JBUR 5396 No.

of Pages 8

burns xxx (2017) xxx –xxx

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier.com/locate/burns

Review

Aromatherapy for the relief of symptoms in burn

patients: A systematic review of randomized
controlled trials

Jiae Choi a , Ju Ah Lee b , Zainab Alimoradi c , Myeong Soo Lee a, *

a
Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
b
Department of Korean Internal Medicine, College of Korean Medicine, Gacheon University, Incheon, South Korea
c
Department of Midwifery, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran

article info abstract

Article history: Background: Aromatherapy is often used to manage several conditions, including pain,
Accepted 13 October 2017 psychological distress, and burn-related symptoms. The objective of this review was to
Available online xxx assess the current evidence regarding the efficacy of aromatherapy as a treatment for burn
wounds.
Methods: The following fifteen databases and trial registries were searched for studies
Keywords:
published between their dates of inception and January 2017: AMED, CINAHL, EMBASE,
Aromatherapy
MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as six
Burns
Korean medical databases and four Iranian databases. All the trials included in the review
Systematic review
were randomized controlled trials (RCTs) assessing the efficacy any type of aromatherapy as
Randomized controlled trials
a treatment for burn-related symptoms. Study selection and data extraction were performed
by two independent reviewers, and the risk of bias (ROB) in the trials included in the review
was assessed using the Cochrane ROB assessment tool.
Results: Four RCTs met our inclusion criteria, including two RCTs comparing the efficacy of
aroma inhalation as a treatment for pain and anxiety with that of placebo controls. Both
studies showed that aroma inhalation was superior to placebo with respect to relieving pain
and anxiety. The third study compared the effects of aroma inhalation on sleep quality with
those of music therapy and showed that two the treatments exert equivalent effects on the
above parameter, and the fourth trial compared the ability of aroma inhalation to reduce pain
and anxiety with that of no treatment. The results showed that aroma inhalation can reduce
pain but not anxiety.
Conclusions: The evidence from the above trials is not sufficient to conclude that
aromatherapy effectively relieves symptoms in patients with burns. However, the findings
of the trials do not seem very plausible, and the trials themselves were of low quality and
included only small numbers of patients. Studies that are adequately powered and feature

Abbreviations: CENTRAL, The Cochrane Central Register of Controlled Trials; PRISMA, Preferred Reporting Items for Systematic Reviews
and Meta Analyses; RCT, randomized controlled trials; STAI, State-Trait Anxiety Inventory; SR, systematic review; VAS, visual analog scale.
* Corresponding author at: Clinical Research Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon
34054, South Korea.
E-mail addresses: mslee@kiom.re.kr, drmslee@gmail.com (M.S. Lee).
https://doi.org/10.1016/j.burns.2017.10.009
0305-4179/© 2017 Elsevier Ltd and ISBI. All rights reserved.

Please cite this article in press as: J. Choi, et al., Aromatherapy for the relief of symptoms in burn patients: A systematic review of
randomized controlled trials, Burns (2017), https://doi.org/10.1016/j.burns.2017.10.009
JBUR 5396 No. of Pages 8

2 burns xxx (2017) xxx –xxx

better designs are needed to investigate the potential mechanisms underlying the effects of
aroma therapy on pain and anxiety.
© 2017 Elsevier Ltd and ISBI. All rights reserved.

Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.1. Criteria for considering studies for inclusion in this review . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.1.1. Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.1.2. Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.1.3. Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.1.4. Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.1.5. Outcome measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.2. Search methods used to identify studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.3. Study selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.4. Data extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.5. Risk of bias assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
2.6. Data synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
3.1. Study description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
3.2. Risk of bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
3.3. Outcome measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
3.3.1. Inhaled aromatherapy vs. placebo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
3.3.2. Inhaled aromatherapy vs. music therapy . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
3.3.3. Inhaled aromatherapy vs. aromatherapy massage vs. no treatment . . .... .... .... .... .... ... .... 00
3.3.4. Adverse events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
5. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
Conflicts of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... ... .... 00

