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The objective of this study was to compile existing scientific evidence regarding the effects of essential oils (EOs) administered via inhalation for the alleviation of nausea and vomiting. CINAHL, PubMed, and EBSCO Host and Science Direct databases were searched for articles related to the use of EOs and/or aromatherapy for nausea and vomiting. Only articles using English as a language of publication were included. Eligible articles included all forms of evidence (nonexperimental, experimental, case report). Interventions were limited to the use of EOs by inhalation of their vapors to treat symptoms of nausea and vomiting in various conditions regardless of age group. Studies where the intervention did not utilize EOs or were concerned with only alcohol inhalation and trials that combined the use of aromatherapy with other treatments (massage, relaxations, or acupressure) were excluded. Five (5) articles met the inclusion criteria encompassing trials with 328 respondents. Their results suggest that the inhaled vapor of peppermint or ginger essential oils not only reduced the incidence and severity of nausea and vomiting but also decreased antiemetic requirements and consequently improved patient satisfaction. However, a definitive conclusion could not be drawn due to methodological flaws in the existing research articles and an acute lack of additional research in this area. The existing evidence is encouraging but yet not compelling. Hence, further well-designed large trials are needed before confirmation of EOs effectiveness in treating nausea and vomiting can be strongly substantiated.
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A Brief Review of Current Scientific Evidence Involving
Aromatherapy Use for Nausea and Vomiting
Pei Lin Lua, PhD, and Noor Salihah Zakaria, BSc
Abstract
Objectives: The objective of this study was to compile existing scientific evidence regarding the effects of
essential oils (EOs) administered via inhalation for the alleviation of nausea and vomiting.
Methods: CINAHL, PubMed, and EBSCO Host and Science Direct databases were searched for articles related to
the use of EOs and/or aromatherapy for nausea and vomiting. Only articles using English as a language of
publication were included. Eligible articles included all forms of evidence (nonexperimental, experimental, case
report). Interventions were limited to the use of EOs by inhalation of their vapors to treat symptoms of nausea
and vomiting in various conditions regardless of age group. Studies where the intervention did not utilize EOs
or were concerned with only alcohol inhalation and trials that combined the use of aromatherapy with other
treatments (massage, relaxations, or acupressure) were excluded.
Results: Five (5) articles met the inclusion criteria encompassing trials with 328 respondents. Their results
suggest that the inhaled vapor of peppermint or ginger essential oils not only reduced the incidence and severity
of nausea and vomiting but also decreased antiemetic requirements and consequently improved patient satis-
faction. However, a definitive conclusion could not be drawn due to methodological flaws in the existing
research articles and an acute lack of additional research in this area.
Conclusions: The existing evidence is encouraging but yet not compelling. Hence, further well-designed large
trials are needed before confirmation of EOs effectiveness in treating nausea and vomiting can be strongly
substantiated.
Introduction
Nausea and vomiting are symptoms that can be caused
by various diseases and certain life events such as
pregnancy.
1
Depending on the underlying pathogenesis,
these symptoms may appear in acute or chronic form. Nausea
is defined as an unpleasant sensation around the throat, upper
gastric region, or abdomen or commonly described as feeling
‘‘sick to the stomach.’
2
Vomiting or emesis can be denoted as
‘‘throwing up’’ (the forceful expulsion of the stomach contents
through the oral or nasal cavity).
2
The frequent number of
occurrences of nausea and vomiting sometimes cause these
symptoms to be regarded as inconvenient or a nuisance rather
than being seen as a medical problem. Failure to address the
focal issues of these symptoms can be debilitating, causing
unnecessarily prolonged recovery times, and may eventually
lead to serious complications such as pneumonia, dehydra-
tion, and malnutrition.
3
To date, the main pharmacological intervention for nausea
and vomiting involves antiemetic prescription. Considerable
progress has been made in antiemetic therapy, particularly
with the use of a 5-HT
3
receptor antagonist, a highly effective
antiemetic, particularly beneficial for high-risk patients,
especially chemotherapy and radiotherapy recepients.
4
Nevertheless, despite the availability of this modern treat-
ment, nausea and vomiting remain among the most common
symptoms experienced by a large number of patients in
medical conditions such as postoperative, chemotherapy,
and radiotherapy recipients, with the reported incidence
reaching to over 50% of the populations.
5–7
Self-care reme-
dies such as drinking ginger or peppermint teas, eating bland
foods, and relaxation have been commonly attempted, es-
pecially for temporary or mild nausea and vomiting.
3,8
Un-
fortunately, nausea and vomiting can also impose negative
impacts on the quality of life (QoL),
9
thus warranting greater
attention to improve patients’ health outcomes. With an
emphasis on improvements in current practices along with
the increasing demand for holistic care, the integration of
complementary therapies into mainstream treatment may
help to achieve desirable patient outcomes.
Centre for Clinical and Quality of Life Studies, Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Terengganu,
Malaysia.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 18, Number 6, 2012, pp. 534–540
ªMary Ann Liebert, Inc.
DOI: 10.1089/acm.2010.0862
534
Aromatherapy refers to the therapeutic use of fragrant
substances, called essential oils (EOs), to help improve
physical and mental health and QoL
10
and represents a
possible form of complementary and alternative medicine
(CAM) for nausea and vomiting. EOs are usually obtained
by steam distillation of aromatic plants,
11
whereas other
kinds of extracts that are not obtained by steam distillation
are not considered as EOs.
12
Different aromatic plants pro-
duce EOs with different fragrance and therapeutic charac-
teristics depending on their chemical constituents.
