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review

Aromatherapy: Reviewing
evidence for its mechanisms of
action and CNS effects
Neal Cook, lecturer in nursing and specialist practitioner in critical care and Jacinta Lynch, lecturer in nursing, University of Ulster, School of
Nursing, Magee Campus, Northland Road, Londonderry BT48 7JL. Email: nf.cook@ulster.ac.uk

he place of aromatherapy, a branch of herbology, in and absorption through the surface of the lungs. Inhalation

T health care practice has been much debated in recent


years, with its use as an adjunct in enhancing health
and quality of life alongside conventional medicine
is thought to stimulate the olfactory nerve and subsequently
act on the limbic system (Moss et al, 2003). The limbic
system, closely associated with arousal mechanisms, com-
increasing (Thomas, 2007; Buckle, 2007). However, the municates with both branches of the autonomic nervous
principles that underpin aromatherapy and its application system, influencing the sympathetic and parasympathetic
are often not well known, despite aromatherapy being an divisions (Figure 1). This provides the intricate connection
ancient and well established therapy (Thomas, 2002). This between the mind and the body. A problem in one area of
presents a challenge to nurses as nursing care should be the body can affect another as a result of the way in which
based on rationale and an evidence base. This article aims mental and emotional responses are processed by the cen-
to provide an overview of the principles that underpin tral nervous systsem (Keville and Green, 1995).
aromatherapy and its neurological mechanisms of action Essential oils are composed of many chemical compo-
so that practitioners can validate and appraise its use nents or molecules. Once absorbed into the circulation,
contemporary practice. they stimulate the olfactory bulb, then the cerebral cortex,
followed by the thalamus and the limbic system of the
The nervous system and essential oils brain (Bear, 2006). The limbic system is a complex sub-
Essential oils are volatile compounds and enter the body in cortical region of the brain which is composed of 53
three main ways: absorption through the skin, inhalation regions and 35 associated tracts (Buckle, 1998). Of these
regions, the amygdala and the hippocampus, both part of
the limbic system, are of particular importance in the
The nervous system processing of aromas. They govern the emotional response
and the formation and retrieval of explicit memories
(Buckle, 1998; Bear, 2006).
To break this down further, the aromas of essential oils
are related to their particular chemical composition. At the
Central nervous Peripheral
molecular level, the vibratory rate of the oils has been
system nervous system
reported to complement that of the human energy field or
aura. This reportedly enhances and extends this field, in
effect energizing it (Boon, 2006). These electrochemical
Brain and
spinal cord

Abstract
Somatic nervous Aromatherapy is an ancient and well established discipline, with its roots
Autonomic
nervous system sytem based in herbology. While aromatherapy has existed in health care practice
in many cultures for thousands of years, the mechanisms of its actions, and
therefore its place in contemporary health care, are often not widely
known. This article explores such mechanisms of action in the nervous
Sympathetic Parasympathetic
nervous system nervous system system, illustrating the principles of how this health care discipline can
potentially provide a successful adjunct to the care of those with
neurological disorders.
Blood vessels,
glands, internal Skeletal muscles Key words
organs ■ Aromatherapy ■ Essential oils ■ Massage ■ Olfaction

Accepted for publication following double-blind peer review 27 October 2008.


