BACKGROUND:Essential oils were proven to possess analgesic activity in adults. Children with diabetes are exposed to highly painful interventions such as self-monitoring of blood glucose (SMBG).

OBJECTIVE:An evaluation of the analgesic properties of two essential oils during SMBG in diabetic children.

SUBJECTS:We included 73 hospitalized children (age<18 years) with well-controlled type 1 diabetes.

METHODS:The study extended over a period of 1 month (2 weeks for control group and 1 week for orange and lavender oil application). The measurements were performed four times per day in a shared room during SMBG. Pain intensity was evaluated by visual analog scale (VAS) and change of baseline heart rate (ΔHR%). An aromatherapy device was used to disperse essential oils in the testing room.

RESULTS:We performed 647 individual measurements of pain intensity andΔHR%. Girls reported higher VAS scores [median, Me 0.5 (interquartile range, IQR 0-1) vs. 0 (IQR 0-0.5), p=0.0036]. Both age and duration of diabetes correlated with ΔHR% [r=-0.14, p=0.0005; r=-0.12, p=0.0025]. Negative correlations were also noted for VAS/age [r=-0.12, p=0.0030] and VAS/durationof diabetes [r=-0.12, p=0.0034]. Aromatherapy did not alter the VAS score (p=0.40), while ΔHR% decreased with borderline significance (p=0.0639). After adjustment for patient's age and sex lower ΔHR% was associated with essential oil application (p=0.0252). Aromatherapy did not have any influenceon VAS scores in multivariate analysis (p=0.35).

CONCLUSION:Aromatherapy decreased the autonomic response to a painful stimulus by loweringΔHR%, but did not affect the perception of pain reported by VAS.

PURPOSE:The purpose of this study was to determine if using essential oil products for adult patients reduced the need for antiemetics for postoperative nausea and vomiting (PONV).

DESIGN:A prospective and retrospective cross-sectional design using a convenience sample.

METHODS:Double blinded to the type of essential oil, subjects randomly selected a nasal inhaler containing peppermint, ginger, or a combination of both. A prophylactic dose was given preoperatively, and during the postoperative period nausea was assessed using verbal descriptive scale.

FINDINGS:Overall 322 same day surgical patients were analyzed (control group [n = 179] and intervention group [n = 143]). The intervention group had a greater history of PONV but received fewer doses of antiemetics postoperatively compared with the control group. There was no significant difference in the effectiveness of the three types of inhalers.

CONCLUSIONS:Aromatherapy demonstrated a statistically significant (P<.05) reduction in the need for antiemetics to treat PONV.

OBJECTIVE:This study was designed to evaluate the effectiveness of lavender aromatherapy on pain, anxiety, and level of satisfaction associated with the peripheral venous cannulation (PVC) in patients undergoing surgery.

METHOD:One hundred and six patients undergoing surgery were randomized to receive aromatherapy with lavender essential oil (the lavender group) or a placebo (the control group) during PVC. The patients' pain, anxiety, and satisfaction scores were measured.

RESULTS:There was no statistically significantly difference between the groups in terms of demographic data. After cannulation, the pain and anxiety scores (anxiety 2) of the patients in the lavender group were significantly lower than the control group (for p = 0.01 for pain scores; p < 0.001 for anxiety 2 scores). In addition, patient satisfaction was significantly higher in the lavender group than in the control group (p = 0.003).

CONCLUSION:Lavender aromatherapy had beneficial effects on PVC pain, anxiety, and satisfaction level of patients undergoing surgery.

OBJECTIVE:To investigate the efficacy of aromatherapy with essential oils of Rosa damascena for the management of premenstrual syndrome (PMS).

METHODS:The present triple-blind randomized clinical trial was conducted between March 5, 2016, and February 20, 2017, among female students attending Shiraz University of Medical Sciences, Shiraz, Iran, who experienced PMS, had a menstrual cycle of 24-35 days, were not using vitamin supplements or hormonal drugs, and did not have any underlying diseases. Block randomization was used to assign participants to an intervention group receiving aromatherapy with R. damascena at a 4% concentration or a control group who received aromatherapy with 100% sweet almond oil. Aromatherapy was performed for 5 minutes, twice daily, for a total of 5 days during the luteal phase. The premenstrual symptoms screening tool questionnaire was completed at baseline and after 1 and 2 months of treatment. Per-protocol analyses were performed with patients and investigators masked to group assignments.