13
For
example, lavender (Lavandula angustifolia) and its main con-
stituents, linalyl acetate and linalool, exhibit local anesthetic
effects in animal in vitro models.
14
Additionally, in other
animal studies, a-bisabolol from chamomile (Matricaria re-
cutita) EOs was identified as having strong anti-inflamma-
tory effects.
15
The main therapeutic properties of EOs also
include antiseptic, antibacterial, wound-healing, immune-
stimulant, as well as calming, sedative, analgesic, uplifting,
and stimulating effects.
16
For thousands of years, aromatherapy has been used in
countries such as Egypt and India as an ancient tradition of
herbal medicine.
17
Aromatherapy could be applied either
through inhalation of fragrances, topical application (with
or without massage enhancement), or both. In France, the
practice of medical aromatherapy involves internal use (in-
gestion) of EOs
15
such as the consumption of peppermint
(Mentha piperita) oils for gastrointestinal disorders to reduce
colonic spasm during colonoscopy
18
and the symptoms of
irritable bowel syndrome.
19
Other than that, EOs can also be
diffused in the air, added in the warm bath water, or used in
plant poultices or compresses. However, for the purpose of
this review, the focus is on the therapeutic use of EOs pri-
marily via inhalation of its vapors. Due to its advantage of
being a noninvasive and relatively low-risk treatment, aro-
matherapy could serve as a promising modality to improve
patient care.
20
However, with the advances of evidence-
based medicine, empirical research is consistently required to
evaluate the efficacy of this treatment modality. For the time
being, substantial evidence for clinical trials on aromather-
apy is limited to relaxation alone.
15
Despite the limited clinical evidence, there are encourag-
ing indications from basic science research that certain EO
vapors are absorbed by inhalation and alter brain func-
tion.
21–23
Herz
24
proposed two hypothetical mechanisms for
the effects of odors on mood, behavior, and physiology:
pharmacologic and psychologic mechanisms. Pharmacolo-
gically, the fragrances of EOs may deliver direct effects on
the central/ autonomic nervous system and endocrine sys-
tem regardless of conscious evaluation. Following inhalation,
volatile EO molecules pass to olfactory receptors in the nose,
which recognize their molecular characteristics, and send
signals to the brain via the olfactory nerve. In addition, some
of the constituents pass into the bloodstream via the lungs
and consequently produce their effects directly on brain
neurons after passing through the blood–brain barrier.
25
Apart from that, based on psychologic hypothesis, the po-
tential effects of smell depend on emotional learning, con-
scious perception, as well as belief and expectations. As such,
the perceived quality of the odors is also accountable for the
individual responses.
Although aromatherapy represents the most regularly
practiced CAM modality by users, it is also one of the least-
researched therapies. At the present time, there are no re-
views for aromatherapy on the Cochrane database.
26
A new
review is in process as a team is updating the review and
preparing a protocol to evaluate the effectiveness of aroma-
therapy for postoperative nausea and vomiting
26
(this was
also confirmed through personal communication with the
main author). As such, the objective of the current review is
to compile the currently available scientific evidence on the
effects of aromatherapy for nausea and vomiting.
Methods
The authors sought to identify all clinical trials and re-
views involving the therapeutic use of inhaled aromatherapy
to alleviate nausea and vomiting. Eligible articles included all
forms of evidence (nonexperimental, experimental, case re-
port). Interventions were limited to the use of EOs by vapor
inhalation to treat symptoms of nausea and vomiting in
various conditions regardless of age group. Studies where
the intervention did not utilize EOs or were concerned with
only alcohol inhalation and trials that combined the use of
aromatherapy with other treatments (massage, relaxations,
or acupressure) were excluded. An inclusive search for
clinical research was carried out in major biomedical, nurs-
ing, and specialist CAM databases such as CINAHL,
PubMed, EBSCO Host, and Science Direct. The search en-
compassed all articles published by the end of November
2010. The basic search terms used included aromatherapy,
essential oils, scent, fragrance, nausea, vomiting, and com-
plementary therapy. In order to obtain the widest range of
studies, no limit was set for the date of publication. In ad-
dition, the bibliographies of the located studies were scanned
for further relevant studies. Nevertheless, only articles using
English as a language of publication were included in this
review. Further information on unpublished and ongoing
research was traced using relevant databases such as Clin-
icaltrials.gov (US). Figure 1 shows the flow of the literature
search process.
Results
All reviewed studies are summarized in Table 1. The
searches identified four clinical studies and one review article
involving a total of 328 study participants. Three (3) studies
investigated postoperative nausea and vomiting (PONV) and
one study focused on oncology nausea and vomiting. All
studies concluded that inhaled aromatherapy served as an
effective treatment for the nausea and vomiting. Other con-
siderations for practical use of aromatherapy included the
reduction in antiemetic requirement such as prochlorperazine,
droperidol, ondansetron, or metoclopramide, increased pa-
tient satisfaction, and improved cost effectiveness.
These studies varied from simple observational studies to
the use of a randomized controlled trial. The outcomes
evaluated included PONV and oncology nausea. Visual an-
alog scale (VAS), standard descriptive ordinal scale, nausea
section of the Edmonton Symptom Assessment System
(ESAS), as well as the reported incidence were the instru-
ments used to measure the intended outcomes. In the An-
derson and Gross
5
trial, a 100-mm VAS was rated by the
respondents at 2 and 5 minutes postintervention. A study
by Tate
27
collected the information related to nausea on a
4-hourly and 12-hourly basis.
