Aromatherapy for Symptom Relief in Patients with Burn: Comparison
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Aromatherapy, also known as essential oil therapy, uses plant, flower, or herb extracts to enhance health and wellbeing. Aromatic essential oils have been widely studied for first-degree burn injuries due to their ability to relieve pain, reduce scarring, as well as reduce inflammation and antimicrobial activity. 

  • anxiety
  • aromatherapy
  • burns
  • pain

1. Introduction

The management of burn injury is a long-term process and requires the same priorities as all other trauma patients. Depending on how deeply and severely a burn penetrates the skin’s surface, burn injury is classified as first-, second-, or third-degree. A first-degree burn usually involves only the epidermis with redness, pain, dryness at the burn site with no blisters. A second-degree burn affects the epidermis and dermis, resulting in a red, blistering, swollen, and painful burn site. A third-degree burn damages the epidermis and dermis, leaving the burn site white or charred and devoid of sensation due to the loss of nerve endings [1]. Despite the advances in therapeutic techniques, burn patients of different severities still suffer from considerable pain and discomfort. Burn injuries often include physical, physiological, and sociological consequences which result in poor quality of life [2]. Thus, essential oils which are known to possess therapeutic and medicinal properties have become an option for the management of burns [3].
Aromatherapy, also known as essential oil therapy, uses plant, flower, or herb extracts to enhance health and wellbeing [4][5]. Aromatic essential oils have been widely studied for first-degree burn injuries due to their ability to relieve pain, reduce scarring, as well as reduce inflammation and antimicrobial activity [6]. A review study has shown that aromatherapy could alleviate pain and reduce anxiety by stimulating the parasympathetic nervous system [7]. Moreover, studies have also been shown that essential oils contain chemical constituents with analgesic-like activity and inhalation of essential oils could stimulate the brain to exert neurotransmitters through olfactory system [8][9]. Aromatherapy also contains oxides that have been found to be analgesic [10]. Essential oils could also stimulate endorphin production, resulting in effects such as pain-reducing, stress releasing, relaxed feeling, and alert enhancement [11]. A systematic review also has shown that essential oils contain bioactive constituents with anxiolytic-like activity [12]. A few studies also reported that aromatherapy alleviate symptoms of cancer such as pain and nausea, and symptoms of behavioral and psychological associated with dementia [13][14][15][16][17][18] (Table 1).

2. Aromatherapy for Symptom Relief in Patients with Burn

aromatherapy has the potential in reducing pain and anxiety. Inhaled aromatherapy plus routine care showed beneficial effects in relieving pain after dressing, as compared to placebo plus routine care or routine care alone. Compared to routine care alone, inhaled aromatherapy plus routine care showed superior effects in calming anxiety after dressing. Similarly, aromatherapy massage plus routine care compared with routine care alone also presented favorable effects in easing general anxiety.
Table 1. Summary of randomized clinical studies of aromatherapy for managing symptoms in patients with burns.
First Author

(Year) [Ref.]		 Total Sample Age (Range or Mean)/ Diagnostic Criteria Intervention (Regimen) Control (Regimen) Main Outcomes Main Results

(Effect Estimate)		 (Year)Trial Registration Number Total Sample Age (Range or Mean)/Diagnostic Criteria

Registration Time
Intervention (Regimen) Control (Regimen) Main Outcomes Trial Registration Number
Bikmoradi (2016) [19] 50 (A: 33, B: 34)/

second degree burn or second and third degree burns		 (A) Damask Rose (inhale, 40%, 5 drops, 20 min before dressing, 2 nights, n = 25), plus routine care (B) Placebo (distilled water, 5–30 min, n = 25), plus routine care Pain (VAS)

[dressing]		 MD-0.88 [−1.27, −0.49], p < 0.001
Arjomandzadegan (2017) 60/(14–50 yrs)

Second degree burn		IRCT

201302249759N4

While recruiting
(A) Thyme (spray, 1 to 5 times/day, n = 30), plus B Sadeghi (2020) [20] 120 (A:37, B:37, C:35)/

second degree burns <30%		 Second degree burns(A) Damask Rose (inhale, 40%, 6 drops, breath 5 times, 60 min, n = 40), plus C (A) Thyme (spray, 1 to 2 times/day, n = 50), plus rinse with saline and silver ointment(B) Placebo (distilled water, 6 drops, breath 5 times, 1 h, n = 40), plus C

(C) Routine care (n = 40)		 (B) Placebo (distilled gas1 to 2 times/day, n(1) Pain (VAS)

(2) Anxiety (STAI) [dressing]		 = 50), plus rinse with saline and silver ointment(1) A vs. B, MD-0.82 [−1.25, −0.39], p < 0.001; A vs. C, MD-1.02 [−1.48, −0.56], p < 0.0001

(2) A vs. B, MD-15.85 [−18.35, −13.35], p < 0.00001; A vs. C, MD-3.17 [−3.83,−2.5], 		Grid and depth of woundp < 0.00001 IRCT

2017030632129N3		 IRCT20161017030336N1

While recruiting
Azizi (2019) [21] 120 (A:39, B:37, C:34)/

second degree burns <30%		 (A) Lavender (inhale, 2%, 10 drops, breath 5 times, 60 min, 1 time, n = 40), plus C
Froutan (2018) 60/(18–60 yrs)

Second and third-degree burns		 (A) Essential oils (inhale, Damask Rose (40%, 5 drops), lavender (10%, 7 drops), n = 30), plus B(B) Placebo (distilled water, 10 drops, 1 h, 1 time, n = 40), plus C

