Pain Management

Pain

is the body's way of communicating that damage has occurred (or is going to occur). The end goal is to signal that repair needs to occur and that, if applicable, the tissue damage needs to stop occurring. Pain can be acute, happening due to an injury or localized area of damage. This type of pain is relieved by addressing the problem.
Pain can also be chronic, which is much longer-lasting. Chronic pain may be constant or intermittent. It is more difficult to resolve.

Approaches to pain will differ due to the type of pain, the severity of pain, and the underlying cause of the painful event. Chronic pain requires long-term, frequent applications of pain-relieving products, while acute pain may be managed through a single intervention or small group of interventions. Essential oils are powerful tools for pain relief and can be used for both acute and chronic pain.

Measuring Pain

Pain is a subjective outcome, there is no laboratory tool or diagnostic test that measures the level of pain an individual experiences in a standardized method. Ultimately the experience of pain is highly personal and subjective based on the individual’s perceptions and experiences.

Both subjective and objective outcomes have measurement instruments (blood pressure cuff, scale) to quantify an experience and enable an individual to set goals. For objective outcomes, these are often laboratory tests or diagnostic tools, but for subjective outcomes, these are frequently surveys and other information-gathering instruments.

The two pain measurement instruments used in our classes are the Visual Analog Scale (Scott and Huskisson) and the McGill pain questionnaire (Melzack). The VAS is useful for acute pain as it measures the pain “right now,” whereas the McGill instrument is ideal for chronic pain.

Pain Management Approaches

Whether the pain is caused by teething, an injury, or an underlying condition, pain relief is often achieved by topical application of an agent which is capable of alleviating pain. This can happen one of two ways: depression of the cutaneous sensory receptors, as in the case of anesthetics and some analgesics, or stimulation of these receptors, as in the case of a rubefacient, which is often accomplished by counterirritation (BNF, 2008).

The purpose of a counterirritant is to produce pain relief that is beyond skin- deep and reaches the joints, muscles, and tissues deeper in the body that may be producing the pain (Morton, 2002). In other words, these can numb the skin, but unlike other topical applications, this effect can also penetrate deeper to also alleviate deep, underlying pain.

They accomplish this by increasing, rather than decreasing the stimulation–or irritation–to these sensory receptors in the body. This irritation may cause reddening of the skin and increases blood flow to the area, often resulting in pain relief.
Counterirritants have been used for pain relief since antiquity. Heat is a type of counterirritant that is often used to produce pain relief in sore muscles and injuries. Ice is another type of counterirritant that is frequently used for injuries and for teething babies (Barkin, 2013).

These are examples of thermal counterirritants, where the change in temperature acts as the irritant which produces relief. Botanicals contain chemical counterirritants, which chemically, rather than thermally, stimulate these receptors.

Common examples of chemicals within these botanicals include capsaicin (found in hot peppers), menthol (from peppermint), and eugenol (from clove) (Derry, et al, 2009; Akehi, et al, 2013; Promod, et al, 2010). Modern researchers have found that chemicals such as eugenol in clove induce irritation with rapid desensitization, ultimately resulting in numbness–like many modern pain relievers, these chemicals are uncomfortable to apply but that discomfort is short-lived and rapidly followed by relief from pain (Klein, et al, 2014)

Essential Oils for Pain Relief

Clove Bud Oil

Clove is rich in eugenol, with the bud containing up to twice the concentration as the leaf. Undiluted clove oil can burn and irritate the skin so it should never be applied to an open wound or a sensitive area. Eugenol not only acts as a counter-irritant, it increases blood flow to the area and is a potent antimicrobial.

Collectively, these actions enable the oil to alleviate pain, speed wound healing, and protect against infection. In clinical trials, it has been shown to decrease the wound healing time in anal fissures, reduce infection risk and alleviate pain in toothaches, and alleviate topical pain as well as pharmaceutical benzocaine gel. Typical dilution for a pain relief product ranges from 1% to 20%, with a total of <10 drop per day for an otherwise healthy adult.