AROMATHERAPY FOR NAUSEA AND VOMITING 535
The interventions also differed as evidenced by the use of
a variety of EOs. In two studies, peppermint oil was used for
nausea and vomiting treatment in the experimental
group.
5,27
Specifically in one trial, patients were asked to
inhale the vapors deeply through the nose three times from a
scented gauze pad held directly under their nostril, then to
exhale slowly through the mouth.
5
In another study, con-
senting patients were also offered peppermint oils that were
administered through the inhaler for 5 seconds.
28
Geiger
25
used ginger essential oil in his study in which 5% Zingiber
officinalis (ginger) in grape-seed oil was applied below the
nose immediately before surgery. Additionally, the solution
was put on the pulse-points of both wrists for patients to
sniff if they experienced nausea postoperatively. The Stringer
and Donald
29
trial employed a personalized aromatherapy
inhalation device, known as Aromastick, whereby a choice of
two blends of essential oils was available for patients to
choose. One of the revealed blends consisted of peppermint
and lemon (Citrus limonum). This device was held by patients
approximately 6 inches under their nose while breathing in
and it could be used as necessary, allowing self-symptom
management.
Three (3) studies of controlled trials reported using dif-
ferent controls or placebos. Geiger
25
and Tate
27
compared
their aromatherapy intervention to a no-treatment group.
Additionally, peppermint essence was also used in the study
by Tate
27
in his three-arm evaluations to assess the efficacy of
peppermint EOs for PONV. Conversely, the respondents in
the Anderson
5
trial were provided with placebo gauze pads
prepared by placing 2 mL of isotonic saline.
A substantial number of patients had reported the benefits
of using aromatherapy. This was evidenced by 82% of re-
spondents indicating the benefits of Aromasticks for nausea
management whereby almost half (47%) settled their nausea
problem.
29
Another study also showed that 80% of high-risk
patients did not experience PONV after the application of
5% ginger EOs nasocutaneously.
25
In addition, self-reported
nausea score was significantly different between the placebo
and experimental groups.
27
Despite overall nausea score
decreasing significantly after aromatherapy administration,
the reduction was independent of treatment
5
attributed to
the favorable effects of controlled breathing patterns.
Discussion
Study outcomes
The overall findings from the reviewed studies suggest
that aromatherapy can offer beneficial effects for nausea and
vomiting. However, there are very few published research
articles as well as apparent methodological flaws on this
subject matter, providing room for improvement. Most of the
studies included had examined the efficacy of aromatherapy
on PONV patients, enabling the possibility of evaluating its
effectiveness for various types of clients. However, they were
confined only to limited sample sizes (n=17–160) and their
study designs were not entirely satisfactory. Difficulties in
recruiting and retaining patients were problems common to
all clinical trials due to the use of broad exclusion criteria and
inadequate outreach to populations such as individuals with
low income, ethnic minorities, and the elderly.
30
This factor
would limit the patient participation and clearly reduce
generalizability. With only one study adopting a randomized
control design,
5
attempts to evaluate the actual clinical ben-
efit of this complementary therapy remain challenging.
Placebo/control
Selecting the appropriate placebo for aromatherapy in-
tervention can be difficult. Wiebe
31
suggested that the con-
trol for CAM trials should sufficiently mimic active
treatment to support the blinding of patients.
32
For instance,
the study by Tate
27
used a fragrance-matched artificial pla-
cebo (peppermint essence) as a comparator, lacking in
menthol composition compared to peppermint EOs. Most
aromatherapists believe that synthetic fragrances are inferior
to EOs, although they are often composed of many of the
same compounds.
33
This is because synthetic fragrances lack
natural or vital energy; however, this has been contested by
odor psychologists and biochemists who believe in the im-
portance of therapeutic odor in treating various illnesses.
34
Menthyl acetate, which is responsible for peppermint’s
minty aroma and flavor,
35
might also be favorable in nausea
conditions. However, because adaptation to the odorant oc-
curs quickly (in which the smell receptors become less re-
sponsive to respond to repeated or continued stimuli of
constant odor intensity), this condition reduces the potency
of the odor to treat an ill condition, thus supporting the
pharmacologic effects of EOs.
34,36
Therefore, the respondents
could be blinded by using peppermint essence, since the
smell was similar except it was devoid of the active thera-
peutic compound in peppermint essential oils (menthol).
However, an experienced practitioner might be able to dis-
tinguish the differences considering the lack in menthol in
peppermint essence, hence moderating its cool sensation
properties. As such, the evaluation on the blinding may give
valuable information, especially in adopting a double-blind
study design. For instance, Graham et al.
37
revealed that
their attempts to blind patients for aromatherapy interven-
tion were not 100% effective, although most were uncertain
FIG. 1. The flow in the literature search process.
536 LUA AND ZAKARIA
Table 1. Scientific Evidence on Aromatherapy for Nausea and Vomiting
No.