RESULTS:There were 66 participants enrolled and 64 completed the study (33 in the intervention group and 31 in the control group). At 2 months, aromatherapy with R. damascena was associated with improved psychological (P<0.001), physical (P<0.001), social (P=0.002), and total (P<0.001) PMS symptoms compared with baseline. By contrast, no improvements were recorded in the control group.

CONCLUSION:Aromatherapy with R. damascena improved multiple symptoms of PMS.

IRANIAN REGISTRY OF CLINICAL TRIALS:IRCT2016031113940N3.

PURPOSE:This study examined the effect of peppermint spirits on postoperative nausea in women following a scheduled C-section.

DESIGN:A pretest-posttest research design with three groups was used. The peppermint group inhaled peppermint spirits, the placebo aromatherapy control group inhaled an inert placebo, green-colored sterile water, and the standard antiemetic therapy control group received standard antiemetics, usually intravenous ondansetron or promethazine suppositories.

METHODS:Women were randomly assigned to a group on admission to the hospital. If they became nauseated, nurses on the mother-baby unit assessed their nausea (baseline), administered the assigned intervention, and then reassessed participants' nausea 2 and 5 minutes after the initial intervention. Participants rated their nausea using a 6-point nausea scale.

FINDINGS:Thirty-five participants became nauseated post-operatively. Participants in all three intervention groups had similar levels of nausea at baseline. The nausea levels of participants in the peppermint spirits group were significantly lower than those of participants in the other two groups 2 and 5 minutes after the initial intervention.

CONCLUSIONS:Peppermint spirits may be a useful adjunct in the treatment of postoperative nausea. This study should be replicated with more participants, using a variety of aromatherapies to treat nausea in participants with different preoperative diagnoses.

OBJECTIVES:Structured exposure to odors is an acknowledged therapy in patients with smell loss but has also been shown to be effective in depression. The latter might rely on connections between olfactory and emotional structures, suggesting possible effects of a similar approach in pain patients. Based on neuroanatomy, there are several interfaces between the"pain network"and olfactory system, such as the limbic system, hypothalamus, and mediodorsal thalamus. We aimed to investigate whether structured exposure to odors may impact perceived pain in patients with chronic low back pain.

DESIGN:Randomized controlled parallel-group design. Subjects were tested on two occasions, at baseline and after four weeks.

SETTING:Ambulatory.

SUBJECTS:Forty-two patients with chronic low back pain.

METHODS:For all patients, olfactory function (using the"Sniffin'Sticks"test kit), detection, and pain thresholds for cutaneous electrical stimuli (applied to the forearm) were tested at baseline and after four weeks. Twenty-eight patients exposed themselves to four odors (rose, vanilla, chocolate, peach) every two hours over a period of four weeks (training group). Control patients (N = 14) underwent no such"olfactory training"(nontraining group).

RESULTS:Pain thresholds were significantly increased in patients who performed olfactory training compared with patients who did not train with odors. Detection thresholds and olfactory function remained unchanged.

CONCLUSIONS:The present results indicate that regular exposure to odors increases pain thresholds in patients with chronic back pain and could be useful for general pain control in these patients. Furthermore, olfactory training in chronic pain patients might help to reduce chronification of pain by desensitization.

This preliminary investigation compares peripheral blood cell counts including red blood cells (RBCs), white blood cells (WBCs), neutrophils, peripheral blood lymphocytes (PBLs), CD4(+), CD8(+) and CD16(+) lymphocytes, CD4(+)/CD8(+) ratio, hematocrit, humoral parameters including serum interferon-gamma and interleukin-6, salivary secretory immunoglobulin A (IgA). Psychological measures including the State-Trait Anxiety Inventory (STAI) questionnaire and the Self-rating Depression Scale (SDS) between recipients (n = 11) of carrier oil massage and aromatherapy massage, which includes sweet almond oil, lavender oil, cypress oil and sweet marjoram oil. Though both STAI and SDS showed a significant reduction (P<0.01) after treatment with aromatherapy and carrier massage, no difference between the aromatherapy and control massage was observed for STAI and SDS. Aromatherapy, in contrast to control massage, did not significantly reduce RBC count or hematocrit. However, aromatherapy massage showed a significant (P>0.05) increase in PBLs, possibly due to an increase in CD8(+) and CD16(+) lymphocytes, which had significantly increased post-treatment (P<0.01). Consequently, the CD4(+)/CD8(+) ratio decreased significantly (P<0.01). The paucity of such differences after carrier oil massage suggests that aromatherapy massage could be beneficial in disease states that require augmentation of CD8(+) lymphocytes. While this study identifies the immunological benefits of aromatherapy massage, there is a need to validate the findings prospectively in a larger cohort of patients.

