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The Biopsychosocial approach, first described by Dr. George Engel, describes health and illness as a combination of biological, psychological and social factors. This model asks us to look at not only the biological aspect of human functioning but all the other things that influence our daily processes including emotions and beliefs behind behaviors (psychological), as well as cultural, social environment and economic factors (social).

Literature Review

Conclusions

Utilizing Essential Oils Within the Biopsychosocial Model to Address Orthopedic Injuries - Megan Richardson, MS, Dipl Ac, LAc, ATC

References

Pain• A systematic review and meta-analysis found several articles to show aromatherapy in

conjunction with conventional treatments to positively impact subjective pain scores. Specifically, pain was reduced in patients experiencing low back pain (lavender), neck pain (lavender), episiotomy (lavender), menstrual pain (lavender, clary sage, and marjoram), labor pain (lavender), post-operative knee replacement (eucalyptus), cesarean section (lavender.

• Aromatherapy massage using a blend of lavender, eucalyptus and ginger essential oils was superior to conventional massage to reduce pain and stiffness and improve physical function in patients with knee osteoarthritis. (Arslan) Activities of daily living were significantly improved in knee osteoarthritis patients receiving aromatherapy massage using lavender oil.

• Inhaling rose essential oil along with NSAID treatment reduced pain in primary dysmenorrhea more than NSAID treatment alone.

• Meta-analysis showed that abdominal massage EOs (lavender, clary sage, marjoram, cinnamon, clove, and rose) superior to massage with placebo oils in reducing pain of primary dysmenorrhea. Massage with lavender oil has a higher effect size than massage with mixed essential oils

• Copaiba essential oil reduced chronic inflammatory infiltrates, decreased tissue necrosis, reduced macrophages and neutrophils after researcher induced damage to the tongue and brain of rats. Administering white pepper, long pepper, cinnamon, saffron and myrrh EO showed the ability to reduce inflammation and increase pain tolerance in rats.

• In hospital acute care settings aromatherapy reduced pain, anxiety and post-operative nausea. Sweet marjoram is effective in reducing reported pain scores, Lavender and sweet marjoram were effective in reducing reported anxiety, and ginger decreased episodes and complaints of nausea. Several studies found an inhaled mixture of essential oils of peppermint, spearmint, ginger, and lavender was found to be effective to reduce post-operative nausea and vomiting.

Mental• Peppermint and sage essential oils were found to decrease mental fatigue and improve

performance during cognitive tasks. The benefits were most significant 3-4 hours after ingestion of the EO.

Anti-viral/Immunity• Bergamot, cinnamon, eucalyptus, lavender, lemon balm, lemongrass, geranium, tea tree,

thyme, bai qian root, and yuxingcao root essential oils were found to have antiviral effects against the influenza virus.

Mood• A systematic review of 12 RCTS found aromatherapy massage and aromatherapy to be

effective in the treatment of depressive symptoms such as sadness, worthlessness, desperation, changes in sleep and diet, poor concentration and memory, fatigue, and suicidal ideation as measured by various objective assessment tools. The oils which produced positive effects were: lavender, geranium, rose. rosemary, rose otto, yuzu, bergamot, lemon, clary sage, roman chamomile, sandalwood, jasmine, Melissa, and juniper.

Stress• Nurses and patient care technicians in several hospital units: trauma intensive care, surgical

specialty care, and orthopaedic trauma all reported less work related stress and improved job satisfaction after 30 days of diffusing lavender essential oil during work shifts.

• A RCT in healthy adults showed a reduction in perceived stress and depression, as well as better sleep quality after exposure to a blend of essential oils for 24 hours per day for 4 weeks. The essential oil blend consisted of: lemon, eucalyptus, tea tree, and peppermint. (Lee) A meta-analysis of 5 RCTs found favorable effects to aromatic exposure to peppermint and lavender essential oils on cortisol levels and controlling stress.

1. Arslan DE, Kuthuturkan S, Korkmaz M. The effect of aromatherapy massage on knee pain and functional status in participants with osteoarthritis. Pain Manag Nurs. 2018 In press

2. Hodge NS, et al. A prospective randomized study of the effectiveness of aromatherapy for relief of postoperative nausea and vomiting. 2014, 29 (1), 5-11.

