Intractable Peripheral Edema in Hospice: A Clinical Aromatherapy Case Study and Review of the Literature

Purpose:

Many patients experience peripheral edema nearing end-of-life. Although peripheral edema is directly related to numerous hospice admitting diagnoses and co-morbid conditions, it may also be related to medication administered for palliation. Unfortunately, current pharmacological approaches to reduce acute, chronic, and neuropathic pain (i.e.: morphine and gabapentin) also have adverse effects which include peripheral edema. At times, peripheral edema is intractable to both pharmacological (i.e.: bumetanide, furosemide, and metolazone) and non-pharmacological (elevation, fluid and sodium restrictions) approaches. Aromatherapy is often understood as aroma from essential oils eliciting psychological or physiological responses via the limbic system in the brain, but when applied topically, essential oils elicit physiological changes at and/or near the site of application. Essential oils of Cupressus sempervirens (Cypress), Foeniculum vulgare (Fennel), Lavendula angustifolia (Lavender), and Zingiber officinale(Ginger) will be studied. While the efficacy to reduce peripheral edema using the primary constituents of these essential oils (i.e., monoterpene alcohols, esters, ketones, oxides, monoterpenes, sequiterpene alcohols, sequiterpenes, and phenylpropanoids,) has been previously investigated, the holistic use of these essential oils has not been well studied. The purpose of this project was to present a clinical aromatherapy case study and review the literature as a foundation for future research investigating the effectiveness of clinical aromatherapy in reducing peripheral edema in end-of-life patients unresponsive to standard pharmacological and non-pharmacological approaches.

Methods:

The case study was conducted over a three week period, following guidelines of the National Association for Holistic Aromatherapy, by a registered nurse and certified clinical aromatherapy practitioner. PubMed, CINAHL, OvidMedline, and ProQuest databases were searched for peer-reviewed journal articles in English with the following keywords: aromatherapy, cypress, end-of-life, essential oil, fennel, gabapentinoids, ginger, hospice, opioids, and peripheral edema.

 Results:

The case study demonstrated efficacy of the clinical aromatherapy blend in reducing upper and lower bilateral peripheral edema over the course of three weeks. However, the literature review found insufficient evidence-based knowledge on the use of clinical aromatherapy for reduction in peripheral edema in patients at end-of-life. No studies were found assessing holistic essential oil efficacy in reducing peripheral edema. There were, however, a small number of efficacious studies found utilizing chemical constituents within essential oils for this purpose.

 Conclusion:

The possible peripheral edema reducing capacity of essential oils has yet to be explored beyond clinical aromatherapy case studies. Clinical aromatherapy has the potential to diminish adverse effects of pharmachological approaches to pain management at end-of-life, thus warranting further research.