Complementary Therapies (Aromatherapy & Herbal Medicine): Clinician Information

Zachary Munn. Evidence Summaries - Joanna Briggs Institute. Adelaide: Nov 2, 2007. 1 pgs

QUESTION
What is the evidence regarding complimentary therapies such as aromatherapy and herbal medicine?

CLINICAL BOTTOM LINE
Complementary therapies are those which are used in addition to traditional medical methods to assist in a person's treatment and have been gaining in popularity in recent times1,2.

Aromatherapy and herbal medicine are both types of complementary therapy. Exploration and research into the effects of complementary therapies has been encouraged by some authors as to align its principles with holistic care, as not all complementary therapies are well accepted by health professionals3. A major criticism of complementary therapies is that many are not based on scientific evidence1,2,4. Complementary therapies aim to treat the whole person and not just the symptoms of the disease. 4

* Complementary therapies for cancer patients have been described as an extension of supportive care services, such as individual and group counselling, social work assistance and nutritional guidance, which all aim at relieving symptoms, enhancing well being and increasing quality of life. 5(Level IV)

* As complimentary therapies are increasingly being used with some claiming to be able to completely heal (rather than cure) a person, it is important to thoroughly test the efficacy of these treatments. 4(Level I)

* Music is an example of complimentary therapy. A systematic review assessed music as an intervention in the hospital setting. The results displayed that playing music to patients while they are resting in a bed or chair reduces their anxiety and improves their mood. Further research is required to evaluate the impact of music on outcomes such as pain, sedation and analgesic effect. 6(Level I)

AROMATHERAPY
The main principle of aromatherapy focuses on utilising the scents of plants and flowers to alter moods, influence psychological and spiritual states, and influence the physical state through the mind-body connection. 1(Level IV)

* Aromatherapy may be of most benefit when utilised for conditions associated with high stress and anxiety. 3(Level IV)

* Aromatherapy has been shown to enhance therapeutic massage and promote beneficial effects. 3(Level IV)

* Aromatherapy has been used in pre-operative patients, with authors citing its cost-effective sedatory and antiemetic effects. 3(Level IV)

* Educating nurses regarding aromatherapy use has been advocated to justify and encourage pre-operative use. 3(Level IV)

* It has been noted that aroma therapy is susceptible to criticism due to the lack of rigorous research conducted focusing on its effects. The standards for practice or products used for aromatherapy are not reliable at this time. 7(Level IV)

* A systematic review of aromatherapy found that aromatherapy massage could be helpful for anxiety reduction for short periods. There was no support, however, for aromatherapy massage use in the health care setting. The report concluded that there were no long lasting effects of aromatherapy massage of benefit or detriment to the patient. 8(Level I)

* A systematic review assessed aromatherapy in patients with dementia. The results from one trial demonstrated a significantly favourable effect in favour of the intervention (10% Lemon Balm and base solution applied topically to arms and face twice daily for 1-2 minutes for four weeks). The results must be interpreted with caution as they are only from one trial, with most studies on aromatherapy in dementia being of qualitative nature or small scale, low methodological quality. 2(Level I)

* A systematic review assessing the use of aromatherapy and massage for symptom relief in cancer found massage (alone or in conjunction with aromatherapy) may reduce anxiety in cancer patients in the short term although there was insufficient evidence to draw firm conclusions. 9(Level I)

* A systematic review assessed the use of aromatherapy for the treatment of patients with psychiatric conditions. They found that the use of Kava and St John's Wort were effective as psychotropic medicines. The authors recommended herbal medicine use as an adjunct to conventional techniques. 10(Level I)

HERBAL MEDICINE
There is an abundance of literature referring to the effectiveness of herbal products. The reliability and knowledge of Germany's Institute for Drugs and Medical Devices, who base their opinion on clinical trials, case reports and expert opinion, cites the safety of many herbs. 11 (Level IV)

* The US Food and Drug administration has not endorsed herbs as therapeutic drugs because of the lack of rigorous testing. Systematic investigation of herbal remedies is needed. 12(Level IV)

* As they are natural, herbs have been perceived to be harmless, when the truth is that little is known about the safety of herbal remedies. It has been suggested that herbal remedies may cause liver and kidney damage, have been advocated for illnesses they do not cure, and may be highly contaminated. There is evidence that herbs have caused adverse reactions such as allergic and toxic reactions, possible mutagenic effects and drug interactions. 12(Level IV)

* A systematic review was performed to assess the effectiveness of kava extract. The results showed that kava appeared to be an effective symptomatic treatment option for anxiety, and that it is relatively safe for short term treatment (1-24 weeks). However, the authors concluded more information was required. 13(Level I)

* A systematic review was performed assessing the use of herbal medicines for treating low back pain. Some evidence was found supporting the use of herbal medicine. Harpagophytum Procumbens (Devil's Claw) was found to be better than placebo for short term improvement. Harpagophytum Procumbens was found to be equivalent to rofecxib. Salix alba (White Willow bark) was suggested to be better than placebo, whilst three low quality trials deemed Capsicum Frutescens (Cayenne) superior to placebo. The quality of many of the trials was poor. 14(Level I)

* It has been advocated that herbal products undergo the same quality control procedures as other drugs, such as post-marketing surveillance and other mechanisms to detect safety problems. 12(Level IV)

* It should be known that the safety of herbal remedies relies on advice given by practitioners, vendors or books on the subject. Herbal remedies may hinder access to other effective therapies if recommended without due consideration of the persons clinical presentation. 12(Level IV)

BEST PRACTICE RECOMMENDATIONS
Herbal remedies may have potential benefit in treating a variety of conditions, although caution must be taken when recommending these products due to possible complications and the lack of evidence surrounding them. (Grade B)

* Aromatherapy in conjunction with massage may assist in short term anxiety relief in patients. (Grade B)