First
author (year) Aims/purposes Sample Design/interventions
Outcome
measures Results Comments
1 Stringer
(2010)
To evaluate the
effects of a new
aromatherapy
intervention
using Aromastick
Oncology
patients
with
anxiety,
nausea and
sleep
disturbance
(n=160)
Retrospective service
evaluation
Aromastick was given to the
referred patients consisting
of a choice of 2 blends of
essential oils (of which one
combination =peppermint
+lemon; the other
unstated)
Frequency of
using
Aromastick
and
perceived
benefit
Reduced anxiety, nausea, sleep disturbance
with 47% of nauseous patients reported
fewer symptoms prior to the use of
Aromastick
Effect of Aromastick may be directly
proportional to the frequency of their use
No report on antiemetic use
No known side-effects
Non-randomized and
uncontrolled trial
No baseline measurement
was taken by validated
tools
Unable to rule out the
placebo effects
2 Buckle
(2007)
To discuss the
expansion of
aromatherapy,
particularly in
the field of
nursing
Nauseous
patients
(n=17)
A review paper; included
one controlled clinical trial
(CCT) assessing undiluted
peppermint oil in plastic
personal inhaler
Nausea
section of
the
Edmonton
Symptom
Assessment
System
Reduced nausea ( p<0.001) Small sample size
Secondary reference
3 Geiger
(2005)
To evaluate the
efficacy of 5%
ginger essential
oils
administered
nasocutaneously
to prevent
postoperative
nausea and
vomiting
(PONV)
Patients at
high risk for
PONV from
post-
anesthesia
recovery
unit (PACU)
(n=100)
CCT
1. Nasocutaneous
application of 5% ginger
essential oil (experimental)
applied on pulse points of
both wrists for patients to
sniff
2. Standard anti-emetic
treatment (control)
Incidence of
nausea and
vomiting
80% of high-risk patients had no complains
of PONV
No report on antiemetic use
No known side-effects
Nonrandomized trial
Unquantifiable control
variables
4 Anderson
(2004)
To determine the
efficacy of
aromatherapy
with isopropyl
alcohol or
peppermint oil
in nauseous
patients after
outpatient
surgery
Ambulatory
surgery
patients in
PACU with
PONV
(n=33)
Randomized control trial
Inhalation of 2 stacked 2†·2
gauze pads containing:
1. 1 mL of 70% isopropyl
alcohol
2. 2 mL isotonic saline
+0.2 mL of peppermint oil
3. 2 mL isotonic saline
(placebo)
VAS 100 mm
severity of
nausea at 2
minutes
and 5
minutes
post-
intervention
and level of
satisfaction
Overall nausea score significantly decrease
but did not differ among treatment groups.
Overall patient satisfaction was significantly
correlated with the decrease in the nausea
score 5 minutes after aromatherapy
Reduced intravenous antiemetic use by
nearly 50% (droperidol, ondansetron, or
metoclopramide)
No known side-effects
Small sample size
No control group (without
active treatment)
5 Tate (1997) To evaluate the
efficacy of
peppermint oil
through
inhalation for
PONV
Gynecological
patients
with PONV
(n=18)
CCT
1. No treatment (control)
2. Peppermint essence
inhaled from bottle
(placebo)
3. Peppermint oil inhaled
from bottle (experimental)
Standardized
descriptive
ordinal
scale on
nausea at 4-
hour and
12-hour
intervals
Experimental group:
Lower prevalence and /or intensity of nausea
More tolerance to analgesia
Less requirement for antiemetics
(prochlorperazine, ondansetron, or
metoclopramide)
The cost of drug treatment was
considerably reduced by half
No known side-effects
No statistical significance
was detected for all
variables except less
incidence of nausea in
experimental group
compared to placebo
group
Nonrandomized trial with
small sample size
537
or wrong about the treatment they actually received.
Therefore, it is important for future trials to choose the ap-
propriate placebo as well as to conduct the blinding assess-
ment in order to minimize (if not eliminate) the placebo
detection effect.
Assessment methods
There were no standard and consistent measures to assess
nausea and vomiting. Three (3) studies measured the se-
verity of nausea either using the VAS, nausea section of
ESAS, or a standardized descriptive ordinal scale, whereas
another two studies only reported the incidence of the
symptoms. VAS is commonly used to measure a variety of
subjective responses including the assessment of ‘‘feeling.’’
38
Generally, it consists of a 100-mm-long line in which the
lower anchor end corresponds to ‘‘no symptom’’ and the
higher anchor end signifies ‘‘unbearable symptom.’’ Nausea
intensity measurement using VAS serves an advantage over
other methods, considering that continuous data have ratio
properties and are well suited for statistical analysis, unlike
categorical scales
38
in the nausea section of ESAS or stan-
dardized descriptive ordinal scale. This instrument is also
easy to be self-administered for the patients because of its
simplicity and speed of completion as well as being unhin-
dered by a language barrier.
39
However, the estimation of
nausea intensity with VAS requires an ability to transform a
complex subjective experience to a visual–spatial display,
which involves perceptual judgment and accuracy. Potential
investigator bias might also occur, since patients may require
lengthy instructions from trained staff before completion.
Despite these limitations, VAS may still serve as a useful self-
reported tool in assessing nausea and vomiting considering
individual subjective perception of these symptoms.
Essential oils (EOs)
Inconsistencies in terms of the type of EOs and how they
were delivered (including dose, blended or single oil used)
hampered comparisons between these studies. Peppermint
and ginger oils have been regularly used in the aroma-
therapy intervention for nausea, using various methods of
administration including oral preparations. The selection of
these EOs was associated with the role of their chemical
constituents, which help in the relief of gastrointestinal
symptoms.
24,26
Peppermint oils have been shown to be an
effective remedy for morning sickness, dyspepsia, and other
gastrointestinal complaints; its effectiveness is attributed to
its antispasmodic properties.
40
In addition, the botanical
form of ginger was often advocated as beneficial for nausea
and vomiting in various conditions including motion sick-
ness, pregnancy-induced and postoperative conditions.
41-42
On the other hand, aromatherapists particularly use the
EOs in a blend form, since they are believed to be more
effective as the therapeutic value is generated by the reac-
tion and balance of the oils’ constituents.
