Essential Oil Therapeutics and Palliative Care
While holistic or clinic essential oil therapeutics does not offer cures, it does contribute to the maintenance, enhancement and wellbeing of long-term palliative care patients and their families.
The information that follows provides the historical background and use of plants and their essences throughout the ages. This not only provides the foundation moving forward but also offers a brief look into our history and the importance of plants in medicinal, cosmetic and culinary applications. The focus for this discussion highlights the analgesic and anti-inflammatory properties of frankincense, myrrh and rose essential oils along with methods of application. Used alongside traditional medicine as a complimentary therapy or on its own, essential oil therapeutics has a secure place in long-term palliative care environments.
The History of Essential Oil Therapeutics
The use of aromatic plants traces back thousands of years across ancient civilizations (Buckle, 2015). Many countries such as China, Egypt, France, Greece, India, Iraq, Switzerland, Syria, Tibet and the United States have a history of using aromatic plants as part of their healing traditions. The pharmacopoeia of ancient Egypt (circa 2800 BCE) perfected the art of aromatherapy. Their use of the gum resins, frankincense and myrrh, are an example of an aromatic essential oil synergy blend. Prescribed for the treatment of blood stagnation, inflammation and pain (Rhind, 2016), both Egyptian and Chinese healers used this combination as it imposed, through observation, a greater therapeutic effect than each essential oil used on its own. Recent research confirms this phenomenon often referred to as ‘synergy’ (Rhind, 2016). The high priests used a well-known Egyptian perfume called kyphi, or kuphi. This preparation was a mixture of sixteen ingredients with its main constituent’s calamus, cassia, cinnamon, peppermint, citronella, juniper, henna, myrrh and raisins (Tisserand, 1977). Plutarch, a Greek writer and philosopher, said of kyphi that it could lull one to sleep, relieve anxieties and brighten dreams (Tisserand, 1977, p. 22). Our history of plants and their use in ritual practices, ceremonies, culinary applications and medicinal practice spans geographical areas and takes us back thousands of years.
Integrating essential oil therapeutics as a complimentary therapy in long-term palliative care environments has numerous benefits. These benefits are not isolated to just the patient; they extend to family members, friends, nursing staff, residents or anyone that has a connection to the patient. This “family” unit benefits from essential oil therapeutics and the treatment of distressing symptoms that may include anxiety, fear, pain, inflammation, fatigue and nausea. This paper outlines, based on research and established traditions of use, the therapeutic effects of frankincense, myrrh and rose essential oils. The constituents that make up these essential oils share important characteristics that when blended together provide synergistic or additive potential to treat pain and inflammation.
Essential oils are chemically complex substances that, when used correctly, have the potential to provide relief from a variety of symptoms such as pain and inflammation. Bensouilah et al described essential oils as “volatile odoriferous oil extracted from aromatic vegetable plant material by physical means” (Bensouilah et al, 2006, p. 12). Methods of extraction include distillation or expression (cold pressing of citrus fruit pericarp). Solvent extracted product, such as absolutes and resinoids, are classified differently and used for fragrant flowers and plant material that cannot be steam distilled (Bensouilah, 2006). Produced by the secondary metabolism of the plant, essential oils are present within distinctive oil cells or secretory glands found on the surface of the plant or within the tissue. Bensouilah et al described essential oils as “complex mixtures of mono (C10) and sesquiterpene hydrocarbons (C15), and oxygenated compounds derived from these hydrocarbons, which include alcohols, aldehydes, esters, ketones, phenols, acids and oxides (Bensouilah et al, 20016, p. 14).
Dubin (2010) described pain as a “complex constellation of unpleasant sensory, emotional and cognitive experiences provoked by real or perceived tissue damage and manifested by certain autonomic, psychological, and behavioral reactions” (Dubin, 2010, p. 1). While the complex intricacies of how our bodies process pain falls outside the scope of this paper, a basic understanding of the chemical constituents of essential oils and how they affect the pain transmission process will be described. Specialized sensory neurons referred to as nociceptors alert the body to potentially dangerous stimuli. These pain receptors travel through nerves into the central nervous system (CNS) to the thalamus. The thalamus then sends the ‘pain’ message to the cerebral cortex where it is processed. Rhind (2016) stated several studies indicate essential oil constituents have anti-nociceptive effects and that some components appear to have multiple modes of action. Having multiple modes of action indicates usefulness for different types of pain. A reduction in pain sensitivity using essential oil therapeutic blends is a complimentary modality that can stand alone or be combined with the conventional analgesics of opioids and/or non-steroidal anti-inflammatory drugs (NSAIDs). Rhind (2016) described the result of a systematic review completed from a number of published papers a positive outcome for essential oil therapeutics. The author stated, “the great diversity of mechanisms that may be associated with the analgesic effect of these monoterpenes is amazing” (Rhind, 2016, p. 76). One such constituent, found in frankincense essential oil, is para-Cymene. Studies have shown this cyclic monoterpene to have analgesic action with “excellent” anti-nociceptive potential. Para-Cymene works via the opioid system in that it binds to opioid receptors in the central nervous system (CNS) inhibiting pain (Rhind, 2016). Native to the Red Sea region, frankincense is a small tree that grows in rocky areas throughout northeast Africa (Sade, 2017). Discovered by the Chinese and also known as Olibanum, frankincense has been used throughout history in religious ceremonies and rituals. In fact, it was one of the three gifts from the magi (wise men) given to the infant Jesus (Sade, 2016). Frankincense’s warm, deep balsamic fragrance has a multitude of therapeutic activities that benefit the cardiovascular, circulatory, respiratory, muscular and skeletal systems. Studies carried out in a New York hospice on a pilot group of terminally ill patients experiencing moderate to severe pain had a positive outcome when using frankincense essential oil (Buckle, 2015). Outcomes measures for this study included blood pressure (BP), respiration and psychological changes. The entire frankincense group of individuals responded positively to all measures compared to the control group at 50% (Buckle, 2015). Another study carried out on a group of patients that were all in the active stages of dying used frankincense in a foot and leg massage. Restlessness decreased after the treatment for nine out of the ten patients, their breathing slowed and most of them slept peacefully following treatment (Buckle, 2015). This level of caring is extremely beneficial for not only the patient but their loved ones as well. Providing comfort, support and enabling a patient the best quality of life is the heart of essential oil therapeutics. Dame Cicely Sounders, known for her role in the hospice movement wrote, “we do not have to cure to heal” (Buckle, 2016, p. 329).