tub treatments, and shower baths. Therefore, aromatherapy

1. Introduction
Patients with burns endure great pain while undergoing
treatment, which comprises dressings and debridements. In
addition, patients with burns also face numerous chronic
problems, such as burn-related deformities, as well as
various physical, mental, and social problems. Thus, burns
are devastating injuries that often result in impaired
emotional well-being and poor quality of life [1]. Therapies
containing aroma oils, as well as topical dressings, have
emerged as options for the management of burn wounds [2].
These therapies are believed to provide symptom relief,
which is considered one of the most critical aspects of caring
for such patients including infection control, minimization of
iatrogeny, survival, and fast aesthetical and functional
recovery.
Aromatherapy is defined as any therapy entailing the use of
essential oils extracted from herbs, flowers and other plants to
improve physical, emotional, and spiritual well-being [3,4] and
treat various diseases. These oils are absorbed by the body in
different ways. They may be inhaled; however, their absorp-
tion can also be stimulated via massages, compression, aroma
has attracted great interest from physicians and researchers
working in the burn field [5]. Aromatherapy stimulates the
parasympathetic nervous system via the hypothalamus—
thereby reducing patients’ heart rates, blood pressures,
respiratory rates, oxygen consumption, and metabolism—
which enables patients to remain relaxed, alleviates pain and
reduces stress and anxiety [6]. The aromatic oils used for
aromatherapy are derived from aromatic plants, which have
been shown to exhibit anti-inflammatory and antimicrobial
effects. Aromatherapy reduces stress and pain, enhances
alertness and feelings of relaxation, and reduces anxiety by
stimulating endorphin production. Moreover, the oxides in
aromatic oils have been found to have pain reducing effects [7].
People with burns may experience pain, anxiety, or stress.
Several studies have shown that aromatherapy attenuates the
behavioral and psychological symptoms of dementia, as well
as the pain, nausea, vomiting and other symptoms associated
with cancer [8–14]. However, evidence indicating that aroma-
therapy is effective as a treatment for patients with burns has
yet to be uncovered. Previous studies regarding this issue have
failed to find such evidence. Therefore, in this study, we
focused on evaluating the effects of aromatherapy on pain and

