Reviewed: Bikmoradi A, Harorani M, Roshanaei G, Moradkhani S, Falahinia GH. The effect of inhalation aromatherapy with damask rose (Rosa damascena) essence on the pain intensity after dressing in patients with burns: a clinical randomized trial. Iran J Nurs Midwifery Res. May-June 2016;21(3):247-254.

The severe pain of serious burns is exacerbated by the need to clean, debride, and re-dress wounds daily. Pain control is important in the healing and recovery process. Narcotic and non-narcotic drugs are commonly used for this purpose, but adverse effects and/or increased tolerance may limit their efficacy. The clinical use of inhaled essential oils, generally referred to as aromatherapy, is increasingly becoming accepted as an adjunct pain-control method. and it is used to reduce stress, anxiety, fatigue, and depression, symptoms that often affect patients with burn wounds. Aromatherapy’s mechanisms of action, particularly when essential oils are used as inhalants, remain mostly unknown. Damask rose (Rosa damascena, Rosaceae) essential oil (DREO) has been little-studied in relation to pain, although some studies report palliative, sleep-promoting, anticonvulsant, and relaxing effects. 

This randomized, placebo-controlled, clinical trial investigated the effects of DREO in patients in the burn ward of Besat Therapeutic and Educational Center of Hamadan University of Medical Sciences in Hamadan, Iran. It was conducted from May to October 2013. Patients were 18-65 years of age; could speak, see, and communicate; and had second- and/or third-degree burns. Patients (N = 54) with inhalation, self-inflicted, or electrical burns; burns on the face or eyes; a history of allergies or respiratory illness; or apparent allergy to DREO during the study were excluded. All patients received analgesic and sedative drugs one hour before and immediately after wound dressing.

Data were collected via a questionnaire covering demographic information and the cause and extent of burn wounds. A visual analog scale was used to measure pain intensity (0 = no pain, 1-3 = some pain, 4-6 = moderate pain, and 7-10 = severe pain). For two consecutive days, pain scores were recorded 30 minutes before entering the wound-dressing room and at 15 and 30 minutes after leaving the wound-dressing room. Ten minutes after the initial pain measurement each day, patients in the active group inhaled five drops of 40% DREO (manufacturer information not provided) in distilled water for 20 minutes via gauze pads attached to their collars; those in the control group inhaled five drops of distilled water by the same method. Patients were sent directly to the wound-dressing room after their 20-minute aromatherapy session each day. This intervention was administered by nurses, with patients in the DREO group treated in a different room to avoid carryover between patient groups, without researchers’ knowledge. Gauze pads were then removed before patients were treated by researchers whose noses were covered.

Most patients were male (60% in the active group, 52% in the control group), and the average age of patients was 33.2 ± 10.6 years in the active group and 34 ± 12.4 years in the control group. The most common cause of burns was fire (84% in the active group and 96% in the control group); although figures for other causes are not given, caustic substances were mentioned as having caused some. Mean length of hospitalization was 22.5 ± 10.6 days for those in the active group and 22.6 ± 9.7 days for the control group. Patients in the active group had burns over 23.7% ± 8.6% of their bodies, and patients in the control group had burns covering 23.2% ± 8.9% of their bodies. There were no significant differences in demographic characteristics between groups. Four enrolled patients were removed from the study due to discharge from the hospital (one in each group), unwillingness to participate (one in the placebo group), and intolerance of the treatment (one in the active group).

Before the first intervention on day one, the mean pain score was 5.4 in both groups; 80% of patients in the active group and 96% of those in the control group reported moderate pain. At 15 minutes after patients’ burns were dressed, average pain scores were 6.8 in the active group and 7.6 in the control group; 68% of patients in the active group and 96% of patients in the control group reported severe pain. At 30 minutes after treatment, average pain scores had diminished to 6.4 in the active group and 7.3 in the control group, with 40% and 92%, respectively, still reporting severe pain. Before the second intervention, mean pain scores were 5.4 in both groups, with 96% of the active group and 100% of the control group reporting moderate pain. At 15 minutes after the second burn dressing, mean pain scores were 6.8 in the active group and 7.6 in the control group, with 72% and 96%, respectively, reporting severe pain. Thirty minutes after the second treatment, mean pain scores were 6.5 in the active group and 7.4 in the control group, with 52% of the active group and 96% of the control group still reporting severe pain. 

On both days, there was a statistically significant difference in mean pain intensity between the two groups at 15 minutes (P = 0.010 for day one; P = 0.001 for day two) and 30 minutes (P = 0.001 for both days) after treatment. The increase in pain caused by dressing of burns was significantly less in the active group (P = 0.01). Analysis of variance using repeated measures showed a significant difference in pain severity between the two groups before and after treatment (P = 0.027). Mean pain intensity during the three time periods reported (30 minutes before treatment, 15 minutes after treatment, and 30 minutes after treatment) was significantly different between the two groups (P = 0.001).

This study was small and of short duration, and the effect size was moderate (on average, slightly less than one point on a 10-point scale of pain). Another weakness is that the inactive, unscented placebo would have been obvious to patients so they would not really have been blinded. Future studies should use a control that has an odor but no reported use in pain, and perhaps a third intervention as well that has a reported use for pain management. However, given the intense pain of burn wounds and their treatment, and the low cost and ease of administration of aromatherapy, DREO may be beneficial as an adjunct pain treatment. More research is warranted.

—Mariann Garner-Wizard