Date Presented 04/01/2022
OTs have a valued role in the management of pain, using aromatherapy as an alternative modality to reduce pain, muscle tension, and stress in the acute clinical setting. Preliminary results have shown that aromatherapy reduced pain, tension, and stress and was a valued intervention in identifying nonopioid pain management strategies for the resumption of activities of daily living.
Primary Author and Speaker: Carlene Mull
PURPOSE: To show the value of aromatherapy provided by an Occupational Therapist (OT) in the acute clinical setting for the reduction of pain, muscle tension, and stress for patients with intractable pain. Pain is costly not only to the healthcare system but also to the individual and to society at large. The use of opioids for pain management has led the US Center for Disease Control and Prevention to term the wave of misuse as an epidemic. Aromatherapy is a useful adjunct in the management of pain as part of an initiative to reduce the use of opioids in a clinical setting. Pain and stress activate the sympathetic nervous system, causing a cascade of events including: shortness of breath, tight muscles, anxious thoughts, increased heart rate, constriction of blood vessels, and the release of biochemicals (cortisol, adrenaline, and inflammatory markers). Conversely, a relaxation response activates the parasympathetic nervous system: slowing of breath, slowing heart rate, dilation of blood vessels, reduced production of biochemical markers. Prepackaged aromatherapy offers comfort and calming to patients experiencing pain, assisting to achieve a relaxation response. Additionally, pain triggers negative emotions such as worry, fear, anxiety, sadness, that feed into the pain cycle and amplify pain. Also known as pain catastrophizing. Aroma stimulates the olfactory receptors which send messages from the nose to the limbic system, part of the brain that controls emotions. The study of aromatherapy found lavender helped to promote calmness, wellness, and reduce stress and anxiety thus interrupting the pain cycle.
DESIGN: An OT collaborated with LVHN physicians, Risk Management, Infection Control and Occupational Health to clear the use of aroma in the hospital setting. The product was reviewed and the utilization of aroma tabs developed by Elequil was chosen for clinical use. A questionnaire provided by Elequil for aroma tab use was modified to address sensitivities to fragrance and potential contraindications in the acute clinical setting. A clinical pathway for aromatherapy treatment was developed.
CRITERIA FOR INCLUSION: Adult patient (18+) in the Emergency Department or Observation Unit presenting with intractable pain, or patients admitted with intractable pain and open to receiving aromatherapy. From March 2021 until June 2021, chart review and data collection occurred for assessment of effectiveness of a new clinical pathway and patient response to implementation of aromatherapy treatment.
METHOD: After completing competency provided by Elequil for their aroma tab use and screening for contraindications via questionnaire (based on interest in aromatherapy and allergies/sensitivities to lavender, peppermint), OTs provided aromatherapy to patients with uncontrolled pain. Pre and post pain, muscle tension, and stress levels were rated by the patient using Wong-Baker Face Scale. Post pain, muscle tension, and stress were obtained on both a 5-minute and 60-minute interval post application.
RESULTS: There was an 11% reduction in pain (7.45 to 6.64) five minutes post application and 15% reduction in pain (7.45 to 6.32) sixty minutes post application. There was a 22% reduction in muscle tension (6.76 to 5.30) five minutes post application, and 32% reduction in muscle tension (6.74 to 4.63) sixty minutes post application. Finally, there was a 27% reduction in stress (7.35 to 5.35) five minutes post application and 36% reduction in stress (7.35 to 4.72) sixty minutes post application of aromatherapy.
CONCLUSION: Clear and consistent reduction in rating for all three categories tested: pain, muscle tension, and stress, after introduction of aromatherapy by an OT. Utilized for pain education, tolerance for ADL, return to life roles.
References
Darnell, B..D, Sturgeon,J , Hah, J.M., Kao, M, Mackey, S. (2014) From Catastrophizing to Recovery, J. Pain Research. (7)pp. 219-226.
Holistic Nursing Pract. (2019) Effects of Aroma on Pain and Anxiety Scores in Adult Patients Admitted to a Community Hospital on Medical Unit or Telemetry Unit; A Pilot Study. Nov/Dec; 33 (6)pp. 346-353
Kim, J.T., Ren C.J., Fielding G. (2007). Obese Surgery. Treatment with Lavender Aromatherapy in the Post Anesthetic Care Unit Reduces Opioid Requirements of Morbidly Obese Patients During Laparscopic Adjustable Gastric Banding.
Johnson, S. A. (2015). Evidence- based essential oil therapy: The ultimate guide to the therapeutic and clinical application of essential oils. Scott A. Johnson Professional Writing Services, LLC. Moudi M, Go R, Yien CY, Nazre M. Vinca alkaloids. Int J Prev Med. 2013;4(11):1231-5.