The idea of aromatherapy, using essential oils, has been considered as an alternative antidepressant treatment. In the present study, we investigated the effect of Roman chamomile essential oil inhalation for two weeks on depressive-like behaviors in Wistar-Kyoto (WKY) rats. We found that inhalation of either Roman chamomile or one of its main componentsα-pinene, attenuated depressive-like behavior in WKY rats in the forced swim test. Using isobaric tags for relative and absolute quantitation analysis (iTRAQ), we found that inhalation of α-pinene increased expression of proteins that are involved in oxidative phosphorylation, such as cytochrome coxidase subunit 6C-2, cytochrome c oxidase subunit 7A2, ATPase inhibitor in the hippocampus, and cytochrome c oxidase subunit 6C-2, ATP synthase subunit e, Acyl carrier protein, and Cytochrome b-c1 complex subunit 6 in the PFC (prefrontal cortex). In addition, using the quantitative real-time polymerase chain reaction technique, we confirmed an increase of parvalbumin mRNA expression in the hippocampus, which was shown to be upregulated by 2.8-fold in iTRAQ analysis, in α-pinene treated WKY rats. These findings collectively suggest the involvement of mitochondrial functions and parvalbumin-related signaling in the antidepressant effect of α-pinene inhalation.

Previous studies have suggested that sensory cues associated with cigarette smoking can suppress certain smoking withdrawal symptoms, including craving for cigarettes. In this study we investigated the subjective effects of a cigarette substitute delivering a vapor of black pepper essential oil. Forty-eight cigarette smokers participated in a 3-h session conducted after overnight deprivation from smoking. Subjects were randomly assigned to one of three conditions: one group of smokers puffed on a device that delivered a vapor from essential oil of black pepper; a second group puffed on the device with a mint/menthol cartridge, and a third group used a device containing an empty cartridge. Subjects puffed and inhaled ad libitum from the device throughout the session during which no smoking was allowed. Reported craving for cigarettes was significantly reduced in the pepper condition relative to each of the two control conditions. In addition, negative affect and somatic symptoms of anxiety were alleviated in the pepper condition relative to the unflavored placebo. The intensity of sensations in the chest was also significantly higher for the pepper condition. These results support the view that respiratory tract sensations are important in alleviating smoking withdrawal symptoms. Cigarette substitutes delivering pepper constituents may prove useful in smoking cessation treatment.

ETHNOPHARMACOLOGICAL RELEVANCE:Lavender (Lavandula angustifolia) essential oil (EO) has a long history of use in emotional illness, including anxiety disorders. Cognitive mechanisms of learning and memory play a pivotal role in the etiology and maintenance of anxiety since exposure to cues related to aversive situations induces high arousal and anticipatory anxiety. Memory become labile after its reactivation and can be modulated by reconsolidation or extinction. Inhibition of memory reconsolidation or facilitation of memory extinction may be effective in preventing or minimizing the effect of contextual cues on anticipatory anxiety.

AIM OF THE STUDY:We investigated the effect of Lavandula angustifolia EO in the memory updating of conditioned contextual fear.

MATERIALS AND METHODS:Adult male C57Bl6 mice were submitted to fear conditioning. Two days after conditioning the mice underwent a reactivation session in a hybrid context and were then immediately exposed to vaporized water or essential oil at concentrations of 1%, 2.5% or 5% for 3 h. Two days later, the mice were tested in the original or an altered context and their freezing behavior was measured. In addition, mice were subjected to a fear memory recovery protocol followed by a reinstatement session.

RESULTS:In the contextual fear test, 1% essential oil, but not 2.5% or 5%, reduced the freezing behavior response, whereas after a reinstatement session, exposure to 1% essential oil increased the freezing behavior response.

CONCLUSIONS:These results suggest that Lavandula angustifolia essential oil enhances memory extinction and, consequently, inhibits memory updating.