Peppermint Oil

Peppermint is rich in menthol, which exhibits cooling effects when applied topically. When applied to painful areas, it restricts blood flow in a way similar to an ice pack. One study compared menthol with ice and found that the two have similar actions on the body. The amount of menthol in your peppermint oil can be determined by a third party chemical analysis of the oil's contents.
Combining peppermint with warming oils and herbs provides a sensation of both hot and cold, which is ideal for sore muscles and acute pain. Caution should be taken as concentrated method applications may burn the skin.
Typical dilution for a pain relief product ranges from 2% to 100%, with a total of <10 drops a day for an otherwise healthy adult.

Other Essential Oils

Cinnamon is rich in cinnamaldehyde, a chemical which acts as a counter- irritant and powerful antimicrobial. It is useful for deep muscle pain and is used in an advanced technique known as drenching undiluted for advanced pain relief. Typical dilution for a pain relief product ranges from 2% to 100%, with a total of <20 drops a day for an otherwise healthy adult.

Ginger reduces pain by increasing circulation, delivering healing benefits through increased blood flow in the affected area. It also delivers anti-inflammatory benefits. In scientific studies, it has been used topically for pain relief for chronic pain in concentrations ranging from 1% to 10%, with a total of <25 drops a day for an otherwise healthy adult.

Essential Oil Inhalation

Inhalation of oils which calm the CNS can increase an individual’s tolerance to pain and many calming essential oils are useful as additional tools for pain management.

Orange Oil: Unlike clove, cinnamon, and peppermint, which treat pain topically, orange oil relieves pain through inhalation. This makes it ideal for conditions where topical application is impractical or unsafe, such as open wounds, childbirth, and broken limbs. While clinical trials use the oil nonstop for pain relief, best practices include a 15-30 minute exposure with a 30-60 minute break between each exposure to reduce the risk of headaches and other side effects.

Bergamot Oil: Bergamot is not typically utilized in clinical trials for pain relief; it is known for its anti-anxiety actions. In clinical studies, including research conducted here at FSIHS, bergamot essential oil has been found to reduce overall stress levels and to reduce anxiety related to an actual anxiety disorder. Bergamot is best inhaled in 10-15 minute intervals, as needed.

Dig Deeper

Chaieb, K., Hajlaoui, H., Zmantar, T., Kahla‐ Nakbi, A. B., Rouabhia, M., Mahdouani, K., & Bakhrouf, A. (2007). The chemical composition and biological activity of clove essential oil, Eugenia caryophyllata (Syzigium aromaticum L. Myrtaceae): a short review. Phytotherapy research, 21(6), 501-506.

Pergolizzi Jr, J. V., Taylor Jr, R., LeQuang, J. A., Raffa, R. B., & NEMA Research Group. (2018). The role and mechanism of action of menthol in topical analgesic products. Journal of clinical pharmacy and therapeutics, 43(3), 313-319.

Topp, R., Ledford, E. R., & Jacks, D. E. (2013). Topical menthol, ice, peripheral blood flow, and perceived discomfort. Journal of athletic training, 48(2), 220-225.

Taher, Y. A., Samud, A. M., El-Taher, F. E., ben- Hussin, G., Elmezogi, J. S., Al-Mehdawi, B. F., & Salem, H. A. (2015). Experimental evaluation of anti-inflammatory, antinociceptive and antipyretic activities of clove oil in mice. Libyan Journal of Medicine, 10(1), 28685.

Halder, S., Mehta, A. K., Mediratta, P. K., & Sharma, K. K. (2012). Acute effect of essential oil of Eugenia caryophyllata on cognition and pain in mice. Naunyn-Schmiedeberg's archives of pharmacology, 385(6), 587-593.

Meet Dr Hawkins

Dr. Hawkins brings 20 years of expertise in the integrative health field to her role as Executive Director of the Franklin School of Integrative Health Sciences and the leader of our clinical research team.

She holds a Bachelor’s Degree in Environmental Health from Union Institute and University, a Master’s Degree in Health Education & Promotion from the University of Alabama, a post-graduate certificate in epidemiology from the London School of Hygiene and Tropical Medicine, a PhD in Health Research from Middle Tennessee State University, and is completing the post-doctoral Global Scholars Research Training Program at Harvard Medical School. She also holds certifications in numerous natural health fields including aromatherapy, aromatic medicine, herbalism, childbirth education, and labor support.