Please cite this article in press as: J. Choi, et al., Aromatherapy for the relief of symptoms in burn patients: A systematic review of
randomized controlled trials, Burns (2017), https://doi.org/10.1016/j.burns.2017.10.009
JBUR 5396 No. of Pages 8
burns xxx (2017) xxx –xxx
symptoms of psychological distress including anxiety and
depression associated with burns.
2. Methods
2.1. Criteria for considering studies for inclusion in this
review
2.1.1. Studies
We included randomized controlled trials (RCTs) of all
publication languages in the review and excluded quasi-
randomized trials, non-randomized trials, observational stud-
ies, case reports, abstracts, or letters from the review.
2.1.2. Participants
Patients of any age, gender or ethnicity who had suffered
burns, regardless of their severity, were included in the review.
2.1.3. Interventions
Aromatherapy is defined as any therapy entailing the use of
technology to extract essential oils from aromatic plants to
develop medicines, as well as to relieve patients’ health
problems. This review included studies assessing the efficacy
of any type of aromatherapy—including aromatherapy ad-
ministered via massage or the inhaled or oral routes—
regardless of how the therapy was dosed, prepared, or
processed.
2.1.4. Controls
All types of control interventions, including placebo treat-
ments, conventional medicines, standard care methods, and
non-treatments, were included in the review. Studies com-
paring two types of aromatherapy were excluded from the
review.
2.1.5. Outcome measures
Primary outcomes
 Pain, which was measured with visual analogue scales,
numerical rating scales or other validated instruments,
including the McGill pain index
 Symptoms of psychological distress, including anxiety and
depression
Secondary outcome
 Adverse events (AEs)
2.2. Search methods used to identify studies
The following electronic databases were searched for studies
published from their dates of inception to January 2017: AMED
(EBSCO), CINAHL (EBSCO), EMBASE (EBSCO), MEDLINE
(PUBMED), and the Cochrane Central Register of Controlled
Trials (CENTRAL), as well as six Korean medical databases
(Korea Med, Oriental Medicine Advanced Search Integrated
System (OASIS), DBPIA, the Korean Medical Database (KM
base), the Research Information Service System (RISS) and the
Korean Studies Information Services System (KISS)) and four
Please cite this article in press as: J. Choi, et al., Aromatherapy for the relief of symptoms in burn patients: A systematic review of
randomized controlled trials, Burns (2017), https://doi.org/10.1016/j.burns.2017.10.009
3
Iranian databases, namely, Scientific Information Database
(SID), IranDoc, MagIran, and IranMedex. The searches were
conducted using the Medical Subject Headings (MeSHs)
“aromatherapy” or “essential oil” AND “burns” OR “burn
wounds”. In addition, the reference lists of potentially eligible
articles were searched manually to identify additional relevant
reports. No restrictions regarding publication year or language
were imposed.
2.3. Study selection
The titles and abstracts of all the papers identified through the
above electronic and manual searches were screened to
determine if the studies in question were eligible for inclusion
in the review. Potentially relevant articles were subsequently
retrieved, and their texts were read in full to determine if they
met the abovementioned inclusion criteria. These processes
were conducted by two reviewers (Choi J, Lee JA), and their
results were subsequently validated by a third reviewer (Lee
MS). Disagreements between the reviewers regarding study
inclusion were resolved through discussion.
2.4. Data extraction
Data extraction was performed by two independent reviewers
(Zainab A and Choi J) using a predefined form, and the results
of the procedure were subsequently validated by the above-
mentioned third reviewer. The following information was
extracted from each trial included in the review: the first
author and year of publication, sample size, mean age,
therapeutic regimen, control intervention, primary outcome
measures, and main results, as well as the results summary
and data regarding AEs. Data regarding changes in symptom
severity were also extracted. If such data were reported at
different intervals during the treatment periods of the
included studies, only the total mean change or the final
mean change in symptom severity was used for analysis.
2.5. Risk of bias assessment
The Cochrane Collaboration risk of bias (ROB) assessment tool,
a validated research tool used to determine if study results
have been affected by selection bias, performance bias,
detection bias, attrition bias, reporting bias or another form
of bias, was used to assess the ROB in the included studies. The
ROB in each of the above domains was scored as high ( ), low
(+) or unclear (?). The ROB assessments were performed
independently by two reviewers (Choi J, Zainab A). Any
disagreements were resolved through discussion [15].
2.6. Data synthesis
The RCTs were clinically heterogeneous with respect to the
type of interventions (plant oil), controls and outcomes used
therein. Therefore, we decided to perform a qualitative review
rather than pool the data statistically. The estimated effect
sizes for each treatment and control intervention evaluated in
the included studies were calculated and compared using
Review manager 5.1 (Copenhagen: The Nordic Cochrane
Center, Cochrane Collaboration, 2011) [15].
JBUR 5396 No. of Pages 8
4 burns xxx (2017) xxx –xxx
3. Results
3.1. Study description
The above searches yielded 1758 potentially relevant articles, 4
of which met our inclusion criteria (Fig. 1). The key data
pertaining to the studies are summarized in Table 1 [16–19]. All
of the included RCTs originated from India and evaluated the
efficacy of inhaled aromatherapy. One trial [19] also evaluated
the efficacy of aromatherapy massages as another active
intervention. Moreover, two studies assessed the efficacy of
lavender oils, and one trial assessed the efficacy of damask
rose oil. A study also evaluated the effects of a blend of
lavender oil and rosa damscene.
3.2. Risk of bias
The details regarding the ROB assessments are presented in
Fig. 2. Three RCTs had a high ROB with respect to the
sequence generation methods that they used for randomi-
zation (based on date of admission) [17–19]. All the trials had
an unclear ROB with respect to allocation concealment.as
well as an unclear or a high ROB with respect to patient,
personnel and/or assessor blinding, as all the trials provided
insufficient or no information regarding assessor blinding.
All the RCTs had a low ROB with respect to attrition bias.
None of the trials’ protocols were published; thus, we
Fig. 1 – PRISMA diagram for included studies.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta Analyses
Please cite this article in press as: J. Choi, et al., Aromatherapy for the relief of symptoms in burn patients: A systematic review of
randomized controlled trials, Burns (2017), https://doi.org/10.1016/j.burns.2017.10.009
determined that they had an unclear ROB with respect to
selective outcome reporting because we were unable to
determine whether they included information pertaining to
all expected outcomes. All the RCTs had a low ROB with
respect to data from other sources, as all the biases
attributable to such data were accounted for at the data
extraction phase. Moreover, the RCTs also had a low ROB
with respect to the baseline comparability of their aroma-
therapy and control groups, as all of them reported that the
baseline characteristics of the two groups were comparable.
However, the overall quality of the RCTs was less than
optimal, and all of them had some methodological flaws.
3.3. Outcome measures
3.3.1. Inhaled aromatherapy vs. placebo
Two RCTs compared the effects of inhaled aromatherapy on
pain and anxiety with those of placebo, and one RCT [17]
compared the effects of inhaling damask rose essence (n=25)
with those of receiving placebo (n=25) in patients with burns
who were suffering from symptoms caused by dressing
application. The results of the latter trial showed that
aromatherapy significantly reduced the severity of the pain
elicited by dressing application compared with placebo
(P<0.0001). Another RCT [18] compared the effects of inhaled
lavender essential oil on anxiety (n=30) with those of placebo
(n=30) and showed that aromatherapy significant reduced
anxiety levels compared with placebo (P=0.0007).
 JBUR 5396 No. of Pages 8
randomized controlled trials, Burns (2017), https://doi.org/10.1016/j.burns.2017.10.009
Please cite this article in press as: J. Choi, et al., Aromatherapy for the relief of symptoms in burn patients: A systematic review of

