The Effect of Lavender Oil in Patients with Renal Colic: A Prospective Controlled Study Using Objective and Subjective Outcome Measurements

Abstract

Objective:

To assess the usability of lavender oil as an adjuvant in the medical treatment of pain due to renal stones.

Methods:

One hundred patients age 19–64 years diagnosed with renal colic were included in the study. Group 1 (n=50) received standard medical therapy (diclofenac sodium, 75 mg intramuscularly); group 2 (n=50) received aromatherapy (lavender oil) in addition to the standard medical treatment. In both groups, the severity of the pain was graded between 0 (no pain) and 10 (severe pain) by using the visual analogue scale (VAS).

Results:

The VAS values at the beginning and at 10 and 30 minutes in group 1 were 7.70±1.61, 5.02±2.20, and 2.89±1.96, respectively; in group 2, the values were 7.83±2.02, 4.42±2.46, and 2.20±1.74, respectively. The VAS values for the male patients in group 1 at the beginning and at 10 and 30 minutes were 7.61±1.47, 4.80±2.00, and 2.67±1.74; in the female patients, the values were 7.81±1.80, 5.40±2.41, and 3.72±1.94. For the male patients in group 2, the VAS values at the beginning and at 10 and 30 minutes were 8.25±2.01, 4.93±2.72, and 2.96±1.90, respectively; for the female patients, the values were 7.52±1.94, 4.15±1.95, and 1.21±0.91, respectively. Results are presented as mean±SD. Although there was no significant difference between the VAS values at the beginning and at 10 minutes in both groups, the VAS values at 30 minutes in the group receiving aromatherapy plus conventional treatment were statistically significantly low.

Conclusion:

These findings suggest that the use of aromatherapy, which is a nonpharmacologic treatment method, as an adjuvant to conventional treatment methods will help decrease pain, particularly in female patients.

Introduction

Renal colic is a state that develops secondary to the formation of a stone in the ureter and is described by individuals as the most severe form of pain. No consensus on the ideal treatment protocol has yet been reached.¹ In general, diagnoses are made and treatments are administered in hospital emergency departments.² Flank or side pain is the most common symptom. Pelvic, abdominal, and back pain are also encountered in this patient group.³

The treatment of this pain is very important. About half of the patients presenting with renal colic require acute treatment in the hospital.⁴ The drugs used must both release the smooth muscle spasm and effectively alleviate pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are primarily used in the treatment of renal colic; however, opioid analgesics should be used if response to NSAIDs is inadequate.^1,4 NSAIDs and opioid analgesics also spontaneously provide sufficient passage for the stones.^3,5,6 As an addition to the classical treatment, various treatment methods can also be used, such as intravenous paracetamol, intra-nasal desmopressin, acupuncture, and aromatherapy.^1,7
–9

Aromatherapy can be described as treatment using the pure essential oils obtained from the roots, leaves, and flowers of plants in order to help maintain a high level of physical and mental health.¹⁰ The use of aromatherapy dates back 6000 years ago; however, there is little experimental evidence regarding its use. It can be administered in many ways, such as via massage, baths, inhalation, and vapor.¹¹ Today, it is used to decrease the discomfort caused by anxiety, pain, the adverse effects of chemotherapy, and discomfort after surgery, as well as to increase energy (positive effect of mood enhancement) and support sleep.^12

–16 Lavender oil has been used in humans to decrease depression of moderate severity, anxiety, and pain.^17
–19 Furthermore, the anti-inflammatory and analgesic effects of lavender oil have been demonstrated.²⁰

Although numerous studies have supported medical treatment that decreases the pain of renal colic, very few studies have focused on alternative therapies, such as aromatherapy and acupuncture.^7,9 A search of the literature identified no studies evaluating the effects of lavender oil on the pain associated with renal colic. Because of the comforting, anti-inflammatory, and analgesic characteristics of lavender oil, the current study sought to assess its usability as an adjuvant and auxiliary in the drug treatment of renal colic.

Materials and Methods

Patients

This study was carried out after approval from the Gaziosmanpasa University Ethics Committee (approval no. 14-KAEK-137). Written informed consent forms were obtained from all participants. One hundred patients whose ages ranged between 19 and 64 years were included in the study.