33
The evidence
from the Stringer and Donald
29
trial on the effectiveness of
blended EOs to reduce nausea and vomiting is still deba-
table, as its retrospective design prevented the exclusion
of various study biases. Considering these facts, the im-
portant issues mentioned need to be further explored to
maximize the potential benefits of EOs use via inhaled
aromatherapy.
Side-effects
No known side-effects prior to aromatherapy adminis-
tration were reported by these studies, suggesting the mini-
mal invasive property of these EOs. In fact, only a few
isolated cases of allergic reactions were documented in the
literature.
43
Yet, with its volatility and the skin’s absorbent
nature, some EOs do possess the potential to initiate allergic
reactions.
44
Aromatherapy oil should therefore not be con-
sidered as a safe alternative to existing pharmacotherapy
until rigorous safety trials have been completed. Concerning
inhalational aromatherapy, only one incidence of idiosyn-
cratic allergic reactions with Anthemis nobilis essential oils
was reported (after inhalation of one drop of smelling
strip).
44
This incidence was among two serious cases that
were indicated by the author after 10 years of teaching in
aromatherapy. Thus, although the reviewed studies had not
indicated any untoward incidences, the risk still exists, re-
quiring precautionary measures to minimize any unwanted
consequences from EOs use.
Outcomes on antiemetic use
The reported outcomes in these reviewed studies have
also highlighted the reduction in the use of analgesic and
antiemetic medications. These positive responses are of value
for extrapolating to gauge the benefits toward less inherent
expenses and potential side-effects related to the pharmacologic
interventions, although the claims were not based on validated
outcomes measures. Therefore, future trials are recommended,
which should include an analysis of medication use as a result
of aromatherapy administration as well as cost effectiveness
assessment related to this complementary treatment.
Limitations
Despite the rather captivating findings from this review,
there are several limitations that need to be mentioned.
First, only five articles were reviewed and more than half
of the studies used small sample sizes. Even though a thor-
ough research strategy was employed, it cannot be assured
that all relevant trials have been located. Second, although
all the studies have stated that the aromatherapy interven-
tion was administered via inhalation, the method and du-
ration varied widely, which may directly or indirectly
influence the outcomes. Third, due to the restriction im-
posed by the search selection criteria, only one study was a
randomized controlled trial, while the others were using a
quasi-experimental design. No scoring system or quality
assessment for data extraction was adopted for this review,
considering the subdued data and the small number of
available studies that satisfied the selection criteria. Al-
though the excluded studies are not displayed in this review,
the inclusion criteria had served as a precise tool in selecting
the articles through which non-peer-reviewed publications
such as dissertations and non-English articles were excluded.
Conclusions
In summary, it is concluded that inhaled aromatherapy
using peppermint and ginger EOs may have potential ben-
efits in alleviating nausea and vomiting in postoperative and
oncology patients. Although the overall outcomes seem
promising, methodological weaknesses such as small sample
538 LUA AND ZAKARIA
sizes, quasi-experimental design, imprecise measuring tools,
inappropriate placebo, and varied doses or methods of EOs
application restricted these studies, thus compromising any
concrete conclusion. Hence, studies of this nature need to be
further replicated and improved before confirmation of the
effectiveness of EOs in treating nausea and vomiting can be
strongly substantiated.
Acknowledgments
The authors would like to sincerely thank Associate Pro-
fessor Dr. Nik Mazlan Mamat, Dean, Kulliyyah of Allied
Health Sciences, International Islamic University Malaysia
(IIUM) for his support and guidance.
Disclosure Statement
No competing financial interests exist.
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AROMATHERAPY FOR NAUSEA AND VOMITING 539
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Address correspondence to:
Pei Lin Lua, PhD
Centre for Clinical and Quality of Life Studies
Faculty of Medicine and Health Sciences
Universiti Sultan Zainal Abidin
Kampus Kota, Jalan Sultan Mahmud
20400 Kuala Terengganu
Terengganu 20400
Malaysia
E-mail: peilinlua@unisza.edu.my
540 LUA AND ZAKARIA
... As scents are known to mitigate nausea and sickness [61,88,99], previous work utilized different odors to combat motion sickness symptoms [72,79]. Ranasinghe et al. [72] used a peppermint scent while experiencing a first-person-view rollercoaster simulation in VR. ...
... This highlights the importance of the perceived intensity of the scent as a key criterion for studies exploring the effects of olfaction on VR experiences. Peppermint odor has also been tested in other studies concerning the possible alleviation of nausea and vomiting (for an overview see [61]). Results indicate that the inhalation of peppermint and ginger essential oils effectively reduced the onset and severity of nausea and vomiting [61,88]. ...
... Peppermint odor has also been tested in other studies concerning the possible alleviation of nausea and vomiting (for an overview see [61]). Results indicate that the inhalation of peppermint and ginger essential oils effectively reduced the onset and severity of nausea and vomiting [61,88]. ...
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Motion sickness is a prevalent side effect of exposure to virtual reality (VR). Previous work found that pleasant odors can be effective in alleviating symptoms of motion sickness such as nausea. However, it is unknown whether pleasant odors that do not match the anticipated scent of the virtual environment are also effective as they could, in turn, amplify symptoms such as disorientation. Therefore, we conducted a study with 24 participants experiencing a pleasant odor (rose) and an unpleasant odor (garlic) while being immersed in a virtual environment involving either virtual roses or garlic. We found that participants had lower motion sickness when experiencing the rose odor, however, only in the rose environment. Accordingly, we also showed that the sense of disorientation was lower for the rose odor, however, only while being immersed in the rose environment. Results indicate that whether pleasant odors are effective in alleviating motion sickness symptoms depends on the visual appearance of the virtual environment. We discuss possible explanations for such effects to occur. Our work contributes to the goal of mitigating visually induced motion sickness in VR.