Table 1 – Summary of randomized clinical studies of aromatherapy for burns.

First Total sample Age Intervention Control (regimen) Main outcomes Main results Author’s conclusions
author (range or mean)/ (regimen) (effect estimate)
[Ref] diagnostic criteria
Bikmoradi 50(A: 33.2, B: 34)/second (A) Damask Rose (B) Placebo (distilled water, Pain(VAS) 1.22 [ 1.83, 0.61], . . . could be effective for
(2016) [18] degree burn or Second (inhale, 40%, 5–30min, n =25) P <0.0001 relieving the pain . . .
and third degree burns 5 drops,15–30min,
2 nights, n =25)
Harorani 60(18–65)/second degree (A) Lavender (inhale, 2%, (B) Placebo (distilled water, Anxiety (STAI) 0.93 [ 1.46, 0.39], . . . with Lavender
(2016) [19] burns or second and 2 drops, 20min, 3 nights, n.r., n= 30) P =0.0007 essential oil
third degree burns n=30) . . . reduce anxiety in

burns xxx (2017) xxx –xxx

together patients with burns.
Salimi 48(20–65)/second degree (A) Lavender (inhale, 10%, (B) Music therapy Sleep quality (VAS) -0.48 [-1.05, 0.09], NS . . . did not have a
(2016) [17] burn or second and third 7 drops, 20min. 3nights, (instrumental and gentle considerable effect on
degree burns n=24) music, 20 min, n.r. n =24) sleep quality . . .
Seyyed- 90(A: 34.6, B: 35.0, C: 37.7)/ (A) Essential oils (inhale, (C) No treatment(n =30) 1) Pain (VAS) 1) A vs. C: 0.67 [-1.19, . . . showed the positive
Rasooli second degree burns lavender oil 7drops and Rosa 2) Anxiety (STAI) 0.14], P =0.01; B vs. C: 0.28 [-0.79, effect of aromatherapy massage
(2016) [20] <20%/ damascene 3 drops, 30 min, n.r., 0.22], NS; A vs. B: 0.29 [-0.22, 0.80], NS and inhalation aromatherapy in
n=30) 2) A vs. C: 0.46 [-0.97, 0.05], NS; B vs. reducing both anxiety and pain
(B) Essential oils (massage, laven- C: 1.04 [-1.58, 0.50], P =0.0002; A
der oil 7drops and Rosa dama- vs. B: 0.16 [-0.66, 0.35], NS
scene 3 drops, 30min, n.r., n =30)