3. Hur MD, et al. Aromatherapy for stress reduction in healthy adults: a systematic review and meta-analysis of randomized clinical trials. 2014, 79, 362-369.

4. Johnson K, et al. Use of aromatherapy to promote a therapeutic nurse environment. Intensive Critical Care Nurs. 2017, 40, 18-25.

5. Johnson JR, et al. The effectiveness of nurse-delivered aromatherapy in an acute care setting. Complimentary Therap in Med. 2016, 25, 164-169.

6. Kennedy D, et al. Volatile terpenes and brain function: investigation of the cognitive and mood effects of mentha x piperita L. essential oil and in vitro properties relevant to central nervous system function. Nutrients. 2018, 10, 1029-36.

7. Kennedy D, et al. Monoterpenoid extract of sage with cholinesterase inhibiting properties improves cognitive performance and mood in healthy adults. J Psychopharmacol. 2011, 25, 1088-1100.

8. Lakhan SE, Sheafer H, Tepper D. The effectiveness of aromatherapy in reducing pain: a systemic review and meta-analysis. Pain Research Treatment. 2016.

9. Lee M, et al. The effects of aromatherapy essential oil inhalation on stress sleep quality and immunity in healthy adults: randomized controlled trial. 2017, 12, 79-86.

10.Sanchez-Vidano DI, et al. The effectiveness of aromatherapy for depressive symptoms: A systemic review. Evid Based Complementary Altern Med. 2017.

11.Setzer WN. Essential oils as complementary and alternative medicines for the treatment of influenza. Am J Essential Oils Natural Products. 2016, 4 (4), 16-22.

12.Stallings-Welden LM, et al. A comparison of aromatherapy to standard care for relief of PONV and PDNV in ambulatory surgical patients. J Peri Anesthesia Nursing. 2018, 33 (2), 116-128.

13.Sut N, Kahyaoglu-Sut H. Effect of aromatherapy massage on pain in primary dysmenorrhea: A meta-analysis. 2017, 27, 5-10.

14.Teixeira FB, et al. Copaiba oil-resin modulates the inflammation in a model of injury to rats’ tongues. BMC Complementary Alt Medicine. 2017, 17, 313.

15.Uzuncakmak T, Alkaya SA. Effect of aromatherapy on coping with premenstrual syndrome: A randomized controlled trial. Comp Therap in Medicine. 2018, 36, 63-67.

16.Zhang Y, et al. Anti-inflammatory, anti-nociceptive activity of an essential oil recipe consisting of the supercritical fluid CO2 extract of white pepper, long pepper, cinnamon, saffron, and myrrh in vivo. J Oleo Science. 2014, 63 (12), 1251-1260.

The aromatic and topical use of essential oils are cost effective, preventative tools to assist the orthopedic patient physically, emotionally, and mentally.

Introduction

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MSK Injury, PainIllness/wellness

Nutrition & DigestionSleep

Biological

RelationshipsCulture/Customs

Work/Family dynamicsTravel requirements

Mental Outlook

Socio-culturalStress

Illness/wellnessPersonality Type

Coping mechanisms

Psychological

DisclosuresMegan Richardson has the following financial disclosures: Sells and distributes doTERRA Essential Oils

LimitationsMany studies, even RCTs, looking at essential oils have fundamental design issues. More high-quality standardized experiments are needed to truly understand the beneficial effect of essential oils.

Aromatherapy is defined as the therapeutic use of plant derived concentrated essences which are extracted by distillation. Essential oils contain volatile organic compounds that exert a pharmacological effect by penetrating the body by oral, dermal, or olfactory administration. Essential oils are an affordable and effective modality that can be used by the patient to improve physical, psychological and spiritual health and wellbeing.

Aromatherapy

We can see that factors other than musculoskeletal injury can be affecting our patient’s health and ability to heal from musculoskeletal injury. This may explain why two people with seemingly similar injuries heal in different ways. It also makes us ask what else is going on within each world of those two people that may be affecting healing; such as how are they sleeping, eating, how do they respond to the demands of work and life, what are their coping mechanisms, how are their inter-personal relationships, how were they raised to deal with conflict/health, etc.

The injured orthopedic patient often struggles with psychosocial issues in addition to the physical pain, disability, and functional restrictions resulting from their injuries. Issues such as anxiety, depression and fear not only impact how the patient copes with an injury socially, but can impact his or her ability to physically heal.

Sleep