The Effect of Aromatherapy Hand Massage on Pain Level and Vital Signs in Elderly People With Chronic Non-malignant Pain
Phase: NA
Conditions: Non-malignant Chronic Pain
Sponsor: Haben Tesfu Gebreselassie

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The effect of aromatherapy hand massage on pain level and vital signs in elderly 
people with chronic non-malignant pain 
 
 
27 February 2021 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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The effect of aromatherapy hand massage on pain level and vital signs in elderly 
people with chronic non-malignant pain 
 
Abstract 
Objective: The aim of this study is to determine the effect of aromatherapy hand massage on pain 
level and vital signs in elderly individuals with chronic non-malignant pain. 
Background: Chronological aging accompanied by different factors exacerbate chronic pain which 
makes the senior population prone for various complications. Thus, the medical community is 
forced to seek safer and easier alternative treatments.  
Material and Method:  66 elderly individuals with chronic non-malignant pain who had visited an 
algology outpatient polyclinic university hospital in Izmir, Turkey between 01 May 2019 - 30 
August 2019 and met the sampling criteria have been randomly selected into aromatherapy, placebo 
and control groups. Data collection was carried out using Individual Diagnosis Form, Visual 
Analogue Scale and Brief Pain Inventory. Before and after intervention, data collection forms were 
filled and pain level and vital signs were evaluated. 
Results: The mean age of the elderly individuals in the study was 73.74 ± 6.257.  Participants pain 
severity after aromatherapy decreased by 42.24%. When comparing vital sign pre-post procedure; 
systolic blood pressure value for the placebo group was significantly lower. Right after 
intervention, pulse rate was significantly lower in aromatherapy and placebo groups while post 
intervention body temperature in aromatherapy group was found to be higher and statistically 
significant. 
Conclusion: This study has shown that aromatherapy hand massage is effective on lowering pain 
level and positively influencing vital signs of elderly individuals with chronic non-malignant pain. 
Considering these beneficial effects, aromatherapy massage can be used as an independent nursing 
intervention in elderly individuals who are suffering from chronic pain. 
 
 

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Relevance to Clinical Practice 
 Aromatherapy massage can be considered as a safe solution to manage chronic pain for the elderly 
population with nurses who are fully aware of the holistic modality.  
 
KEYWORDS: aromatherapy, elderly, massage, pain, vital signs 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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1. Introduction  
One of the biggest changes seen in the twenty-first century is the large increasing rate of the elderly 
population. According to the World Health Organization’s report, the number of individuals over 
the age of 60 is expected to reach two billion by the year 2050. In the same year, 434 million senior 
individuals   are estimated to be over the age of 80 years old (WHO, 2018). Despite advances in 
modern medical science and health-oriented lifestyle changes, there is insufficient evidence that 
show the modern elderly society is healthier than the previous generation (WHO, 2018; Segue 
Technologies, 2015), since they continue to suffer age related illnesses like chronic pain 
(Dziechciaz, Balicka & Filip, 2013). 50% of elderly population who live in the community are 
suffering from chronic pain while this number rises to 80% for those who live in nursing homes. It 
is also reported that 48.8% of senior individuals seek medical help due to pain related complains 
and out of this people 19% state to experience sever pain level (Pateinakis, Amygdalas, Pateinaki & 
Pyrpasopoulou, 2013; Jones et al., 2016). Secondary to chronic pain elderly people are facing 
complications like anxiety, depression, anorexia, loss of body weight and impaired mental 
functions. Moreover, it negatively affects their functionality, quality of life and social activities 
(Pateinakis Amygdalas, Pateinaki & Pyrpasopoulou, 2013; Karp, Shega, Morone & Weiner 2008; 
Wahle & Schwenke, 2013). Conventionally used pharmacological methods may not always be 
suitable to treat elderlies’ chronic pain, as serious complications and side effects such as excessive 
sedation and confusion can take place (IASP, 2018; Paladini, Fusco, Coaccioli, Skaper & Varrassi, 
2015). For this reason, it becomes crucial for the medical world to turn towards non-
pharmacological alternative treatments like aromatherapy, as these methods have the ability and 
capacity to alleviate chronic pain and associated syndromes without side effects (Paladini, Fusco, 
Coaccioli, Skaper & Varrassi, 2015; Simpson, 2015). Besides to its other countless benefits 
aromatherapy has many physical and psychological benefits; It reduces muscle tension and 
minimizes pain and decreases stress and stress-related symptoms by providing relaxation. 
Combining aromatherapy with the M technique hand massage, can give satisfactory results, as this 
massage technique is an extremely soft, comfortable and relaxing massage type that can be applied 
to even the most fragile patient; which makes it the perfect choice to handle chronic pain in the 
elderly community (Fellowes, Barnes & Wilkinson, 2004; Buckle, 2008). 
 