n.r.:not reported; STAI: Spielberger State Trait Anxiety Inventory; VAS: visual analog scale.

5
JBUR 5396 No. of Pages 8

6 burns xxx (2017) xxx –xxx

Fig. 2 – (A) Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all
included studies. (B) Risk of bias summary: review authors’ judgement of each item's risk of bias for each. Included study (+): low
risk of bias ( ): high risk of bias; (?): unclear risk of bias.

3.3.2. Inhaled aromatherapy vs. music therapy 3.3.4. Adverse events

One trial compared the effects of inhaled lavender oil (n=24) on None of the trials included in the review assessed the
sleep quality in patients with burns with those of music incidence of AEs associated with the above treatments.
therapy (n=24) [16]. The results failed to show that inhaled
lavender oil had a significant effect on sleep quality in the
indicated group (P=0.10). 4. Discussion

3.3.3. Inhaled aromatherapy vs. aromatherapy massage vs. no
treatment
One trial compared the effects of inhaled lavender essential oil
and rosa damascene (n=30) on pain and anxiety in patients
with burns with those of aromatherapy massages (n=30) and
no treatment (n=30) [19]. The results showed that inhaled
aromatherapy is comparable with aromatherapy massages
and no treatment with respect to its ability to reduce pain and
anxiety. Additionally, inhaled essential oils were found to have
favorable effects on pain compared with no-treatment, while
aromatherapy massages were not found to have such effects.
In contrast, inhaled aromatherapy failed to reduce anxiety,
while aromatherapy massages had favorable effects on
anxiety.
Few RCTs have tested the ability of aromatherapy to provide
symptom relief in patients with burns. Two RCTs featuring
placebo control groups showed that inhaled aromatherapy can
relive pain and anxiety [17,18], and another trial showed that
inhaled aromatherapy has effects on sleep quality equivalent
to those of music therapy [16]. One recent RCT showed that
inhaled aromatherapy can alleviate pain and that aromather-
apy massages can reduce anxiety [19]. Taken together, these
findings indicate that inhaled aromatherapy may be able to
alleviate pain and anxiety. However, the small number of
studies included in the review, as well as the moderate ROB
associated with the results of the review, have prevented us
from drawing a firm conclusion regarding the efficacy of
aromatherapy.

