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What is Aromatherapy - Aroma-therapy is the use of 'Aroma' as a therapy to promote health and wellbeing. Aromatherapy has been used in one form or another for thousands of years and is still as valuable today. The Aroma comes from the essential oils of aromatic plants and is used both in the cosmetics/perfume industry as well as in medicine.
Aromatherapy in the management and treatment of rheumatoid and musculoskeletal autoimmune disorders: Part III
The third part of this paper continues suggestions for the use of essential oils and other aromatherapy preparations that can bring relief to many of the problems experienced by patients diagnosed with disorders in the rheumatoid family. The general symptoms most frequently brought to the attention of doctors and therapists are discussed initially, followed by detailed listings of less common problems associated with the more rare syndromes.
Oedema and lymphatic drainage
Whereas the swelling encountered in gout should not be treated with diuretic oils, other types of oedema and lymphatic congestion found in this family of diseases can be successfully treated by aromatherapy drainage. This can be achieved by the use of appropriate essential oils alone, but if the therapist is trained in manual lymphatic drainage, lymphatic drainage massage or reflex lymphatic drainage the treatment will be far more effective.
Usually the patient will experience increased diuresis following the treatment and a noticeable reduction in swelling can be observed. Oedema of this sort is caused by rapid fluid shift in the interstitial spaces during inflammatory processes during the acute stage of the disease, and is difficult to move if the patient has restricted movement due to pain or stiffness in the muscles and joints.
Several of the essential oils suggested are good adjuvant therapy to diuretic therapy, and some stand alone in their ability to assist the body with fluid balance.
Aromatherapy for oedema may be used via several routes including massages, compresses, baths and soaks. When massage is given directly to the oedematous area, or over bony prominences in an oedematous area, care should be taken especially in the elderly patient, that the skin is not damaged.
In some cases it may be advisable to use compresses over the oedematous area for one or two treatments and use drainage massage to the rest of the limb or body until the fluid begins to drain and the swelling subsides. Only light effleurage movements should be used, and fluid should be moved proximally to the trunk from the limbs, gradually including more distal areas until all are included.
Essential oils and related products for oedema and lymphatic drainage
Some of the family of prostaglandins are chemical mediators produced at the site of injury or inflammation. They, along with other mediators such as histamine and kinins dilate capillaries causing heat, swelling and subsequent pain in the affected area. The traditional use of aspirin and later NSAID’s for pain are effective because they interfere with prostaglandin production.
Research is now available that demonstrates the effective use of essential oils for the reduction of peripheral pain by the use of terpene-containing oils, and interference with prostaglandin production efficacy. Aromatherapy applications in compresses, baths, soaks and massages can all be used to good effect using very small quantities of essential oils as indicated. Low doses give excellent pain control, however higher doses of some oils such as Syzygium aromaticum and Cinnamomum zeylanicum can cause more problems by sensitizing or irritating the skin.
Essential oils and related products for pain
Essential oils for prostaglandin counter activity
In cases of pseudogout, anti-inflammatory oils can give relief when applied topically. Sometimes massage is too painful thus baths, soaks and compresses are more suitable ways to apply the oils to affected areas or the whole body. Pseudogout tends to be a disease of elderly women although men can be affected.
The joints most often involved are the knees and wrists, rendering the patient immobile and unable to care for herself due to intense pain. Orthodox treatments are the same as for gout, with NSAID’s, Colchicine and steroid injections used singly or in combinations.
Some patients are permanently comfortable with these prescriptions, but many find they are only partially successful and in time they can become ineffective. Rest is a vital part of the recovery process, because if the patient does not rest, the affected joints are at risk of permanent damage due to inflammation.
Essential oils and related products for pseudogout
Fever is not a common problem with the majority of auto-immune diseases, but when it does occur as in severe rheumatoid arthritis it can be extremely debilitating and stressful. Measures for fever reduction such as loose cotton clothing and bed clothes, tepid sponging, fans and cool breezes through an open window can be implemented with or without the use of essential oils. However, some essential oils, especially those containing camphor, eucalyptus or menthol can create a cooling effect, relieving the symptom of heat, but they must always be used with caution for patients with concurrent respiratory disease, especially asthma, as they can all cause respiratory tract spasm. The oils can be used for washes, compresses, inhalations, and small areas of massage such as the feet. Indeed, cooling the feet by washes, compresses or simple application of the blend when the whole body is overheated, can be more restful as there is less contact between the therapists’ hands and the patient.
