Now what was I to do. My client shows up anxious and shares with me that she has just been diagnosed with Multiple Sclerosis. Usually, I would go right into my routine, talk for a little bit to understand how she was dealing with it all and then we would make our way to the table, I would insert a few acupuncture needles and then end the session with a massage. However, this was not going the way I thought it would. She was clearly upset. She was so anxious and wound up I thought to myself, how can I help her if I can’t use the tools of my trade. I invited her to lay down for a moment and had her take a few deep breaths, and I remembered I had lavender oil in my cabinet. The oil was a gift from a friend to use in a room diffuser. Honestly, I never used the oil until that moment. I knew I couldn’t send her home without doing something, so I put a little massage oil in the palm of my hand and added one drop of Lavender oil and mixed them together. With the tip of my index finger, I began to gently placing the lavender scented oil on a few strategic acupuncture points. I sat by the treatment table and within 10 minutes she was fast asleep. From that moment on I was an essential oils believer and I understood the power of this plant medicine.
Today, I find essential oils an integral part of my palliative care practice, I have found them invaluable. Two of the most versatile oils I use are lavender and bergamot.
ESSENTIAL OIL THERAPY
Essential oil therapy refers to the use of “therapeutic grade essential oils to promote physical, emotional, and spiritual health and well-being”1 It is often referred to as “aromatherapy,” Not all oils have a pleasant smell and don’t let the aroma in aromatherapy trick you, inhalation of the oils is only one of the ways the oils are absorbed.
The therapeutic value of an oil relies on the following:
• Chemical constituents
• Route of administration
• Emotional association, the patient has with the scent
The most common ways of administration:
• Inhalation, direct or diffusion
In her book, Complementary Therapies in Nursing, Ruth Lindquist, states that once absorbed into the circulatory and nervous systems, the chemicals may eventually affect all body systems.
Some of the most common symptoms experienced by patients’ in palliative care are anxiety, depression, stress, and pain and supportive research2 leads us to believe that essential oils are a beneficial adjunct to relieve these symptoms.
KEEPING IT SIMPLE
It is always best to not overload the palliative patient with too many scents so let’s keep it simple and start with two of the most versatile essential oils, lavender, and bergamot.
One of the most studied essential oils today, lavender3 has some of the most versatile properties.
• Encourages restful sleep
• Helps relieve headaches
• Reduces anxiety
• Good for stress management
Research on Lavender
One study has shown a hand massage with equal parts lavender, frankincense, and bergamot (diluted to 1.5% with sweet almond oil) reduced pain the pain and depression of hospice patients with terminal cancer.4
Another study revealed that inhalation of lavender oils improves the parasympathetic nervous system activity and relieves specific emotional symptoms.5
Still another study says lavender inhaled directly from a glass bottle from 10:00 pm to 6:00 am improved sleep quality of hospital patients in intermediate care unit.6
Safety of lavender
Lavender has one of the highest safety ratings. There is no known contraindication, and the skin sensitization is only moderate if the oil is put directly on the skin. Dilution should be at 0.1%7
With its bright citrusy aroma, some of bergamots3 reported therapeutic properties6 are
• Relieves anxiety helps with grief, loneliness and reduces mood swings
Research on Bergamot
Inhalation of bergamot may reduce stress, depression, negative emotions, anxiety, and fatigue.3
A hand massage with equal parts of frankincense, bergamot, and lavender (as a 1.5% dilution with sweet almond oil) reduced the pain and depression of hospice patients with terminal cancer).4
Another studied showed promising results for chronic pain patients.8 The study indicated that bergamot (BEO) modulates the sensitive perception of pain in different models of nociceptive, inflammatory and neuropathic pain modulating endogenous systems.
Safety of Bergamot
Bergamot does have a risk of phototoxicity, if applied to the skin it is essential to educate the patient not to be in direct sunlight or lay under a tanning bed for at least 12 hours.7
ADMINISTRATION TECHNIQUES FOR PALLIATIVE PATIENTS
Two of the most effective ways to administer essential oils to a palliative patient are inhalation and topical application.
Direct inhalation: breathing in the scent of the oil from a drop or two on a cotton ball, tissue for 5 to 10 minutes as needed to relieve symptoms. Personally, I have found this method to be the most appropriate if you are dealing with a patient in a shared living space. One person in the home or shared hospital room may find the scent pleasant whereas the someone else in the room may find it offensive. Giving patients a little ziplock bag with an essential oil infused cotton ball works perfectly to keep the scent contained and personalized to each individualized person.