Please cite this article in press as: J. Choi, et al., Aromatherapy for the relief of symptoms in burn patients: A systematic review of
randomized controlled trials, Burns (2017), https://doi.org/10.1016/j.burns.2017.10.009
JBUR 5396 No. of Pages 8
burns xxx (2017) xxx –xxx
Our analyses showed that all the included trials had
methodological limitations, including small sample sizes, a
lack of power or sample size calculations, poor reporting, or
high drop-out rates. Moreover, our results showed that the
studies displayed heterogeneity with respect to their patient
populations, interventions, controls, and outcome measures.
Additionally, the vast majority of trials had an unclear or a high
ROB with regard to adequate sequence generation; allocation
concealment; and patient, personnel and assessor blinding.
Although all the RCTs used placebo or no-treatment controls,
all of them failed to report information pertaining to the
success of their blinding methods or the types of blinding
methods that they used to account for the distinct taste and
smell of aroma oil. Additionally, we did not have sufficient
information to determine whether sequence generation and
allocation concealment were conducted appropriately. Fur-
thermore, variations in the treatment regimens used in the
included studies, as well as the relatively short durations of the
intervention periods of the studies, limited the extent to which
we were able to draw conclusions regarding treatment efficacy
or other outcomes. Moreover, the lack of detailed reporting
raised questions regarding the external and internal validity of
the trials. Thus, it was difficult to judge the quality of the
evidence using the GRADE approach due to the heterogeneity
among the trials included in the review.
One review reported that aromatherapy has the potential to
cause AEs, some of which are serious. The frequency of
aromatherapy-related AEs remains unknown. The most
common AE noted in previous studies was dermatitis [20].
However, none of the studies included in this review reported
data pertaining to the incidence of aromatherapy-related AEs,
as such AEs were rare. Moreover, the aromatherapy-related
AEs that were reported were mild with respect to their severity.
Most of the trials concluded that inhaled aromatherapy can be
used as a complementary therapy to facilitate pain relief in
patients with burns.
Appropriate pain control is considered the most important
aspect of caring for patients with burns, and a variety of
methods for relieving pain in patients with burns exist [17].
Most studies, as well as clinical experience, have shown that
various essential oils can help relieve symptoms of stress,
anxiety, depression and other mood disorders [21]. However,
more basic studies are needed to fully understand the
mechanism underlying the effects of aromatherapy for burn
patients.
The limitations of the study are tied to the potential
incompleteness of the evidence reviewed herein. First, the
findings of this review may have been affected by publication
and location bias. The number of trials included in the review,
as well as the total sample size of the trials, was too small to
detect a clinically significant difference (if any) between the
effects of aromatherapy on patients with burns and those of
other therapies. Furthermore, 2 (out of 5) RCTs were performed
by the same research group, indicating that the results of the
analysis should be interpreted with caution. Second, the
existence of methodological, statistical, and clinical heteroge-
neity among all of the studies precluded our measuring pain
and anxiety symptom severity. Our review also had several
strengths, as its included studies were identified by a
comprehensive search strategy without language restrictions,
Please cite this article in press as: J. Choi, et al., Aromatherapy for the relief of symptoms in burn patients: A systematic review of
randomized controlled trials, Burns (2017), https://doi.org/10.1016/j.burns.2017.10.009
7
and its evidence was critically appraised. We accept that
aromatherapy may have positive effects on some patients
with burns; however, we found no evidence to support the use
of this intervention in clinical settings. Moreover, we were
unable to perform a meta-analysis due to the heterogeneity
among the studies included in the review.
5. Conclusions
The evidence regarding the effects of aromatherapy on the
symptoms of burn patients was moderate. However, only a few
rigorous trials regarding this phenomenon are available, and
none of them performed a quantitative analysis. Studies that
are adequately powered and feature better designs are needed