Application of cooling oils, even to such a small area will still produce an overall reduction of the temperature, especially if the essential oils are used in a water-based carrier of Aloe vera gel or emulsion. Essential oils containing menthone such as Mentha piperita and eucalyptol (1,8 cineole), in eucalyptus oils such as Eucalyptus globules have been shown to have anti-pyretic effects.
Inhalation of cooling oils can create a sensation of the ability to breathe more easily and therefore a feeling of coolness is invoked as the fifth cranial nerve is stimulated by the essential oils entering the upper respiratory tract.
A high temperature should only be reduced by one degree an hour. If the process is carried out more rapidly, a rebound effect can occur with the risk of causing rigors in the adult patient and seizures in the paediatric patient.
Essential oils and related products for pyrexia
In Raynauds’ phenomenon and disease, circulatory problems are the single most important concern for the patient. If the therapist can support this, then all the other symptoms will seem less of a problem.
When the hands and feet are well perfused, cellular function and repair can carry on as usual. Unfortunately, patients with this disease are seriously affected by even a small drop in temperature.
The amount of immediate vasoconstriction in the fingers and toes is variable with the differential between the primary and secondary temperatures, but there will always be some degree of capillary shutdown. Patients can sometimes anticipate their problems in some situations by wearing gloves, socks and shoes.
If the degeneration of the soft tissues of the hands and feet is fairly extensive, as it may be in CREST syndrome or Scleroderma, there will be a smaller initial capillary bed to perfuse. If the patient also already has fibrosed or gangrenous plaques anywhere on their hands and feet, they will find it difficult to impossible to wear socks, shoes or gloves, even if they are a size or two larger, due to the exquisite pain caused. It is important to avoid oils with a high irritant potential as the risk of secondary infection following scratching can lead to serious complications.
Use essential oils that are cytophylactic as well as emollient carriers to keep the skin as supple as possible over the gradually tightening muscles and connective tissues. Massage of any style must be gentle, repetitive and gradually increasing in pressure.
If the patient has many plaques, these can be gradually lifted and removed by daily application of essential oils in an emulsion or cream base. The use of carrier oils will often increase the hardening of any plaques, making them more painful, and more difficult to remove. Soaks, compresses, baths and washes should all be at a temperature that is comfortable to the patient and assessed by them before use.
Any sudden increase in temperature can cause rapid dilatation of fragile capillaries in reduced dermal and connective tissues, increasing the pain and compounding the patients’ risk of further local damage, which can become permanent. Treatment is aimed at increasing arteriole and capillary dilatation and maintaining it. Regular, gentle massages in a warm environment with warmed oils are so beneficial as to be almost essential as part of the care protocol for these patients. The hands and feet can be soaked in warm water for 5–10 min before massage is begun; this relaxes the muscles and hydrates the skin, prepares local tissues for massage, improves the patients’ general comfort level and increases capillary resilience, reducing the risk of future digital amputation.
The soaking water can also have mildly dilating oils added with a solubiliser so that the oils do not coalesce in one place, with an increased potential of irritation. Some base oils can be beneficially used without essential oils, but some can have a hardening effect on the skin, especially around the cuticles and nail areas, if the skin is not soaked prior to application.
Essential oils and related products for spasmolytic and tissue saving effects in Raynauds’ phenomenon
Infused (macerated) oils
Calendula officinalis, calendula flowers, Daucus carota, carrot root, Hypericum perforatum, St John’s wort leaves.
Respiratory infection, cough and expectoration
The patients who are diagnosed within this group of diseases may have either an anatomical predisposition to respiratory infections as in ankylosing spondylitis, or they may be in the older age groups and therefore are likely to have weaker respiratory systems.
The symptoms of respiratory infection, cough, increased and discoloured sputum, chest pain, difficult or painful breathing and difficulty in eating and talking can all be helped by the use of essential oils.
Ankylosing spondylitis gradually reduces respiratory capacity as the patients’ spine develops kyphosis. This compromise in respiratory function predisposes to infection. Physiotherapy with oral and inhaled medications will give some supportand assist with airways expansion and expectoration.
Aromatherapy can provide a second line of defence and symptom support. Essential oils can be inhaled or applied to the skin to have an effect on lung tissue. The lungs accept and allow the passage of essential oils relative to their molecular weight and carrier substance. Using steam to carry the oils into the airways enables the patient to inhale more easily into the upper airways. Essential oils without steam can then be used to treat the lower airways once the upper tracts are more relaxed and dilated. Inhalation therapy with essential oils has several effects as the oils are inhaled directly onto the required surfaces as well as increasing humidification to encourage the production and collection of a more fluid expectorant. The mucociliary escalator is supported, making it easier to expectorate.
