.healthline.com/health/fitness-exercise/essential-oils-for-sore-muscles#pain-and-swelling

Hadi N., Hanid A. A. (2011). Lavender essence for post-cesarean pain. Pakistan Journal of Biological Sciences. doi: http://dx.doi.org/10.3923/pjbs.2011.664.667

Howarth A. L., Freshwater D. (2014). Examining the benefits of aromatherapy massage as a pain management strategy for patients with multiple sclerosis. Journal of Research in Nursing. http://dx.doi.org/10.1177/136140960400900206

Jun Y. S., Kang P., Min S. S., Lee J.-M., Kim H.-K., Seol G. H. (2013). Evidence-based Complementary and Alternative Medicine. Effect of eucalyptus oil inhalation on pain and inflammatory responses after total knee replacement: a randomized clinical trial. http://dx.doi.org/10.1155/2013/502727.502727

Kim J. T., Wajda M., Cuff G., et al. (2006). Evaluation of aromatherapy in treating postoperative pain: pilot study. Pain Practice. http://dx.doi.org/10.1111/j.1533-2500.2006.00095.x

LoBisko, S. (2014, July 28). The Power of Olfaction in the Relief of Pain. https://ndnr.com/pain-medicine/the-smell-of-pain/

Nascimento, J. C., Goncalves, V. S. S., Souza, B., Nascimento, L., Carvalho, B., Ziegelmann, P. K., Goes, & T. C., Guimaraes, A. G., (2022, Nov). New Approaches to the Effectiveness of Inhalation Aromatherapy in Controlling Painful Conditions. A Systematic Review with Meta-Analysis. https://www.sciencedirect.com/science/article/abs/pii/S1744388122000962

Osterweis, M., Kleinman, A., Mechanic, D., (1987). Pain and Disability: Clinical, Behavioural, and Public Policy Perspectives. The Anatomy and Physiology of Pain. https://www.ncbi.nlm.gov/books/NBK21952

Shaheen, E. L, Sheafer, H. & Tepper, D. (2016, Dec 14). The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192342/

Sritoomma N., Moyle W., Cooke M., O'Dwyer S. (2014). The effectiveness of Swedish massage with aromatic ginger oil in treating chronic low back pain in older adults: a randomized controlled trial. Complementary Therapies in Medicine. http://dx.doi.org/10.1016/j.ctim.2013.11.002

Stavros, C. (2022, Aug 23). Aromatherapy in Treating Chronic Pain. https://advancedmmc.com/aromatherapy-treating-chronic-pain/

Yip Y. B., Tse S. H. M. (2004). The effectiveness of relaxation acupoint stimulation and acupressure with aromatic lavender essential oil for non-specific low back pain in Hong Kong: a randomized controlled trial. Complementary Therapies in Medicine. http://dx.doi.org/10.1016/j.ctim.2003.12.003

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