to investigate the potential mechanisms underlying the effects
of aromatherapy.
Conflicts of interest
The authors have no conflicts of interest to declare.
Funding
Choi J, Lee JA, Lee MS were supported by Korea Institute of
Oriental Medicine (K17043 and K17111). The funders had no
role in study design, data collection and analysis, decision to
publish, or preparation of the manuscript.
Acknowledgement
None.
REFERENCES
[1] Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P,
Hundeshagen G, Branski LK, et al. Recent trends in burn
epidemiology worldwide: a systematic review. Burns
2017;43:249–57.
[2] Kafi S, Atashkar S, Alavi A, Rezvani S. Relationship of post-
traumatic stress disorder with psychological defence styles in
burn patients. Health Horiz 2013;19:155–60.
[3] Fakari FR, Tabatabaeichehr M, Kamali H, Fakari FR, Naseri M.
Effect of inhalation of aroma of geranium essence on anxiety
and physiological parameters during first stage of labor in
nulliparous women: a randomized clinical trial. J Caring Sci
2015;4:135–41.
[4] Cho MY, Min ES, Hur MH, Lee MS. Effects of aromatherapy on
the anxiety, vital signs, and sleep quality of percutaneous
coronary intervention patients in intensive care units. Evid
Based Complement Altern Med 2013;2013: 381381.
[5] Tamaki K, Fukuyama AK, Terukina S, Kamada Y, Uehara K,
Arakaki M, et al. Randomized trial of aromatherapy versus
conventional care for breast cancer patients during
perioperative periods. Breast Cancer Res Treat 2017;162:
523–31.
[6] Bahraini S, Naji A, Mannani R. Effects of aromatherapy and its
application. J Urmia Nurs 2011;9:1–8.
JBUR 5396 No. of Pages 8
8 burns xxx (2017) xxx –xxx
[7] Santos F, Rao V. Antiinflammatory and antinociceptive effects
of 1,8-cineole a terpenoid oxide present in many plant
essential oils. Phytother Res 2000;14:240–4.
[8] Fellowes D, Barnes K, Wilkinson SS. Aromatherapy and
massage for symptom relief in patients with cancer. Cochrane
Database Syst Rev 2004;2:CD002287.
[9] Forrester LT, Maayan N, Orrell M, Spector AE, Buchan LD,
Soares-Weiser K. Aromatherapy for dementia. Cochrane
Database Syst Rev 2014;2:CD003150.
[10] Smith CA, Collins CT, Crowther CA. Aromatherapy for pain
management in labour. Cochrane Database Syst Rev 2011;7:
CD009215.
[11] Press-Sandler O, Freud T, Volkov I, Peleg R, Press Y.
Aromatherapy for the treatment of patients with behavioral
and psychological symptoms of dementia: a descriptive
analysis of RCTs. J Altern Complement Ther 2016;
22:422–8.
[12] Hines S, Steels E, Chang A, Gibbons K. Aromatherapy for
treatment of postoperative nausea and vomiting. Cochrane
Database Syst Rev 2012;4:CD007598.
[13] Shin ES, Seo KH, Lee SH, Jang JE, Jung YM, Kim MJ, et al. Massage
with or without aromatherapy for symptom relief in people
with cancer. Cochrane Database Syst Rev 2016;6:CD009873.
[14] Soden K, Vincent K, Craske S, Lucas C, Ashley S. A randomized
controlled trial of aromatherapy massage in a hospice setting.
Palliat Med 2004;18:87–92.
Please cite this article in press as: J. Choi, et al., Aromatherapy for the relief of symptoms in burn patients: A systematic review of
randomized controlled trials, Burns (2017), https://doi.org/10.1016/j.burns.2017.10.009
[15] Higgins JP, Green S. Cochrane handbook for systematic
reviews of interventions. John Wiley & Sons; 2011.
[16] Amrollahi A, Salimi T, Farnia F, Lotfi MH. Comparison of the
effects of aromatherapy with lavender essential oil and
musictherapy on sleep quality of burned patients. J
Complement Med 2016;6:1490–9.
[17] Bikmoradi A, Harorani M, Roshanaei G, Moradkhani S,
Falahinia GH. The effect of inhalation aromatherapy with
damask rose (Rosa damascena) essence on the pain intensity
after dressing in patients with burns: a clinical randomized
trial. Iran J Nurs Midwifery Res 2016;21:247–54.
[18] Harorani M, Zand S, Varvanifarahani P, Norozi M, Safarabadi
M. Investigation on the effectiveness inhalation
aromatherapy with Lavender essential oil on the anxiety of
patients with burns. J Complement Med 2016;6:1583–91.
[19] Seyyed-Rasooli A, Salehi F, Mohammadpoorasl A, Goljaryan S,
Seyyedi Z, Thomson B. Comparing the effects of aromatherapy
massage and inhalation aromatherapy on anxiety and pain in
burn patients: a single-blind randomized clinical trial. Burns
2016;42:1774–80.
[20] Posadzki P, Alotaibi A, Ernst E. Adverse effects of
aromatherapy: a systematic review of case reports and case
series. Int J Risk Saf Med 2012;24:147–61.
[21] Herz RS. Aromatherapy facts and fictions: a scientific analysis
of olfactory effects on mood, physiology and behavior. Int J
Neurosci 2009;119:263–90.