... Isopropyl alcohol (IPA), the active component of cleaning alcohol wipes commonly found in clinical settings, is one such substance [21][22][23]. It is non-invasive, inexpensive, associated with minimal adverse events [24] and readily available across healthcare settings. The exact mechanism of action of IPA aromatherapy is not well understood. ...
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Nausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT3) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5-HT3 antagonists for the treatment of nausea across all clinical settings. MEDLINE, EMBASE, PubMed, CENTRAL and CINAHL were searched from inception to 17 July 2023 for randomised controlled trials (RCTs) comparing inhaled IPA and a 5-HT3 antagonist for treatment of nausea. Severity and duration of nausea, rescue antiemetic use, adverse events and patient satisfaction were the outcomes sought. Risk of bias (RoB) was assessed using Cochrane RoB 2. Random-effects model was used for meta-analysis. Combination of meta-analyses and narrative review was used to synthesise findings. The evidence was appraised using GRADE. From 1242 records, 4 RCTs were included with 382 participants. Participants receiving IPA had a significantly lower mean time to 50% reduction in nausea (MD − 20.06; 95% CI − 26.26, − 13.85). Nausea score reduction at 30 min was significantly greater in the IPA group (MD 21.47; 95% CI 15.47, 27.47). IPA led to significantly reduced requirement for rescue antiemetics (OR 0.60; 95% CI 0.37, 0.95; p = 0.03). IPA led to no significant difference in patient satisfaction when compared with a 5-HT3 antagonist. The overall GRADE assessment of evidence quality ranged from very low to low. IPA may provide rapid, effective relief of nausea when compared with 5-HT3 antagonists.
... Because the bedside inhalation of IA may be a cost-effective, readily available, and inexpensive therapy that can be used for the treatment of PONV with a low risk of adverse effects, it is worth exploring the potential benefit of its use. [4] The following manuscript reviews the available information regarding the proposed mechanism of action of IA in treating PONV, clinical applications of its use, and the published literature on IA's efficacy. ...
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Isopropyl alcohol (IA) is a colorless, flammable organic compound that has been used in the manufacturing process of a wide variety of industrial and household chemicals. Inhalation of its vapor has been noted to potentially have antiemetic effects, which may be useful in the treatment of postoperative nausea and vomiting (PONV). However, given the varied study protocols and endpoints assessing its efficacy as antiemetic, clinical trials have yielded mixed results. If effective, inhalation of IA may be a cost-effective, readily available, and inexpensive therapy that can be used for the treatment of PONV with a low risk of adverse effects. The following narrative review explores the available information regarding the mechanism of action of IA in treating PONV, presents clinical information including possible mechanism of action and clinical applications, and reviews the published literature on its efficacy to treat nausea and vomiting with a focus on its use postoperatively. While early studies suggested that inhaled IA may be successful for the short-term treatment of PONV compared with placebo, subsequent studies both in and out of the operating room (OR) have reported conflicting results. In general, studies in the perioperative setting have provided some evidence to support the use of inhaled IA in alleviating or reducing the severity of PONV in adults. In particular, inhaled IA may have a more rapid onset compared with traditional antiemetic agents, but the clinical effect has generally been found to be short-lived. The results outside of the OR and perioperative setting have been somewhat more favorable, generally showing that inhaled IA reduces nausea and vomiting of various etiologies in adults in the emergency department setting. Similarly, it has been shown to reduce the need for rescue antiemetic agents in this area and thus may be considered a cost-cutting strategy with no reported adverse effects. The available literature suggests that inhaled IA may be considered a potential therapy to achieve rapid relief of PONV and assist in the management of nausea and vomiting in adult patients outside of the perioperative setting. There remain insufficient data to determine how inhaled IA may impact PONV in children. Given the mixed results and the limitations of the current studies, additional data are needed to draw firm conclusions regarding the utility of inhaled IA.
... Aromatherapy is one of the complementary therapies commonly used for this purpose. When studies are examined, the use of peppermint and ginger essential oils comes to the fore, especially in coping with CINV (13,(18)(19)(20)(21)(22). ...
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Palliative care is a specialty that aims to prevent and reduce the distress of patients and their families who encounter life-threatening diseases. Especially, it aims to eliminate the problems caused by the cancer itself or the treatment methods. Patients diagnosed as having cancer experience many problems such as nausea, vomiting, anxiety, depression and sleep disturbance due to the disease and its treatment. Patients can search for complementary treatment methods such as aromatherapy in order to reduce or eliminate these symptoms and increase their well-being and quality of life. Aromatherapy is defined as the use of essential oils obtained from plants for therapeutic purposes. Essential oils used in aromatherapy are applied in the form of massage, bath or inhalation. In this review, the use of aromatherapy in the treatment of common symptoms in cancer patients receiving palliative care will be discussed.
... The profession aspect showed that most of them worked as private employees, as many as 15 people. During pregnancy, the mother's time would be spent more at work therefore mother would feel tired and stressed more quickly due to work (Khorasani et al., 2020). The correlation between psychological factors and the incidence of emesis gravidarum was probably due to the fact that mothers tend to be tired during work, and stress can cause anxiety which can trigger the occurrence of emesis gravidarum (Jafarimanesh et al., 2020) Description of the Intensity of Nausea and Vomiting Before and After Being Administered Peppermint ...