Essential oils traverse the mucous membranes of the respiratory tract with ease as they have little in the way of physical barriers to impede them. Lower concentration levels are required and are indeed more effective when administered through the respiratory tract. For direct application to the lungs, they can be used in vaporisers, both dry and steam or the patient can inhale them directly from a tissue or bowl of hot water or a hot water inhaler, available from medical suppliers and pharmacies.
Instructions for use must be carried out with all regards for patient safety. The inhaler or bowl should have hot but not boiling water and only one drop of essential oil added in the first instance.
The first time the patient uses such an inhaler he should inhale slowly and gently to allow the lung tissue to become accustomed to the oil. Some coughing and expectoration may occur following the first inhalation, but this is mostly due to the unaccustomed oil/ steam combinations triggering the cough reflex. Allow the patient to rest before another inhalation is made and never encourage overuse of the procedure. Oils used in this way should have a low irritant effect when the patient first begins to use an inhalation.
Many texts suggest the use of eucalyptus oil of different types, and they can be of benefit to the patient who has extremely tenacious sputum. Experience has shown that the use of more gentle antibacterial and expectorant oils are of more benefit in the long term, and lessen the possibility of upper respiratory tree spasm and asthma. The respiratory tract responds slowly and the patient is able to tolerate more frequent treatments as there are no aggravating side effects from the method. Massages and baths can be used to provide adjuvant sources of application. Antitussive oils should not be used. Although they may reduce the patients’ cough, sputum remains in the respiratory tree and can provide an ideal breeding ground for microorganisms. If sputum is removed easily, the patient has a lowered risk of consolidation and pneumonia; oxygen saturation can be maintained because the physical barrier has been removed and the patients will not only feel better, they will recover more rapidly due to the natural reduction of the microorganisms.
Essential oils and related products for respiratory infection cough and expectoration
Humans cannot survive without the hormonal responses our bodies make to the daily challenges of living. It is when these chemicals, such as the corticosteroids are constantly produced and in inappropriate amounts that we begin to feel distress.
Arthritis and the autoimmune diseases are just a few of the long and growing list of disorders that can be traced back to stress as their origin. They in turn create more stress in the individual, especially if they associate the diagnosis with negativity.
It is possible to prevent and even control these stress-induced disease processes once they have begun by recognising the symptoms that they cause and adjusting our responses to them. The signals of distress can be recognised easily, although they include many that we take for granted as part of life:
In the worst scenario, ‘Acute crisis effects’ can be seen in the patient. For a few it may
necessitate psychological or psychiatric help. Using aromatherapy to relax patients is therefore vitally important not only for tissue healing processes to take place, but for their overall health to be returned to normal.
Positive effects of relaxation are easily measured as:
Essential oils can create a relaxing ambience when correctly chosen and vaporised into the patients’ vicinity; if one then adds aromatic baths, massage, or skin care products into the equation, a relaxation response is almost guaranteed. Some patients dislike body massage, but face, head, foot or hand treatments are often accepted as these are less intrusive. Once relaxation is experienced by the patient from one of these simple interventions, they will often try extended massages such as back plus foot massage and eventually whole body treatments.
Essential oils and related products for relaxation
Sjogrens’ syndrome can be difficult to manage, but we have several routes of application which can be of value as well as a wide selection of essential oils to choose from. Dry skin can be a severe discomfort and a potential site of infection following scratching. Most patients can control their scratching during the day, but at night, especially if they become overheated, they may excoriate large tracts of skin. Massive staphylococcal infection can ensue, and as most strains are multi-resistant to antibiotics, treatment is limited.
Keeping the skin hydrated, intact and supple is the best defence. Moisturisers should be applied immediately following bathing or showering. Essential oils in rich fixed oil bases such as avocado, Persea americana, or jojoba, Simmondsia chinensis, assist with moisturisation.
Essential oils to assist with skin care include those that are anti-inflammatory, antioxidant, vasodilating and cytophylactic. Low doses using very small quantities of several oils will often be effective, encouraging normal regeneration and keratinisation of epithelial cells and such a combination reduces the risk of irritation or sensitisation in susceptible individuals.
Reduced salivary output makes eating difficult or uncomfortable and increases the potential risk of dental caries. Salivary output can be encouraged with inhalations of essential oils of citrus fruits. Even imagining a lemon being cut open will stimulate saliva production in most people so we can use this phenomenon for increasing the output of saliva in our patients by either doing just that or using essential oils of the citrus fruits they most like. Some people have a strong aversion to one or more citrus fragrances so check with them before you instigate the use of fruit or essential oils. Massaging the face and under the chin with gentle use of pressure around the jawbone can also stimulate saliva, but the use of citrus oils on facial skin is not advised as some can cause sensitisation, irritation or photosensitivity.