Inflammation is described by Rhind as “…a protective reaction to any harmful stimuli, such as invasion of pathogens, or injury and damaged cells; acute inflammation is the first stage of the healing process, triggered by the innate immune system” (Rhind, 2016, p. 80). Studies have shown the anti-inflammatory components of essential oils suppress the activity of specific enzymes such as 5-LOX (5-lipoxygenase). Myrrh essential oil contains the component β-caryophyllene that is effective at supressing the pro-inflammatory enzyme 5-LOX. A bicyclic sesquiterpenoid alkene, β-caryophyllene relieves symptoms of anxiety and depression as well has anti-inflammatory, analgesic and anti-carcinogenic properties. The Chinese have used myrrh for centuries because of its effectiveness against symptoms of arthritis. Also used in Ayurveda for inflammatory diseases (Rhind, 2016), myrrh essential oil has therapeutic applications for the respiratory, muscular, skeletal and integumentary systems.
Like frankincense and myrrh, rose has a long history with the first possible distillation by the Arabs in 500 A.D. The Ayurveda book “Veda” written over 7,000 years ago refers to rose in its beautifully written ancient Sanskrit. Art and ancient literature portray rose blossoms as the symbol of love, perfection, beauty, youth and immortality (Sade, 2016). From a therapeutic perspective, rose essential oil has a multitude of applications that include cardiovascular, circulatory, respiratory and emotional. Rose essential oil calms the nervous system when used subtly. It has antidepressant, vasoconstrictor, astringent, sedative and analgesic properties. It would be remiss not to mention the variety of properties this beautiful oil offers. However, for the purposes of this paper, the analgesic properties are of particular interest and will be the focus. Rose essential oil is extremely complex in that it contains more than 300 chemical compounds (Sade, 2016). One of those compounds is citronellol. Contributing to the rose scent and found in significant amounts in rose (up to 45%), citronellol also displays analgesic properties by inhibiting the peripheral and central nervous systems (Rhind, 2016). Rose essential oil has an instantly recognizable scent that provides a deep calming effect offering serenity, peacefulness and tranquility.
Methods of Application
Essential oils are lipophilic substances that are easily absorbed by the skin. Their solubility with the lipids found in the three structural layers of our skin that include the epidermis, the dermis and the subcutis, make dermal absorption possible. When a synergistic blend is applied or massaged into a patient’s skin, the essential oil constituents make their way past the epidermis and enter the complex world of the skins dermis layer. The dermis layer of our skin receives a rich supply of blood. It is a complex world of lymph and blood vessels, nerves, sweat and oil glands, follicles, collagen, fibroblasts, mast cells, and elastin (Price, 2012). The journey of the essential oil constituents continues into the circulatory system where they “pervade the cells of the body” (Price, 2012, p. 130). While there are many factors that affect the penetration of the skin such as area of skin, thickness and permeability of the epidermis, gland opening, reservoirs, enzymes and integrity of the skin, using the skin as a gateway for the application of essential oils is extremely beneficial for patients dealing with pain and/or inflammation.
A variety of methods are available for application of essential oils that include massage, inhalation, diffusing, creams, ointments, gels, compresses (hot and cold) and baths. Massage is one of the best methods for the delivery of essential oil therapeutics. A low dilution (0.05-1%) of a synergistic blend that includes frankincense and myrrh essential oils mixed in carrier oil (30 ml) provides the beneficial aspects of touch with the therapeutic properties these oils offer.
Inhalation, using a nasal inhaler, steamer or through diffusion, is another very effective method for essential oil application. Numerous neural connections exist between the olfactory system and limbic structures such as the amygdala, hypothalamus, hippocampus and temporal cortex (Bensouilah & Buck, 2006). Bensouilah et al describe the diversity of reactions and memories arising from the aromatic molecules are supported with abundant evidence showing mood and behavior responses to odour. One drop of rose essential oil on an inhaler stick, tissue or kleenex is a non-invasive method that can be utilized with palliative care patients living in scent-free environments. Dermal applications that include the use of creams, ointments, gels and compresses are convenient methods used to apply essential oils. Dermal applications do not offer the same level of therapeutic value as massage or inhalation due to a few variables (i.e., emulsifying agents, additional ingredients etc.…) but they are effective nonetheless. Gels offer an excellent medium for patients requiring localized pain treatment. A blend of frankincense and myrrh mixed in aloe vera gel will penetrate the dermal layer quicker and provide fast relief from pain and inflammation.
Essential oil therapeutics offers pain and symptom management, emotional and spiritual support as well as caregiver and bereavement comfort. Frankincense, myrrh and rose all have familiar scents that span generations, especially the elder. Using familiar smells, gentle touch and essential oil therapeutics on long-term palliative care patients help ease pain and inflammation as well provide peace and serenity for the ones we love.
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