... As a result, most guidelines support only the short-term use of medications to treat insomnia, and non-pharmacological approaches to improve sleep are attracting more attention. As a type of non-pharmacological treatment, aromatherapy has been known as one of the most commonly used complementary therapies [9], which is used all over the world because it is cost-effective, noninvasive and low in side effect [10]. Aromatherapy is a treatment that uses concentrated essential oils extracted from herbs, flowers and other plant parts to treat various diseases. ...
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The autonomous, digital, and electric transformation of passenger vehicles is projected to elevate the incidence of motion sickness among occupants. This study investigates the effectiveness of an “anti-motion sickness” system that features dynamic light stimuli to support visual perception of longitudinal motion, combined with relaxing music, perfume and ventilation pulses to enhance user wellbeing. In an experimental design aimed at replicating a realistic passenger drive, fifty-three subjects were tested as front passengers engaged in a gaming activity. Subjective motion sickness ratings were collected throughout the drive, and the development of symptoms was monitored through in-ear physiological measurements, including RR-intervals, core temperature, and oxygen saturation. Post hoc analyses indicated non-significant improvement in subjective assessments of motion sickness. Similarly, physiological measurements did not demonstrate any significant difference across conditions. The tested system was however more effective in mitigating car sickness for low susceptible than for mid-to-high susceptible individuals.
Chapter
Aromatherapy is a medical practice that uses aromatic compounds or essential oils to influence mood and health. Essential oils used in aromatherapy are created from a wide variety of medicinal plants, flowers, herbs, roots, and trees that are found all over the world and have significant, well-documented benefits on enhancing physical, emotional, and spiritual wellbeing. This book is a comprehensive reference on aromatic compounds present in essential oils and their therapeutic use. Starting from fundamentals of essential oil biosynthesis the book guides the reader through their basic biochemistry, toxicology, profiling, blending and clinical applications. The concluding chapters also present focused information about the therapeutic effects of essential oils on specific physiological systems, plant sources, skin treatment and cancer therapeutics. The combination of basic and applied knowledge will provide readers with all the necessary information for understanding how to develop preclinical formulations and standard clinical therapies with essential oils. This is an essential reference for anyone interested in aromatherapy and the science of essential oils.
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Background: Intraoperative anxiety is a common problem when Monitored Anesthesia Care (MAC) is used instead of general anesthesia during minor surgical procedures such as port catheter placement. Nonpharmacological anxiolytics such as aromatherapy have been studied for their effects on preoperative anxiety, but no placebo-controlled study of aromatherapy during surgeries under MAC has yet been performed. Methods: After IRB approval, 70 patients were randomized 1:1 to receive either a lavender/peppermint aromatherapy patch (Elequil Aromatabs®; Beekley Corporation) or a matching placebo patch. The primary outcome, time to readiness for discharge from postoperative acute care units (PACU; min), was assessed every 15 min until a modified postanesthesia recovery score for ambulatory patients (PARSAP) score of 18 or higher was reached. In the preoperative holding area, the assigned patch/placebo was activated and affixed to a folded towel placed aside the subject's head, contralateral to the side of the planned surgery. The towel and patch/placebo were discarded when the subject left the operating room (OR). Results: No difference was found between the treatment and placebo groups on the primary outcome of time to discharge readiness (mean [standard deviation, SD]: 82 [15] vs. 89 [21] min, respectively, p = 0.131). No difference was found between the treatment and placebo groups on the secondary outcomes of intraoperative midazolam dose, intraoperative opioid dose, intraoperative ondansetron dose, or intraoperative promethazine dose. No difference was found between the treatment and placebo groups in the proportion of subjects requiring rescue postoperative nausea and vomiting (PONV) medication in the PACU or the proportion of subjects requiring opioids in the PACU. No difference was found between the treatment and placebo groups in pain intensity in PACU, average PONV score in PACU, or patient satisfaction in PACU. PACU patient satisfaction was high for both the patch and placebo groups (35/35 [100%] vs. 32/34 [94%] "very satisfied," p = 0.239). Conclusions: Aromatherapy treatment is not indicated intraoperatively to reduce anxiety or the use of antiemetics in patients requiring Port catheter placement. Trial registration: Clinicaltrials.gov, identifier: NCT05328973.
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Peloidotherapy and aromatherapy have been used for years in the treatment of numerous inflammatory conditions, including rheumatoid arthritis (RA). The exact mechanism of their action in RA is unclear. The goal of our research is to determine the effect of peloidotherapy and aromatherapy on inflammation parameters in RA patients. Our study included 20 patients of both sexes, with confirmed diagnosis of RA, older than 18 years. Patients were treated during 28 days with combination of peloidotherapy and aromatherapy. Serum samples for detection of levels of inflammation parameters were taken at two intervals: before the start of therapy and at the end of treatment. The results of our study show that there were no significant changes in the parameters of the complete blood count. Nevertheless, a statistically significant decrease in the serum concentration of two markers of inflammation—interleukin-6 (IL-6) and nitrogen-oxide (NO)—was detected. Correlation analyses results say that there is a synchronized drop in the serum concentrations of CRP and the sedimentation rate, and the serum concentrations of fibrinogen and IL-6 are in the same relationship as well as serum levels of IL-6 and NO. Bearing in mind the importance of IL-6 and NO in the pathogenesis of inflammation in RA, we conclude that the application of our therapeutic protocol can be a significant add-on treatment to classic immunomodulators. Due to the small number of study participants, the lack of a control group, and the short follow-up time of patients, additional research is needed.