The anxiolytic-like and stress reduction effects following inhaled administration of essential oil from Chamaecyparis obtusa (EOCO) have been reported. Volatile components are thought to produce these effects of EOCO by neurological transfer and pharmacological transfer. The regions of the brain in which inhaled compounds are found due to pharmacological transfer of EOCO are not known. This research was undertaken to clarify the relationship between the intracerebral distribution ofα-pinene, which is the main component of EOCO, and emotional behavior. α-Pinene was detected as the main component of volatile EOCO. The amount of α-pinene in each region of the brain was measured following inhaled administration of EOCO. The amount of α-pinene was different in each region of the brain. With inhaled administration of 32 μL/L air EOCO, a high concentration of α-pinene was observed. However, no significant differences in the concentration of α-pinene among brain regions were found. A therapeutic concentration of α-pinene (8 μL/L air EOCO) in each region of the brain mayinduce an anxiolytic-like effect, and a high concentration of α-pinene (32 μL/L air EOCO) in each region of the brain may induce an excitatory-like effect. The increases in the concentration of α-pinene from 8 to 32 μL/L air EOCO in the striatum and the hippocampus were significantly lower compared with the increases in other brain regions. These results indicate that regions besides the striatum and the hippocampus participated in the increase in locomotor activity due to the high concentration of α-pinene in the brain.

Abstract Aim: The aim of the present study was to investigate the usefulness of rose essential oil as a supplementary and adjunctive therapy for the relief of renal colic, specifically because rose essential oil is soothing and can act as a muscle relaxant. Materials: Eighty patients who were diagnosed with renal colic in the emergency room were included in the study, with ages ranging from 19 to 64 years. Half of the patients (n=40) were treated with conventional therapy (diclofenac sodium, 75 mg intramuscularly) plus placebo (physiological serum, 0.9% NaCl), while the other half (n=40) were given aromatherapy (rose essential oil) in addition to conventional therapy. In each patient, the severity of pain was evaluated using the Visual Analog Scale (VAS) (0 [no pain] to 10 [very severepain]). Findings: The VAS values prior to the start of therapy, and 10 and 30 minutes after therapy were 8.18±1.36, 5.60±2.02, and 3.75±2.08 for the conventional therapy plus placebo group, while for the conventional therapy plus aromatherapy group, the VAS values were 8.63±1.03, 4.25±1.72, and1.08±1.07, respectively. There was no statistically significant difference between the starting VAS values of the two groups, but the VAS values 10 or 30 minutes after the initiation of therapy were statistically lower in the group that received conventional therapy plus aromatherapy. Conclusion:This study demonstrated that rose essential oil therapy in addition to conventional therapy effectively reduces renal colic pain.

BACKGROUND:The aim was to investigate the effect of aromatherapy using Citrus aurantium blossom essential oil on premenstrual syndrome in university students.

METHODS:In this double-blind clinical trial controlled on 62 students from March 2016 to February 2017. The intervention with 0.5% of C. Aurantium blossom essential oil and control was inhalation of odorless sweet almond oil in the luteal phase of the menstrual cycle. The screening questionnaire (PSST) for PMSwas filled out before and also one and two months after the intervention.

RESULTS:Mean score of overall symptoms of PMS between the Bitter orange and control groups In the first (p < 0.003) and second months (p < 0.001) of the intervention was significant. Besides, decreased the mean score of psychological symptoms in the intervention group (p < 0.001), but on physical symptoms and social function was not significant (p > 0.05).

CONCLUSION:The aromatherapy with Citrus aurantium blossom improved the symptoms of premenstrual syndrome.

Very young infants were given a bath with or without lavender-scented bath oil. The mothers in the lavender bath oil group were more relaxed, smiled and touched their infants more during the bath. Their infants looked at them a greater percentage of the bath time and cried less and spent more time in deep sleep after bath. The cortisol levels of this group of mothers and infants significantly decreased, confirming the behavioral data showing increased relaxation of the mothers and their infants. These findings support a body of research showing the relaxing and sleep-inducing properties of lavender aroma.