Figure 1. The nervous system

British Journal of Neuroscience Nursing December 2008 Vol 4 No 12 595


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impulses stimulate the limbic system and may evoke pow- Massage
erful memories, change human perception, and alter Aromatherapy massage stimulates the parasympathetic
human behaviour as well as activate cognitive responses nervous system through afferent nerve fibres (Howarth,
(Serby and Chobor, 1992; Bear, 2006) (Figure 2). 2002), including the vagus nerve, slowing heart rate and
Stimulation of the olfactory nerve also triggers the increasing peristalsis (Harrington and Haskvitz, 2006)
hypothalamus which controls the subjective response (Figure 3). Further evidence for this is a reduction in res-
from memories, feelings and moods. It is through these piratory rate and heart rate, and increased abdominal/
processes that the brain not only interprets the stimulus of digestive sounds. In addition, massage is thought to
the oil, by retrieving the memory of a past experience or stimulate endorphin release (Maddock-Jennings and
creating a new memory response, but also mediates con- Wilksinson, 2004).
scious perception of the aroma (Bear, 2006), producing Some evidence suggests no impact on either parasym-
either a calming, balancing or stimulating response. In pathetic or sympathetic divisions of the nervous system
addition, scents are known to evoke deeply buried memo- (Reed and Held, 1988). However, this research was con-
ries, including the emotions pertaining to the remembered ducted on elderly patients where the integrity of the olfac-
events (Boon, 2006). Indeed, olfaction is the strongest tory division may not be intact, and the impact of polyp-
sense most strongly linked to memory (Salvo, 2003). harmacy needs to be considered. If lying in a quiet room,
Wright (1977, 1982) has asserted that scent molecules closing one’s eyes, and transcending life can have an
generate a specific vibration frequency which affects the effect on the autonomic nervous system (ANS), it would
receptors through changing specific chemical bonds. Bear appear logical that the parasympathetic division will be
(2006) supports this, identifying that each aroma is inter- stimulated by aroma and therapeutic touch. Many of the
preted by groups of receptor cells, and that in turn each endocrine and ANS functions are not easily altered
aroma activates specific areas of the brain, i.e. a sensory through conscious intent, but massage-induced relaxation
map. Such cortical mapping suggests that such informa- can often allow these unconscious systems to be modified.
tion has an association with social and sexual behaviour A Cochrane review (Fellowes et al, 2008) examined the
(Kolb and Whitshaw, 1990). evidence for aromatherapy and/or massage in view of the
effect on psychological morbidity, symptom distress and
quality of life in patients with a diagnosis of cancer. It
concluded that massage and aromatherapy confer short-
term benefits on psychological wellbeing, primarily in
Olfactory bulb terms of anxiety. There was no conclusive evidence that
3. Perception aromatherapy enhances the effects of massage, requiring
further studies are required to clarify this.
Neocortex
1. Reception
Thalamus
Touch and smell
Aromatherapy is thought to stimulate the parasympathetic
Olfactory response through the effect of touch and smell, encourag-
cortex Pituitary ing relaxation at a deeper level. Relaxation has been
shown to alter perceptions of pain (Buckle, 1999a). When
Hypothalamus
essential oils are inhaled, they have the fastest effect, since
Limbic the chemical components take only seconds to reach the
system brain (Buckle, 1999b). Therefore, it is possible that the
inhaled essential oils might influence the central nervous
Olfactory bulb system, resulting in the reduction of the autonomic
responses to painful stimuli.
2.Transmission
To cerebral
cortex
Harmonization
Through the mediation of stress, by methods that con-
Bone scious thought may not achieve, there lies an opportunity
Olfactory nerve to enhance wellness through the stimulation of the release
fibre of encephalines and endorphins. This can have an analge-
sic effect and create a sense of wellbeing (Kyle, 2006). An
Olfactory cell example of this is the inhalation of ylang ylang, which
Olfactory hair increases arousal but does not cause deactivation at the
(receptors) behavioural level, i.e. the person’s ability to respond to the
environment is maintained alongside his/her cognitive
readiness to respond. This suggests a concept of ‘harmo-
nization’, which has also been described for sandalwood
Figure 2. Olfactory system and lavender essential oils (Hongratanaworakit and

596 British Journal of Neuroscience Nursing December 2008 Vol 4 No 12


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Parasympathetic Sympathetic

Inhibits pupil Dilates pupil


dilation

Stimulates flow Inhibits flow of


of saliva saliva
Ganglion

Medulla oblongata
Slows Accelerates
heartbeat heartbeat

Vagus
nerve

Constricts Dilates
bronchi bronchi

Solar
plexus
Stimulates Inhibits
peristalsis and peristalsis and
secretion secretion

Conversion
Stimulates of glycogen
release of bile to glucose

Secretion of
Chain of adrenaline and
sympathetic ganglia noradrenaline

Contracts Inhibits bladder


bladder contraction

Figure 3. Parasympathetic and sympathetic nervous system divisions

Buchbauer, 2004). This makes these oils beneficial in both Examples of this are the actions of clary-sage and camo-
health and altered homeostasis, particularly within the mile, which are thought to have direct analgesic proper-
nervous system. Bakkali et al (2008) cite 23 studies that ties (Burns et al, 2000). Further studies have determined
demonstrate the pro-oxidant activity of these oils, or some that essential oils may not elicit a direct analgesic effect
of their constituents, which also demonstrate a contribu- on the body, but alter the affective appraisal of experi-
tion to homeostasis. This pro-oxidant activity is reported ence and consequently the retrospective evaluation of
to be efficient in reducing local tumour volume or tumour treatment-related pain (Gedney et al, 2004). This shows
cell proliferation by apoptotic and/or necrotic effects. the complexity of the relationship between essential oils
Evidence exists to support the notion that relaxation and the nervous system, directly reducing pain and also
reduces the body’s response to norepinephrine (Soloman through moderating conscious intent. Howarth (2002)
et al, 1990). Therefore, the involvement of the hypotha- indicates that essential oils containing esters and a high
lamus in the actions of aromatherapy is the integrator terpene level have analgesic properties, e.g. lavender or
between mind and body (Thibodeau and Patton, 1996). roman camomile.