Patients should also be encouraged to carry out mouth exercises of wide smiling, whistling (both audible and silent lip pursing), and taking the tongue around the mouth over all the tooth surfaces. By stretching the tongue in this way the salivary glands and ducts are also stretched and stimulated.
For the female patient with dry vagina symptoms, pessaries or tampons can be used to insert emollients with added essential oils to lubricate and relieve itching. Compresses of emulsions with added essential oils can bring relief to the external labia and perineum. A low dose of 2 drops per 5 ml base should be used and cytophylactic essential oils added just prior to insertion of tampons.
Do not use antiseptic oils as the vaginal flora is very delicately balanced to maintain the correct pH for vaginal health. It is very important that the tampons are removed after 4 h to prevent the potential for infection and toxic shock syndrome. They can however be used daily with good effect.
Most aromatherapy courses correctly instruct students not to use essential oils for the eyes and their surrounding delicate tissues. But for the Sjogrens’ patient, using hydrosols to bathe the eyelids can bring cooling relief for dry, hot eyes. The hydrosol must be fresh and cotton wool balls used for swabbing discarded after single use, to reduce the risk of infection.
Essential oils and related products for Sjogrens’ syndrome
Essential oils specifically for skin moisturisation and cytophylaxis
Essential oils specifically for vaginal dryness
Essential oils specifically for eye comfort and hydration
Problems with the skin may occur as a result of the direct involvement of the skin within the syndromes as in dermatomyositis where the skin is flushed and may be oedematous especially around the eyes. Scleroderma presents as a sign of systemic sclerosis, lupus and in CREST or Overlap syndrome. There is thickening and hardening of the skin, with pigmentation, telangiectasia and changes in underlying soft tissues. Rheumatoid arthritis, especially if extensive or particularly florid may severely affect the patients’ vitamin stores which can affect the skins’ ability to maintain its’ thickness and natural lubrication from sebum output. Although the patient may be pyrexic in the acute stages, they will not necessarily increase their sweat output, and together these problems can lead to very dry skin. If pain prevents the patient from cooking or eating properly, and/or they cannot use cream on their skin because they are in too much pain to massage it into the skin, it will become dry and perhaps cracked. Patients may require general skin care with moisturisation and essential oils for recovery from simple lack of care while they were acutely ill, or they may need infection control and healing oils for damaged areas. Essential oils are best used in low doses with frequent applications of 2–3 times daily until the skin is returned to an acceptable condition. Ongoing care can then be simplified for maintaining the result.
Essential oils and related products for skin rashes
Polymyalgia rheumatica and Giant cell (temporal), arteritis can both have vasculitis pain thus massage for patients with these disorders will require great sensitivity of touch. In some cases they cannot tolerate any touch until their steroid therapy has taken effect. However, when they are comfortable with their pain control, massages can be of great benefit.
Patients with polymyalgia have a unique and sometimes disabling phenomenon from the syndrome where they cannot raise their arms above shoulder level unassisted, and then only with considerable discomfort or pain. Therefore they may require help to undress for their massage and to get dressed again at the end. They may also be unable to lie prone for long periods, or to put their hands above their head when lying in this position.
Vaporisation is especially useful for a relaxing atmosphere and can be implemented from diagnosis. Purpura and even subcuticular haemorrhages can appear in polyarteritis nodosa. They are not necessarily painful, but the risk of causing further damage with massage or irritant oils will have to be considered when planning therapy.
The oils to avoid include all the warming oils as well as potential sensitisers. Once the patient can tolerate touch, cool to warm compresses can be prepared with low doses (two drops to 5 ml), of anti-inflammatory essential oils.
Baths and soaks using a solubiliser to disperse essential oils can be used to augment massage and either one will help with relaxation.
Essential oils and related products for vasculitis
Commiphora myrrha, myrrh resin steam distilled for essential oil,
Helichrysum angustifolium, immortelle/everlasting fresh flowers, steam distilled,
Matricaria recutita, German blue chamomile, dried flowers, steam distilled (Jakovlev et al., 1983).
Aromatherapy for the patient with rheumatoid or autoimmune disease can offer a gentle, safe range of therapeutic interventions for relaxation and physical symptom control. As most of the disorders discussed create a certain level of intercellular and intracellular chemical imbalance, this can also be modified by the increased circulation, and both vascular and lymphatic drainage stimulated by many of the aromatherapy treatments suggested. The Aromatherapist may be offering adjuvant, complementary, or total patient care, and according to their experience and skill may be able to reduce or completely eradicate a patient’s symptoms and discomforts.
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