Indirect Inhalation: breathing in the scent dispersed in ambient air, either by an electric or battery powered diffuser with 3 to 10 drops of oil or a spray bottle filled with 250 mL of water and 10 to 12 drops of oils. (NEVER use a candle or an open flame with patients on oxygen)
Topical application is by massage, light or gentle touch, or through a spray.
With a few exceptions, 100% essential oils should not be applied directly to the skin, but in diluted forms (constituting 1.5% to 2% of a carrier oil, lotion, or gel).9 Half the concentrations are advised for use in patients who are very you, elderly, or medically or cognitively compromised.
OTHER SAFETY CONSIDERATIONS
Since essential oil manufacturers are not regulated by the U.S. Food and Drug Administration (FDA) or any other regulatory body, it is the responsibility of the practitioner to investigate any supplier. Practitioners must know where an essential oil is obtained to ensure that the oil has a known botanical origin, is of high quality, and has been tested for chemical makeup between batches.7,10 Without standardization, it's impossible to guarantee the therapeutic value and safety of any product.
Practitioners need to be vigilant to avoid acquiring diluted essential oils. Adulteration, the practice of adding extraneous and possibly harmful substances such as ethanol, mineral oil, glycol, and others to a solution to increase the profit margin, is common among disreputable manufacturers.7
The National Association for Holistic Aromatherapy (NAHA) emphasizes six factors that influence the safety of an essential oil: quality, chemical composition, the method of application, dosage (or dilution), integrity of skin, and age of the client. It provides these 12 safety guidelines:
Keep oils away from children and pets.
Avoid sunlight and tanning booths for 24 hours after using a photosensitizing essential oil.
Avoid prolonged use of the same essential oil (such as exposures of an hour or more to high levels of its vapor, repeated topical application to the same site, and repeated use over several weeks).
Research any oil before using it on yourself or a patient.
Do not use undiluted oils (those not mixed with a carrier substance) on the skin unless specifically indicated.
If you suspect an allergy or sensitivity, perform a skin patch test.
Know the safety data on any essential oil you use.
Use caution when administering essential oil therapy to women who are pregnant or trying to become pregnant.
Avoid contact between essential oils and the eyes.
Keep all essential oils away from open flames.
Ensure adequate ventilation when using essential oils.
Do not use essential oils internally unless adequately trained in such use.
ESSENTIAL OILS IN A CLINICAL SETTING
A considerable concern regarding the use of essential oils in a clinical setting is that they are not FDA regulated and cannot claim to treat disease. In a medical facility, they may be used only for very specific indications, and the language surrounding their use must be monitored. For example, essential oils can be said to “minimize discomfort” but not to “treat pain”; they can be used to “promote a sense of calm and well-being,” but not to “treat anxiety.”12
In their article, Using Essential Oils to Enhance Nursing Practice and for Self-Care, Melissa Allard and Julie Katseres, says "a committee of three certified aromatherapy practitioners worked closely with a local essential oil supplier to develop blends of oils to assist patients with symptoms and general well-being. Use was limited to inhalation and topical application; staff education emphasized that ingestion of essential oils was prohibited in a clinical setting. After initial staff training, nurse champions provided guidance and support on each of the various hospital units. Our latest data review showed essential oils to be the most widely used integrative modality, representing 64% of all modalities used. Collectively, all integrative modalities demonstrated an 84% effectiveness rate in terms of nurse- or patient-perceived improvement of some aspect of patient comfort, such as mood, ability to rest or sleep, anxiety level, or level of discomfort."
In my practice, I have found essential oils have always provided a simple way to help palliative patients cope with a variety of symptoms they deal with on a daily basis, and for me, it's comforting to know the patient has direct access to utilizing their therapeutic effects when they need to.
I hope the trend toward using non-pharmaceutical strategies continues in healthcare and that research keeps pace with the demand of integrative therapies. It is important for all practitioners to become educated in these modalities and continue to offer patients a choice with regards to their care and healing.
1. Smith LL Essential oils for physical, emotional, and spiritual health: a program of certification in aromatherapy. Arvada, CO Healing Touch Spiritual Ministry Program; 2006.
2. Bruera, Edward, Yennurajallingam, Sriram. Oxford American Handbook of hospice and palliative medicine. ISBN-13: 978-0-19-538015-6. Publisher, Oxford University Press
3. Johnson, Scott. Evidenced-Based Essential Oil Therapy: The Ultimate Guide to the Therapeutic and Clinical Applications of Essential Oils. SA Johnson Professional Writing Services LLC 2015.
4. Chang , SY. Effects of aroma hand massage on pain, state anxiety and depression in hospice patients with terminal cancer. Taehan Kanho Hakhoe Chi. 2008 Aug:38 (4);493-502