British Journal of Neuroscience Nursing December 2008 Vol 4 No 12 597


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Clinical application ment. All of these responses are associated with changes in
Common essential oils have a variety of therapeutic effects hypothalamic activity (Tortora and Grabowski, 2003). As
(Table 1). Pain, stress and emotional trauma are common previously mentioned, the hypothalamus controls the ANS
elements in people who attend aromatherapists for treat- and can therefore regulate defensive reactions such as fear

Table 1. Therapeutic effects of essential oils

Essential Oil Effect Evidence

Bergamot • Stimulates or sedates according to individual need, relieving Lawless, 1994


anxiety and calming fears
• Enhances mood through neuro-limbic pathways Kaddu et al, 2001

Clary sage • Balances and reduces tension Lawless, 1994; Davis, 1995
• Deeply relaxing effect, thus helpful in dealing with muscular Davis, 1995
stress and tension

Lavender • Calming Kirk-Smith, 2003


(Lavandula • Reduces stress through higher α brainwave activity, lower β brainwave
angustifolia) activity, lower electrodermal activity level and higher skin temperature Liu et al, 2003
• Significant impact on autonomic activity which induces relaxation Saeki and Shiohara, 2001
• Key component, linalool, has antispasmodic effects Lis-Balchin and Hart, 1999
• Stimulates the amygdala, producing a sedative effect similar to that Tisserand, 1988; Buckle, 2003
of diazepam and results in pain relief Buckle, 1999a
• Increases parasympathetic activity while depressing sympathetic Saeki and Shiohara, 2001
nervous activity
• In people with dementia promotes longer and better Henry et al, 1994
structured night-time sleep
• Mood balancing effect to help with depression Lawless, 1994
—users self-report more positive emotions Liu et al, 2003
• Significant reduction in performance of working memory, Moss et al, 2003
impaired reaction times for both memory and
attention-based tasks, and increased feeling of contentedness

Lemon • Psychologically strengthening (uplifting) Lawless, 1994; Davis, 1995

Aniseed • Stabilizing and antispasmodic effect on an overactive sympathetic Schnaubelt, 2003


(Pimpinella anisum) nervous system as a result of estragole (methyl chavicol), and other
phenylpropane ethers

Roman camomile • Well-documented antispasmodic, calming, and sedative properties Rossi et al, 1988

Rosemary • Refreshing effect, was shown to decrease blood flow and increase Saeki and Shiohara, 2001
systolic blood pressure immediately after inhalation, as a result of
nervous stimulation
• Significantly enhances performance for overall quality of memory Moss, 2003
and secondary memory factors, impairs speed of memory, increases
alertness and feeling of contentedness
• May increase or decrease seizure activity Maddocks-Jennings and
Wilkinson, 2004

Sandalwood • Characterized by the concept of ‘harmonization’ rather than Hongratanaworakit et al,


relaxation/sedation 2004

Sweet marjoram • Analgesic and antispasmodic Kim et al, 2005

Ylang ylang • Inhalation is shown to decrease pulse rate, indicating a decrease in Hongratanaworakit and
autonomic nervous system arousal Buchbauer, 2004
• Reduces systolic blood pressure, demonstrating a decrease of
sympathetic tone and physiological arousal
• Increases alertness and attention, demonstrating an increase of
arousal in terms of self-evaluation

