Thursday, 6 March 2008

Humble Pie

I am sceptical about the benefits of aromatherapy. I am not anti-complimentary therapy. Just as I am sceptical about the benefits of some drugs, the effect of some injections and the validity of a lot of cardiac surgery, so I am sceptical about aromatherapy.

You smell stuff and get better. Huh?

Some sites are nauseating in their juxtaposition of soft fluffy cuddly safeness and hard longterm pseudoscience. Would you trust this salesman? I wouldn't. Some content just riles me too much.

Several of our band 3 and band 4 staff have undertaken aromatherapy and massage courses. They've been undertaking aromatherapy and hand massage with patients who have dementia. A proportion of patients have behavioural and psychological symptoms of dementia (BPSD). As they're increasingly distraught and disoriented they find it harder to engage with the nursing staff. Confrontational and unhelpful behaviour can escalate. Medication is used to help them regain control to engage in the reality orientation processes with nursing staff. This gives me audit data showing the prevalence of lorazepam use prn (as needed) for BPSD on that day unit.
Staff didn't change. The band 3 and band 4 staff started to do aromatherapy hand massages and burn basil and whatnots. Incidence of BPSD reduced. Prevalence of lorazepam use prn reduced.

Maybe it does work on the limbic system, improving things for a wee while. Maybe it's a placebo effect. I don't know. But it seems to be useful for some of my patients, some of the time, with no significant treatment emergent adverse events.

15 comments:

Xavier Emmanuelle said...

Glad that it seems to be helping your patients.

I try to be open about CAM but I'm rather skeptical about much of it. It's not helping that the salesman on the website you linked to has a mullet...

Lucy said...

First and foremost, 'do no harm'.

I'd say it would be harmful if people were being deliberately duped out of ridiculous amounts of money because they are falsely being led to believe in something which has not been scientifically proving.

In the case as you describe it however, why not?

Elaine said...

Not only may the aromatherapy be helpful but also the one to one attention and touch,

Disillusioned said...

As Elaine suggests, maybe the one to one attention is helpful. Maybe touch and smell help them to "connect" with the world and so not be as disoriented? Could even be, in the long term, that particular scents are associated with particular environments / feelings? I know certain smells can trigger powerful memories for me, and also that I find touch and smell very helpful when I become disoriented or dissociative.

Kathryn said...

Coming at this from the perspective of a priest who has been just as sceptical about the benefits of aromatherapy etc when used with end stage cancer patients etc, couldn't it be something really simple? The impact of touch and of one to one non-demanding attention reconnecting the patient with a part of themselves that they've otherwise lost...(I find that often when I visit patients in psychiatric care, I'm the only person who is not perceived to have an agenda and a set of "right" answers I'm looking for...but aromatherapy would fit into that same category of time just to be cherished)

The Shrink said...

Interesting ideas, and I'm sure there's truth in it all.

The notion that a person's connecting with them (through spending time with them, talking with them, touching them) is pretty much what they did before, though. Sometimes it was doing the ladies' nails, sometimes it was holding a man's hand and letting him chat about his past. So largely the same staff are spending the same amount of time with the same patients with similar interactions.

Kathryn, our Methodist minister and Catholic priest both, curiously, don't spout religion on the wards. They are both seen as accessible and supporting by one and all, staff included. Their lack of agenda and also I think lack of clinical background does give them latitude that the rest of us aren't automatically gifted.

mandy lifeboats appeal said...

I have had reiki, reflexology and neck, back and shoulder massages.

Most helped with anxiety but I think the most important thing was being touched. I felt I was safe, I felt cared for and there is something very soothing about touch.

I use aroma oils at home. I find some helpful, as in they can ease my mind...some make me feel yuk. So maybe it is about individuals and the smells that suit them.

Complementary therapies.Should be exactly that. Not out in some wildnerness as if they were voodoo but complementary to other types of care.

And what suits one person doesn't suit another. For example some people are so traumatised that they can't be touched. Or it may take years to get to such a point for them.

The problem with most of these therapies is that they don't come cheap and it is difficult to get them on the NHS, although not impossible.