Inclusion and exclusion criteria

The patients were evaluated by obtaining detailed medical histories, performing detailed physical examinations, and conducting routine hematologic and biochemical analyses. Direct abdominal radiography and ultrasonography were used to diagnose the kidney stones. Inclusion and exclusion criteria are shown in Table 1.

Table 1.

Inclusion and Exclusion Criteria

Criteria/Health condition	Age (y)
Inclusion
Flank pain and kidney stones	19–64
Exclusion
Allergic rhinitis	<19 and >64
Common cold
History of asthma
Peptic ulcers
Renal dysfunction
COPD
Pregnancy
Anticoagulant treatment
Allergy to NSAID
Had taken NSAIDs within 24 hours

COPD, chronic obstructive pulmonary disease; NSAID, nonsteroidal anti-inflammatory drugs.

Study design

The study was designed as a double-blinded, randomized, placebo-controlled interventional study. The rooms in which the treatments were being given were marked as single or double. The patients were randomly divided into two groups according to the patient numbers. The patients underwent treatment in the same way in two separate rooms that were arranged in the same manner. Conventional treatment (75 mg intramuscular diclofenac) and a placebo (physiologic serum, 0.9% NaCl) were administered to the 50 patients in group 1, who had been placed in the room marked with a single number. Aromatherapy (lavender oil; Cemre, Turkey) was administered as an adjuvant to the conventional therapy (75 mg intramuscular diclofenac) to the 50 patients in group 2, who had been placed in the room marked with a double number. The patients were asked to refrain from talking to each other. The health care personnel, who had not been informed about the study, evaluated the degree of pain experienced by all participants. In addition to the conventional treatment, aromatherapy was administered to the patients in group 2, as previously explained,⁷ at a concentration of 2% using an electronic vaporizer (Robert Tisserand Ltd., West Sussex, United Kingdom). In addition to the conventional treatment, as a placebo, physiologic serum was administered to the patients in group 1 with the electronic vaporizer.

Measurement of pain

The degree of pain in both groups was evaluated by using the visual analogue scale (VAS), in which pain was represented as 0 when the patient felt no pain and as 10 when the pain was most severe. The VAS results were classified as follows: 0, absence of pain; 1–4, mild pain; 5–6, moderately severe pain; and 7–10, severe pain. The mean arterial pressure (MAP) and the beats per minute (BPM) were measured before treatment, 10 minutes after treatment, and 30 minutes after treatment. The VAS scores in both groups were statistically compared.

Statistical analysis

The Levene test was carried out to determine whether the data were normally distributed. The chi-squared test and the independent sample t-test were used to compare the groups. A p-value less than 0.05 was considered to represent statistically significant differences. Statistical analysis was performed using IBM SPSS 20.0 statistical software.

Results

The mean ages and numbers of men and women among the study participants are represented in Table 2. The MAP and BPM values are given in Table 3. Of the 100 participants, 59 were male and 41 were female. While the mean age in group 1 (conventional therapy) was 38.20±12.30 years, the mean age in group 2 (conventional therapy plus aromatherapy) was 36.87±12.24 years.

Table 2.

Patients' Mean Age and Sex

Variable	Conventional therapy	Conventional therapy plus aromatherapy
Patients (n)	50	50
Men/women (n/n)	29/21	30/20
Age (y)	38.20±12.30	36.87±12.24

Age is expressed as mean±standard deviation.

Table 3.

Mean Arterial Pressure and Beats per Minute Values

Variable	Conventional therapy	Conventional therapy plus aromatherapy	p-value
MAP (mmHg)
Initial	86.68±10.65	84.06±9.13	0.295
10 min	81.38±9.77	83.24±9.32	0.460
30 min	82.61±8.29	84.68±9.12	0.672
BPM
Initial	77.75±9.14	75.80±8.30	0.247
10 min	76.60±8.98	76.36±8.68	0.893
30 min	75.35±8.66	76.48±9.12	0.537

Data are expressed as mean±standard deviation.