598 British Journal of Neuroscience Nursing December 2008 Vol 4 No 12


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and rage (Tortora and Grabowski, 2003). Therefore if an (Mollet and Harrison, 2006). With both these elements
essential oil’s use, and its application, can induce relaxation involved, and the known method of action that essential
and reduce sympathetic activity, pain is likely to be less oils have on both emotional and nervous impulse trans-
intrusive and disruptive to the individual. mission, the amelioration of pain responses is firmly
Olfactory abilities are essential in inhalation to achieve anchored within the remit of essential oils.
the effect of essential oils, and therefore cutaneous appli-
cation is often necessary for therapeutic effect (Snow et Multiple sclerosis
al, 2004). This is particularly important in the case of Others have contributed to the knowledge of the role of
those with neurological impairment, such as dementia. aromatherapy in practice. Howarth (2002) conducted an
Olfactory stimulation can enhance cognitive performance audit on a pain service for patients with multiple sclerosis
and mood (Moss et al, 2003). The recipient’s expectations (MS). Of those who received aromatherapy massage with
also play a significant role in determining the effect of oils a blend of essential oils known to be analgesic, 78% con-
that are mood enhancing (Campenni et al, 2004). Essential tinued using essential oils, 55% had improved sleep, 64%
oils may ameliorate disturbances in cognition, mood, improved mobility, 88% improved sense of wellbeing,
sleep and other physical abilities (Diamond et al, 2003). 91% improved ability to relax, and 7% a reduction in
medication consumption. While these were notable effects,
Stress the oils used were not specified and other variables that
Stress may disrupt human emotional and somatic homeos- may have influenced results were not taken into account.
tasis causing negative physiological and psychological
responses (Hubbard and Workman, 1998). Stressed peo- Postoperative care
ple experience anxiety, frustration, fatigue, tension, exas- Anderson and Gross (2004) also trialled the use of aroma-
peration, distraction, behavioural changes and illnesses as therapy in postoperative care, using peppermint oil, iso-
well as low cognitive performance, all of which essential propyl alcohol and saline. These were found to be effec-
oils can help treat if a holistic, psychosocial approach is tive in reducing postoperative nausea by 48%. However,
taken. This is supported by Pemberton and Turpin (2008) the authors noticed that aroma may not have produced the
who determined that Lavandula angustifolia (lavender) effect but rather that a conscious effort to control breath-
and Salvia sclaria (sage) essential oils decreased the per- ing, or placebo effect, may have produced these results.
ception of work-related stress. The study also had a small sample size, but was statisti-
cally significant in that there was randomisation used in
Pain transmission the type of aromatherapy administered and that regression
Pain transmission can also be moderated by essential oils analysis revealed a modest significant correlation between
(Figure 4). Pain is a subjective experience that typically a reduction in reported nausea five minutes after initial
accompanies nociception, but can also arise without a aromatherapy and the patients’ overall satisfaction (ρ2=
stimulus, and therefore includes an emotional response 0.17; P=0.028).

Spinal nucleus Medial Periaqueductal Mesencephalon


of nerve V V lemniscus grey matter
V Reticular formation
VII Neotrigemino- VII
IX IX
X thalamic tract Medulla
Dorsal column Spinoreticular
Multisynaptic
tract
afferent systems
Spinomesen-
Neotrigemino-
cephalic tract
thalamic tract
Paleospino-
thalamic tract

Figure 4. Pain pathways in the nervous system

British Journal of Neuroscience Nursing December 2008 Vol 4 No 12 599


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Conclusions Conflict of interest: None declared


Complementary therapies are often viewed with scepti-
cism, and while the evidence base that underpins many Anderson LA, Gross JB (2004) Aromatherapy with peppermint,
such therapies continues to require development, the evi- isopropyl alcohol, or placebo is equally effective in relieving
dence that does exist should be acknowledge and appraised. postoperative nausea. J Perianesth Nurs 19(1): 29–35
Bakkali F, Averbeck S, Averbeck D, Idaomar M (2008) Biological
The evidence reviewed here indicates some of the mecha- effects of essential oils—A review. Food Chem Toxicol 48: 446–75
nisms of actions of aromatherapy, highlighting that there Ballard CG, O’Brien JT, Reichelt K, Perry EK (2002) Aromatherapy as
is a role for its use as an adjunct in treating neurological a safe and effective treatment for the management of agitation in
severe dementia: The results of a double-blind, placebo-controlled
disorders alongside conventional medicine, therefore aro- trial with Melissa. J Clin Psychiatry 63(7): 553–8
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Table 2. Neurological conditions for which aromatherapy has been shown to be useful

Disorder Symptom Essential oils Evidence

Guillian Barre Pain 5% concentration blend of Shirreffs, 2001 (case study)


syndrome geranium, lavender, and
roman camomile

Guillian Barre Fatigue 5% concentration blend of Shirreffs, 2001 (case study)


syndrome lemon, sweet basil, grapefruit,
black pepper, and peppermint

Multiple sclerosis Disturbed sleep Blend not specified Howarth, 2002: 55% improvement in
sleep; (n =50)

Impaired mobility Blend not specified Howarth, 2002: 64% improvement in


mobility; (n =50)

Diminished well-being Blend not specified Howarth, 2002: 88% improvement


in well-being; (n =50)

Anxiety Blend not specified Howarth, 2002: 91% improvement


in ability to relax; (n =50)

Dementia Agitation/psychosis Melissa Ballard et al, 2002: safe and effective


treatment for clinically significant
agitation in people with severe dementia

Cognitive dysfunction Lavender Lee, 2005: lavender hand massage


and agitation program effective on emotions
and reducing aggressive behaviour
Alzheimer’s type dementia

Hemiplegia Shoulder pain Lavender, rosemary, and Shin and Lee, 2007:
aromatherapy acupressure
peppermint significantly reduces shoulder
pain and improves mobility

Epilepsy Seizures Jasmine Eron, 1957: jasmine can act as a


countermeasure to seizures in
epilepsy as it stimulates activity
in the same cortical region
where epileptic potentials
originate

Ylang ylang, rosemary, Betts, 2003: over one third of patients


rose geranium, lavender, who used aromatherapy and aromatherapy
camomile. with hypnosis were seizure free after
one year

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