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It is proposed that a 5% solution of essential oil of ginger, Zingiber offi-cinale, is an effective post-operative nausea and vomiting (PONV) prevention when administered preoperatively, naso-cutaneously concurrently with conventional therapies to general anaesthesia patients at high risk for PONV. This is a summary of six months clinical experience and impressions of a single anaesthesia practi-tioner using best practice multimodal management plus 5% oil of ginger, Zingiber officinale, in the prevention of PONV in high risk group adult patients. The results of the clinical experience show improvement gained in patient response as measured by lower incidence of nausea and vomiting in the post-anaes-thesia recovery unit (PACU). The group treated with the essential oil of ginger expe-rienced approximately less than 20% nausea in the PACU. This low percentage of high risk PONV patients that experienced nausea in the ginger group mostly required only one single intravenous supplemental medication to control nausea. Approxi-mately, 80% of high risk patients had no complaint of PONV and therefore did not require any further intravenous therapy during recovery from anaesthesia through discharge from PACU. The non-ginger oil treated patients in this clinical experience had a roughly 50/50 chance of PONV. A 5% solution of the essential oil of Zingiber officinale in grape seed carrier oil, when applied naso-cutaneously, can be administered safely for the effective pre-vention and therapeutic management of nausea in general anaesthesia patients at high risk for post-operative nausea and vomiting, with increased patient satisfaction and less expense to patients and hospital. Guidelines and regulations established for the safe use of integrative therapy with an essential oil are critical to observe.
Article
The purpose of this study was to determine the frequency of responses to selected fragrance materials in patients who were fragrance sensitive. 178 patients were evaluated in 8 centers worldwide with a fragrance mix (FM) and 20 other fragrance materials. Reaction to the fragrance mixture (FM) occurred in 78.7% of the subjects. Substances reacting at a rate of 2% or higher included jasmine absolute, geranium oil bourbon, l-citronellol, spearmint oil, 1,3,4,6,7,8-hexahydro-4,6,6,7,8,8-hexamethylcyclopenta-gamma-2-benzopyran, omega-6-hexadecenlactone, dimethyltetrahydrobenzaldehyde (isomer mixture), and alpha-amylcinnamaldehyde. These chemicals should be furthur evaluated to corroborate their allergenicity. We are constantly looking for new fragrance allergens to extend the diagnostic capability of the fragrance mix (FM)
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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, computerised literature searches were performed to retrieve all randomised controlled trials of aromatherapy from the following databases: MEDLINE, EMBASE, British Nursing Index, CISCOM, and AMED. The methodological qualify 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, standardised 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 are probably 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.
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Essential oils, made out of natural aromatic molecules, are endowed with so many physiological and pharmacological properties that they find applications in almost every field of medicine, not only curatively but also from a preventative medicine point of view. Although the perception of, and reaction to, essential oils seems to be slightly different between women and men, all people of all ages benefit from aromatherapy. Provided that the practitioner has the relevant information and has undergone the appropriate training, and that the aromatic extracts used conform to medical quality criteria, aromatherapy and aromatology can bring real complementary help to many patients, far beyond the anti-stress massage approach.Aromatherapy can provide a useful complementary medical service both in healthcare settings and in private practice, e.g. in cancer care, dementia, and depression. There are also many indications for the useful and successful application of essential oils, especially for men, such as stress, sleep disorders, back pain, urinary tract infections, rectal abscess, and sexual health.
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Credit This lesson is good for 0.3 CE units, with a passing grade of 70%. Goal The goal of this program is to inform the participant about cost-effective ways to prevent, identify, and manage nausea and vomiting induced by antineoplastic agents. Objectives At the completion of this program the participant will be able to: 1. List antineoplastic agents associated with a high incidence of nausea and vomiting. 2. Identify patient-specific risk factors for developing chemotherapy-induced nausea and vomiting (CINV) and how these factors may influence treatment of this syndrome. 3. Compare the three major types of CINV, including the pathophysiologic mechanism, time of onset, and symptom duration of each type. 4. Explain the mechanism of action and appropriate place in therapy for each type of antiemetic agent. 5. Differentiate between pharmacologic regimens for the prevention and treatment of CINV in adults. 6. Identify drug-specific factors that must be considered when developing a formulary management strategy for the antiemetic agents. 7. Describe specific information that the pharmacist can share with patients to help them understand and manage CINV.
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In this inquiry-based activity, the usefulness of thin-layer chromatography (TLC) to visualize the difference between spearmint and peppermint is explored. The experiment may be used in any class where TLC is discussed from high school to college. We have used this activity with science majors in an organic chemistry laboratory, with non-science majors in a brewing science class, and in a general science class for elementary education majors. The experiment can be completed in a two-hour period. R-(-)-Carvone and (1R,2S,5R)-(-)-menthol are responsible for the cool and minty sensations associated with these plants. These observable properties and the structural formula of the compounds provide the basis for a good discussion on structure–activity relationships. Keywords (Audience): First-Year Undergraduate / General
Article
This paper describes a research study to investigate the efficacy of peppermint oil as a treatment for postoperative nausea. It uses a three-condition experimental design using statistical analysis to compare groups. The Kruskal–Wallis test was used to establish significance and the Mann–Whitney test to differentiate significance between the groups. The control, placebo and experimental groups of gynaecological patients were compared, using variables known to affect postoperative nausea. They were found to be homogeneous for the purposes of the study. A statistically significant difference was demonstrated on the day of operation, using the Kruskal-Wallis test, P= 0·0487. Using the Mann-Whitney test the difference was shown to be between the placebo and experimental group (U=3; P= 0·02). The experimental group also required less traditional antiemetics and received more opioid analgesia postoperatively. The total cost of the treatment was 48 pence per person.