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2. Background  
Chronic geriatric pain is an unpleasant sensory and emotional experience due to actual or potential 
tissue damage seen in old (65-79 years old) or very old (80 years and over) individuals with pain 
complaints for more than three months (Kaye, Baluch & Scott, 2010).  Among the most prominent 
pain origins in older adults are: lower back or neck pain (65%), musculoskeletal pain (40%), 
peripheral neuropathic pain (40%) and chronic joint pain (20%) (Molton & Terrill, 2014).  
Histological aging accompanied by physiological, psychological and environmental changes are the 
main factors that exacerbate persistent pain. Changes in parts of the brain necessary for pain 
perception occur with normal aging, especially with loss of brain volume in the prefrontal cortex 
and hippocampus (Boehm, Büssing & Ostermann, 2012) making older people more dependent on C 
fibre for the perception of morbid stimulants. The number of myelinated and non-myelinated nerve 
fibres decreases at such a level that the transmission of stimuli is compromised (Metin & Özdemir, 
2016). Age-related differences in pain perception may also be due to reduced functioning of 
endogenous pain modulatory mechanisms, particularly dopaminergic neurons in the basal ganglia 
(Boehm, Büssing & Ostermann, 2012). 
Chronic pain may also cause excessive pain sensitivity because of abnormal spinal nociceptive 
process secondary to repetitive activation, moreover, experiencing constant and extreme pain can 
lead to mood changes like reactive depression, anxiety or sleep disturbances that exacerbates severe 
pain perception accompanied with discomfort (Initiative, 2018).  
According to epidemiological studies, with the increment of chronological age the prevalence and 
threshold of pain also increases, even although pain tolerance for women remains the same or 
decreases, they are more likely to report persistent pain compared with their counterparts (Carrion, 
2012; Farlex, 2012; Boehm, Büssing & Ostermann, 2012). However, based on some evidence, an 
elderly person may have poor pain tolerance for an extended period of time after tissue injury 
(Boehm, Büssing & Ostermann, 2012). This is where aromatherapy comes, being part of an 
alternative medicine that involves a holistic approach using essential oils and some aromatic herbs 
to relives pain. The healing power of aromatherapy has been used by different civilizations for 
almost 6000 years (Nordqvist, 2017).  This natural and gentle form of treatment can access the 
human body through inhaled scent molecules that activate the limbic system, an area in the brain 
that plays an important role for emotion and behaviour. It can also be applied as a topical massage 

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which gives soothing and relaxing feeling by stimulating the nervous system that regulates heart 
rate, blood pressure, stress and breathing patterns.  
On top of all the benefits, easy application, low cost and low side effects are some of the reasons 
aromatherapy is accepted as complementary and integrative medicine (Louis & Kowalski, 2002).  
Aromatherapy has many physical and psychological benefits; It reduces stress and stress-related 
symptoms by providing relaxation, reduces the side effects of treatments, muscle tension and 
minimizes pain (Fellowes, Barnes & Wilkinson, 2004). There are so many other studies that proved 
the positive effects of aromatherapy on depression, anxiety, knee and arthritis pain, abdominal pain, 
constipation, severity of gastrointestinal symptoms and self-confidence (Rho, Han & Kim, 2006; 
Yip & Tam, 2008; Kim et al., 2005; Lämås, Lindholm, Stenlund, Engström & Jacobsson, 2009). 
M technique hand massage is a unique choreographed method that follows certain type of 
movement, pressure and pace which is custom made for the most fragile patient. That is why it has 
been described as "physical hypnotherapy", "spiritual dance" and "the foundation of nursing" 
(Buckle, 2008).  
 
 
3.Material and Methods  
3.1. Study design 
This research study was designed as a randomized placebo-controlled clinical trial. 
3.2. Population and sampling 
66 elderly individuals with chronic non-malignant pain who had visited the Algology polyclinic of 
a university hospital in Izmir-Turkey between 01 May 2019 - 30 August 2019 and met the sampling 
criteria had been randomly selected into aromatherapy (n = 22), placebo (n = 22) and control (n = 
22) groups. Individuals who were included in this research were age 65 and above, must have 
chronic non-malignant pain for at least three months, should not have cognitive impairment, must 
be able to answer questions independently and those who have agreed to be part of the study were 

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included in the sample. In the contrary, patients with dermatological problems, swelling, sign of 
inflammation, neuropathy or loss of sensation and deformity on their hands and/ or arms were 
excluded from the study. Moreover, cancer patients and those who had allergic to lavender oil were 
also excluded. Initial pilot study was performed with total of 6 elderly patients, 2 individuals from 
each group. Sample size was determined via G-power statistical analysis with 95% conﬁdence and 
80% theoretical power. 
3.3. Data collection tools 
Data were gathered as patient information form, visual analogue scale (VAS), brief pain inventory 
and vital signs which were collected by a single researcher via face-to-face interview. 
3.3.1. Patient information form 
The individual identiﬁcation form was created by the researchers in the light of information 
collected from the literature. It was divided into 3 different parts; the ﬁrst part contained 
sociodemographic characteristics such as age, gender, educational status, occupation, social 
security, marital status, and number of children. The second part was regarding health-related 
characteristics such as duration of chronic pain diagnosis whether or not it had been treated, what 
treatment modality was applied, how long the pain complaint had lasted, the presence of other 
accompanying illnesses, and general state of health. The third part vital signs; blood pressure was 
measured with Omron digital arm meter sphygmomanometer, pulse rate as well as respiratory rate 
were counted and evaluated for one whole minute, and body temperature was recorded using 
infrared thermometer. 
3.3.2. Visual analogue scale 
The visual analogue scale (VAS) is a subjective measure for the level of pain consisting of 10cm 
horizontal or vertical line, with "0" indicating no pain at one end while "10" indicates very severe 
pain at the other end. Patients mark the point that corresponds to the pain he/she was experiencing 
during the interview. This scale is a very sensitive method that helps to evaluate pharmacological 
and non-pharmacological treatments that reduce pain (Uyar & Yıldırım, 2010). 
 