MAP, mean arterial pressure; BPM, beats per minute.

The average VAS values of the patients are represented in Table 4. VAS scores in group 1 at the beginning and at 10 and 30 minutes were 7.70±1.61, 5.02±2.20, and 2.89±1.96, respectively; in group 2, they were 7.83±2.02, 4.42±2.46, and 2.20±1.74, respectively. When the male and the female patients in groups 1 and 2 were separated and analyzed again, the VAS values for men in group 1 were 7.61±1.47, 4.80±2.00, and 2.67±1.74 at the beginning and at 10 and 30 minutes. The respective values for women in group 1 were 7.81±1.80, 5.40±2.41, and 3.72±1.94. However, for the men in group 2, the VAS scores were 8.25±2.01, 4.93±2.72, and 2.96±1.90, respectively, and the scores for women in this group were 7.52±1.94, 4.15±1.95, and 1.21±0.91 (Table 5).

Table 4.

Visual Analogue Scale Scores: All Patients

Variable	Conventional therapy	Conventional therapy plus aromatherapy	p-value
VAS score (initial)	7.70±1.61	7.83±2.02	0.412
VAS score (at 10 min)	5.02±2.20	4.42±2.46	0.152
VAS score (at 30 min)	2.89±1.96	2.20±1.74	0.022

Data are expressed as mean±standard deviation.

VAS, visual analogue scale.

Table 5.

Visual Analogue Scale Scores: Male and Female Patients

	Conventional therapy		Conventional therapy plus aromatherapy
Variable	Male	Female	Male	Female	p-value: male patients	p-value: female patients
VAS score (initial)	7.61±1.47	7.81±1.80	8.25±2.01	7.52±1.94	0.285	0.345
VAS score (at 10 min)	4.80±2.00	5.40±2.41	4.93±2.72	4.15±1.95	0.811	0.069

Data are expressed as mean±standard deviation.

In both groups, the VAS values the beginning and at 10 minutes did not significantly differ. However, in group 2, the 30-minute VAS values were significantly lower (p=0.022) (Fig. 1). When the female and the male participants were analyzed separately, although there was no difference between group 1 and group 2 with regard to the VAS values at the beginning and at 10 and 30 minutes in the male participants, the VAS values for the female participants at 30 minutes in group 2 were statistically significantly lower (p=0.0001).

FIG. 1.

Comparison of visual analogue scale (VAS) scores between patient groups at beginning of study (A) and at 10 (B) and 30 (C) minutes. Group 1 conventional therapy group; group 2, conventional therapy plus aromatherapy group.

Discussion

Pain is described as an affective, unpleasant sensory feeling that originates from any part of the body. It can be found together with real or potential tissue damage and related to an individual's experiences.^21,22 The precise measurement of the severity of pain is one of the difficulties most frequently encountered by physicians. Various visual and quantitative scales are used to depict degree of pain, including the VAS.^23,24

In this study, while the average pretreatment VAS value in patients presenting to the emergency unit with renal colic was 7.70±1.6 in the group with conventional treatment, the average VAS values in the group receiving aromatherapy plus conventional treatment was 7.83±2.02. In studies evaluating the effects of various treatments on renal colic, the pretreatment VAS values have been high.^7,25
–27 In the current study, the VAS values at the beginning of treatment were high, which is consistent with the literature.

The pain of renal colic is related to peristalsis that results from spasm, edema, and inflammation in the ureteric smooth muscles, as well as the pressure proximal to the stone. In this condition, histamine and bradykinin and an increase in the sensitivity of the nociceptors are crucial actors.²⁸ In advanced obstruction, renal damage may develop, and secondary to this, prostaglandin synthesis, which is an inflammatory response, will ensue.¹ Prostaglandins are particularly responsible for the pain of colic due to the acute obstruction of the ureter. Agents that decrease the synthesis of prostaglandins lead to diuresis, a decrease in edema in the ureteric mucosa, and the loosening of the smooth muscles, which in turn cause vasodilatation in the afferent arterioles.⁴

Opioid analgesics and NSAIDs are the agents most frequently used to control the pain of renal colic. In the treatment of pain, NSAIDs should be used first; if treatment is unsatisfactory, opioid analgesics should be administered.^1,4 In addition to these agents, calcium channel blockers, selective cyclooxygenase-2 inhibitors, and α-receptor antagonists are also used in medical treatment.¹ Apart from medical treatment, alternative methods such as acupuncture,⁹ heat application,¹ and aromatherapy⁷ are also being used.