(C) Routine care		 Pain (VAS) [dressing] A vs. B, MD-0.38 [−0.94, 0.18], NS; A vs. C, MD-0.40 [−0.88, 0.08], NS (B) Anesthetic drugs (midazolam, fentanyl and ketamine, nIRCT

2017030632129N3
(1) A vs. C: MD-1.73 [−3.03, −0.43],
p < 0.05; B vs. C: −2.46 [−3.64, −1.28], p < 0.0001; A vs. B: 0.73 [−0.54, 2.00], NS

(2) A vs. C: MD-4.76 [−9.93, 0.41], NS; B vs. C: MD-3.03 [−8.36, 2.30], NS; A vs. B: −1.73 [−7.21, 3.75], NS IRCT

201404176918N17

While recruiting
(B) Standard care (rinse with saline and silver ointment, n = 30) Grid and depth of wound IRCT2017032726394N3 = 30) (1) Reducing anesthetic drugs

(2) Brain activity (BIS)

While recruiting
IRCT20171123037599N2 Daneshpajooh (2019) [22] 140 (A:44, B: 40, C: 41, D: 44)/

second or higher degree burn injury		 (A) Rose (inhale, 40%, 5 drops, for 20min, once daily for 3 days, n = 33), plus B (B) Routine care (n = 33)

(C) Benson relaxation (n = 33), plus B

(D) A + C (n = 33), plus B		 Burn specific pain anxiety scale

[dressing]		 A vs. B, MD-3.05 [−3.77, −2.33], p < 0.00001 IRCT

20171212037843N1

While recruiting
Harorani (2016) [23] 60 (18–65)/

second degree burns or second and third degree burns together		 (A) Lavender (inhale, 2%, 2 drops, 20 min, 3 days, n = 30), plus routine care (B) Placebo (distilled water, n.r., n = 30), plus routine care Anxiety (STAI)

[general]		 MD-4.60 [-7.07, -2.13], p < 0.001 IRCT

2013042413110N1

While recruiting
Seyyed-Rasooli (2016) [24] 90 (A: 35, B: 35, C: 38)/

second degree burns <20%/		 (A) Essential oils (inhale, lavender oil 7 drops and Rosa damascene 3 drops, 30min, n.r., n = 30), plus C

(B) Essential oils (massage, lavender oil 7 drops and Rosa damascene 3 drops, 30 min, n.r., n = 30), plus C		 (C) Routine care (n = 30) (1) Pain (VAS)

(2) Anxiety (STAI)

[general]		 Rafii (2020) [25] 105 (A: 36, B: 37, C: 40)/

second- and third-degree burns		 (A) Aroma (massage, lavender oil 2 drops and chamomile 2 drops, 20 min, 3 session within 1 week, n = 35), plus C (B) Placebo (massage, bady oil, 20 min, 3 session within 1 week, n = 35), plus C

(C) Routine care (n = 35)		 (1) Anxiety (STAI)

(2) Sleep

[general]		 (1) A vs. B: MD-0.82 [−3.30, 1.66], NS; A vs. C: MD-5.26 [−7.72, −2.80], p < 0.0001

(2) A vs. B: MD-1.58 [−2.92, −0.24], p < 0.05; A vs. C: MD-1.83 [−3.30, −0.36], p = 0.01		 IRCT

20180120038444N1

Prospective
van Dijk (2018) [26] 287 children (A: 24, B: 28, C: 25 months)/

second- and third-degree burns

Burn incident <1 week		 (A) Aroma (massage, 1% essential oils (chamomile, lavender, neroli), 10–20 min, 1–5 session within 2 weeks, n = 108), plus C (B) Placebo (massage, carrier oil, 10–20 min, 5 session within 2 weeks, n = 90), plus C

(C) Standard nursing care (n = 86)		 (1) MTI, BSC

(2) COMFORT-B

(3) Distress (NRS)

[general]		 (1) NA †

(2) NS

(3) NS		 Trial NL3771 (NTR3929)

Prospective
BSC, behavioural relaxation scale; COMFORT-B, COMFORT behavior scale; IRCT, Iranian Registry of Clinical Trials; MTI, muscle tension inventory; n.r., not reported; NA, not available; NRS, numeric rating scale; NS, not significant; STAI, Spielberger state trait anxiety inventory; VAS, visual analog scale; †, not computable due to large missing values.
Table 2. Summary of ongoing or not published randomized clinical studies of aromatherapy for patients with burns.
Principal researcher
Arjomandzadegan (2018) 100/(2–10 yrs)
BIS, Bispectral index; IRCT, Iranian Registry of Clinical Trials.
The management of burn patients requires delicate care especially in the aspect of pain and anxiety. Aromatherapy has shown encouraging effects in easing pain and anxiety and could play a role in complementing daily routine care. In the meantime, more studies are needed to guide the recommendation of aromatherapy in clinical practice. Current available studies are insufficient to demonstrate great significant effects of aromatherapy in managing burn. As management of burn is often long-termed, it is necessary to extend the period of aromatherapy intervention to fully evaluate its effectiveness. Besides, future studies should also consider a single type of essential oil as the smell and function of each type of essential oil are distinct. In general, well-designed RCT with proper reporting, longer intervention period with specific essential oil, and larger sample size are needed to validate the usage and effectiveness of aromatherapy for the management of burn.

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