Lavender essential oil has been used as an anxiolytic drug, a mood stabilizer, a sedative, spasmolytic, antihypertensive, antimicrobial, analgesic agent as well as a wound healing accelerator. We have studied for the first time the efficacy of lavender essential oil inhalation for the treatment of migraine in a placebo-controlled clinical trial. Methods: Forty-seven patients with definite diagnosis of migraine headache were divided into cases and controls. Cases inhaled lavender essential oil for 15 min, whereas the control group used liquid paraffin for the same time period. Patients were asked to record their headache severity and associated symptoms in 30-min intervals for a total of 2 h. We matched the two groups for key confounding factors. Results: The mean reduction of headache severity in cases was 3.6± 2.8 based on Visual Analogue Scale score. The reduction was 1.6 ± 1.6 in controls. This difference between the controls and cases was statistically significant with p<0.0001. From 129 headache attacks in cases, 92 responded entirely or partially to lavender. In the control group, 32 out of 68 recorded headache attacks responded to placebo. The percentage of responders was significantly higher in the lavender group than the placebo group (p = 0.001). Conclusion: The present study suggests that inhalation of lavender essential oil may be an effective and safe treatment modality in acute management of migraine headaches.

The present study compared the relative effectiveness of simple, commercially available food and non-food olfactory tasks on chocolate craving reduction. Chocolate cravings were induced by a series of coloured photographs and 67 undergraduate women were asked to smell one of three odours (green apple, jasmine, or water). The non-food odorant (jasmine) significantly reduced chocolate cravings relative to both the food and control odorants. Thus simple non-food odorants offer potential scope as a technique for curbing unwanted food cravings.

PURPOSE: It has been reported that mental stress is an independent risk factor for cardiovascular events and impairs coronary circulation. Lavender aromatherapy, one of the most popular complementary treatments, is recognized as a beneficial mental relaxation therapy. However, no study has examined the effect of this therapy on coronary circulation. We aimed to assess the effect of lavender aromatherapy on coronary circulation by measuring coronary flow velocity reserve (CFVR) with noninvasive transthoracic Doppler echocardiography (TTDE). MATERIAL AND METHODS: We enrolled 30 young healthy men (mean age 34+/-4.7 years, range 24-40 years). Coronary flow velocities in the left anterior descending coronary artery were recorded by TTDE at rest and during hyperemia induced with an intravenous infusion of adenosine triphosphate (ATP). CFVR was calculated as the ratio of hyperemic to basal mean diastolic flow velocity. CFVR was assessed at baseline and immediately after lavender aromatherapy (four drops of essential oil diluted with 20 ml of hot water and inhaled for 30 min). Simultaneously, serum cortisol was measured as a marker of stress hormones. To exclude the relaxation effects of rest, the same measurements were repeated in the same volunteers without aromatherapy as a control study. RESULTS: CFVR measurements were obtained in all volunteers (100%). Blood pressure and heart rate responses to ATP infusion were not affected by lavender aromatherapy. Serum cortisol significantly decreased after lavender aromatherapy (8.4+/-3.6 to 6.3+/-3.3, p<0.05), but remained unchanged in controls (9.1+/-3.5 to 8.1+/-3.9, p=ns). In addition, CFVR significantly increased after lavender aromatherapy (3.8+/-0.87 to 4.7+/-0.90, p<0.001), but not in controls (3.9+/-0.8 to 3.9+/-0.8, p=ns). CONCLUSIONS: Lavender aromatherapy reduced serum cortisol and improved CFVR in healthy men. These findings suggest that lavender aromatherapy has relaxation effects and may have beneficial acute effects on coronary circulation.

One increasingly popular type of alternative therapy is aromatherapy, but scientific validation in this field is still rare. The aim of this study was to investigate the effect of rose oil (Rosa damascena Mill, Rosaceae) on human autonomic parameters and emotional responses in healthy subjects after transdermal absorption. In order to exclude any olfactory stimulation the inhalation of the fragrances was prevented by breathing masks. Forty healthy volunteers participated in the experiments. Five autonomic parameters, i.e. blood pressure, breathing rate, blood oxygen saturation, pulse rate, and skin temperature, were recorded. Emotional responses were assessed by means of rating scales. Compared to placebo, rose oil caused significant decreases of breathing rate, blood oxygen saturation and systolic blood pressure, which indicate a decrease of autonomic arousal. At the emotional level, subjects in the rose oil group rated themselves as more calm, more relaxed and less alert than subjects in the control group. These findings are likely to represent a relaxing effect of the rose oil and provide some evidence for the use of rose oil in aromatherapy, such as causing relief of depression and stress in humans.