I think there must be a way of combining therapies, that are proved to have therapeutic effects with more prescription based treatments.

For example what is happening where shrink works. I think trialling things...reviewing their effectiveness (usually more noticeable in stress relief) and then there is a case for combined treatments and/or having staff who can multi task (if they have the time and training). Wowzers!

Jan said...

Before I comment on the above, can I just wave my private parts in the most defamatory way possible in the direction of "pseudo-science" (and let's not forget that this accusation is often levelled at psychiatry itself). The value of personal attention through things like sensitive touch cannot be overstated. A study done years ago asked librarians to touch the hands of people (subtle-like) when they returned their library cards to them after logging thier books out. A control group went untouched. In a general questionnaire about satisfaction with library services, the "touched" reported higher levels of satisfaction than the "untouched".

And we all feel better if our environment smells nice.......

Medically Brunette said...

Funding complementary therapies on the NHS takes money away from more legitimate empirically driven treatments.

Sorry to use case based evidence but its all I've got, a friend of mine with a long standing eating disorder has been offered aromatherapy massage instead of CBT. Is she still ill? yes. has massage helped her? no. Surely the pct should scrap massage for CBT!

If you want these treatments, fine but it should be out of your own moolah. If complementary therapists are such altruistic people who just want to help then they won't mind doing it for free.

The Girl said...

My favourite aromatherapy is from the perfume counter. Much cheaper than the official stuff, funnily enough. ;)

Tainted_Halo said...

It is good to see the wider debates of late conducted in more rational sense. CBT, aromatherapy, etc are potential alternatives to medicine.
Or is that; medicine is a potential alternative to these less harmful interventions? Anyone found an incidence death by aromatherapy?
If cost is an issue - I don't think there's a patent on flowers (yet).

I'd like to see interventions designed on least invasive to most invasive levels and aromatherapy rides some way under medicine for me as a less invasive technique. Of course leaving someone alone can often be as therapeutic more than it is neglect, depending on the perception of the recipient.

The positive benefits of course with aromatherapy are not just the possible olfactory/limbic events but also the touch - and the type of that touch. Perhaps trialling hand massage without the oils would give some more valid data on veracity of this apparent improvement?

Other confounders that might account for the data:
the person doing the hands on being different from the manicurist?
the timing of the intervention - duration and commencing?
and of course...
the effects of the aromatherapy on the staff attitude! (Tho I know you speak highly of them perhaps it has a double calming effect?)

The lorazepam reduction reduces cos the staff all fall asleep?

Faith Walker said...

A friend of mine is trained in aromatherapy massage and sports rehabilitation. He ususally used in in conjunction with other things.

When I was unwell once, he offered me a massage- i accepted his offer and I felt amazing after he'd finished and had the best nights sleep i've ever had.

On the whole, I'm usually pretty sceptical. I don't know if aromatherapy helps, but it certainly can't hurt.

I was sceptical about hypnotherapy as well, but gave it a chance and it gave me my life back!

jayann said...

The kind of aromatherapy you had, faith -- by an already skilled masseur who's also studied aromatherapy -- certainly can help. (So can hypnotherapy, yes, and self-hypnosis/meditation.)

The kind that makes sweeping claims about its ability to heal disease is best left alone...

I don't know if aromatherapy helps, but it certainly can't hurt.

it can -- you're in safe hands (!) -- Robert Tisserand stopped selling some of his oils for that reason.

Harry said...

A few years ago my mum questioned my usage of an air freshener as she'd heard on Radio 4 that they're commonly used by depressed people.

I have no idea if this is true or not, and as far as aromatherapy goes it wouldn't be for me if I were depressed.

Claire said...

Something the staff administering the aromatherapy massages might need to be aware of is the relatively high incidence of hand dermatitis in massage therapists, as reported here:

"...The prevalence of hand dermatitis in massage therapists is high. Significant independent risk factors include use of aromatherapy products in massage oils, creams, or lotions and history of atopic dermatitis." [Archives of Dermatology]

full text available at:
http://archderm.ama-assn.org/cgi/content/full/140/8/991