The mechanism of the effect of aromatherapy, which has become one of the most popular supportive therapies in recent years, is related to the essence oils affecting the human body through odor pathways.^10,29 Odors affect the emotional state in humans.³⁰ Lavender oil is a trustworthy essential oil that has a wide range of therapeutic effects, and very few adverse effects have been reported.³¹ Lavender oil has long been used as an antiseptic and a degasser,^31,32 and for its anxiolytic and anticonvulsant effects.³³ Linalool and linalyl acetate are two important components found in lavender, and the analgesic and anti-inflammatory properties of these components have been demonstrated in human studies and animal models. Linalool in particular has been said to inhibit the secretion of prostaglandin, which causes the contraction of smooth muscles.³⁴

In previous studies, the application of lavender via inhalation has yielded effective results.^16,35,36 Despite the demonstrated anti-nociceptive effect in animal models,³⁷ this state cannot be demonstrated directly in human studies.³⁸ Gedney et al.¹⁸ and Kim et al.¹⁵ reported that administration via inhalation increased patient satisfaction in terms of pain control; however, they attributed this finding not to the analgesic effect of aromatherapy but to its subjective effect of decreasing unpleasant feelings. Another study reported that aromatherapy decreased the pain related to open heart surgery; however, this was reported to be statistically insignificant.³⁹ Furthermore, lavender oil administered via inhalation significantly decreased pain after cesarean delivery and decreased the severity of migraine and the pain at the point of injection in hemodialysis patients.^40
–42

The current study evaluated whether lavender oil has a comforting effect in patients with renal colic. This aromatherapy, when given as an adjunct to conventional treatment, significantly decreased VAS values 30 minutes after the administration compared with values in patients receiving conventional therapy only (p=0.022). Furthermore, the MAP and BPM values at the beginning and at 10 and 30 minutes after the treatment did not significantly differ between groups. In this regard, the MAP and the BPM values were not consistent with those of previous studies.^7,43

The olfactory pathways are connected to the limbic system, which is composed of the amygdala. The stimulation of these areas leads to emotional changes. At the same time, the stimulation of the limbic system may also be effective in reducing pain.³³ Lemon oil has been claimed to affect the olfactory-hippocampal pathway in the rat hippocampus, adjust the secretion of acetylcholine, and affect the sensation of pain.⁴⁴

In the model of pain that is induced by formalin, Aloisi et al. demonstrated that in female rats aromatherapy reduced licking behavior, an indicator of pain, to a higher extent than in male rats.⁴⁵ Ceccarelli et al. stated that aromatherapy affected the olfactory system and changed the secretion of acetylcholine, which is induced by painful stimuli, only in female rats.⁴⁶ This situation may be due to differences in the gonadal hormones.⁴⁷ It is known that estrogens in particular have important effects on the limbic system, which include the hippocampal cholinergic system.⁴⁶

Consistent with the literature, this study showed that aromatherapy statistically significantly decreased pain in female patients. Pain did not significantly decrease in male patients.

In conclusion, a decrease in the pain of patients with renal colic may be related to the inhalation of lavender oil droplets. These droplets would enter the systemic circulation after having passed the nasal mucosa and then inhibit the synthesis of prostaglandins and, on the other hand, alter the secretion of acetylcholine, thus affecting the limbic system.

NSAIDs are the primary treatment for renal colic; when a sufficient response is not obtained, opioid analgesics may be used. On the basis of the results of this study, aromatherapy, which has begun to be used in many fields and the comforting effects of which have been demonstrated, can be used as an adjuvant therapy supporting NSAIDs in patients with renal colic. In this regard, research demonstrating the effect of aromatherapy on pain in both sexes at the molecular level is required.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

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