 

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3.3.3. Brief pain inventory  
Wisconsin Short Pain inventory was developed to evaluate pain status of individuals with cancer or 
chronic diseases. It consists of 15 items and each item takes a value between 0-10. The lowest score 
obtained from the brief pain inventory indicates that there is no pain in the last 24 hours, 1-3 points 
indicate mild pain in the last 24 hours, 4-7 points indicate moderate pain in the last 24 hours, and 8-
10 points indicate severe pain in the last 24 hours (Sritoomma, Moyle, Cooke & o’Dwyer, 2014). 
The validity and reliability study of the brief pain inventory for patients with chronic non-malignant 
pain in Turkey was conducted by Yıldırım et al. (2019). 
3.4. Interventions 
3.4.1. Aromatherapy group 
Initially all the necessary information was given to those who were willing to participate in our 
research, after that a written and verbal consent was obtained from the eligible elderly patients, 
questioners were filled followed by aromatherapy M technique hand massage prepared as 12 drops 
of lavender essential oil mixed in 30 ml of carrier oil (Aroma web., 2019; Denis Brown Essential 
Oils, 2019) was applied for 10 minutes on both hands and arms. Within 10-15 minutes post 
aromatherapy massage VAS and vital signs were re-assessed.     
3.4.2. Placebo group  
A similar procedure like the aromatherapy group was followed for the participants in this group, 
except that an odourless baby oil was applied instead of lavender essential oil.  
3.4.3. Control group 
The elderly individuals who met the inclusion criteria were informed about the study while written 
and verbal consent was obtained when they agreed to participate in the study. No intervention was 
done other than the routine hospital management. But pre-post data were collected within 10-15 
minutes time interval. 
 
 

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3.5. Data analysis  
The analysis of the data obtained from the study was carried out via Statistical Package for Social 
Science (SPSS) package program. In the data analysis; Descriptive statistics number and percentage 
measurement of data were shown with mean and standard deviation values. For the independent 
samples; t-test, one-way analysis of variance, Pearson correlation analysis, chi-square, Kruskal 
Wallis, Wilcoxon, Friedman and Mann Whitney U tests were used. The results were evaluated at 
95% confidence interval and p <0.05 significance level was accepted. 
3.6. Ethical consideration 
Approval to conduct the research was obtained(19-4.1T/26) from Ege University faculty of 
medicine clinical research ethics committee. Written and verbal consent were obtained from the 
elderly patients participating in the study after the researcher stated the intention of the study. 
 
 
 
4. Results 
The mean age of participants in the aromatherapy, placebo, and control groups was 73.14±5.540, 
74.05 ±6.275, and 74.05 ±7.108 years, respectively. It was found that out of all the participants only 
9.1% were illiterate: while the majority (68.2%) have middle school level education that is 77.3% in 
the aromatherapy group, 63.6% in the placebo and control group respectively (Table 1). No 
statistically signiﬁcant difference was found between the aromatherapy, placebo, and control groups 
in terms of age, gender, marital status, educational status, duration of chronic pain diagnosis and 
cigarette consumption (P > .05, Table 1). 
In our study, a statistically significant change was found in the median pain scores of patients with 
chronic pain in the aromatherapy and placebo groups; whereas no statistically significant change 
was found in the control group respectively (P=.000; P=0.011; P=0.317).  Nonparametric analysis 
was used to evaluate the VAS measurement median values to determine pain level as it was not 
compatible with normal distribution. Decrease in pain intensity of elderly individuals was evident in 

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both the aromatherapy and placebo groups. In the experimental group post- aromatherapy M 
technique massage with lavender essential oil, median pain intensity level has decreased drastically 
from 4.5 to 2.0. In other words, participants pain severity after aromatherapy procedure decreased 
by 42.24%, in the contrary only 23.94% declination of median pain level was seen in the placebo 
group (Table2).  
When it comes to the vital sign values; body temperature (p=0.003) and pulse rate (0.029) in 
experimental group were found to be statistically significant, even though systolic as well as 
diastolic blood pressure values in aromatherapy group were not statistically significant but 
clinically decreased medial scores were observed after the application of aromatherapy massage. 
Post procedural measurements of systolic blood pressure and pulse rate values for the placebo 
group were statistically significant respectively (P=0.035; P=0.008) (Table 3). 
 
 
5.  Discussion 
Prior to the modern understanding and use of aromatherapy, it used to be part of the human life 
utilised for different purposes throughout history by various civilizations that extended for the past 
5000 years (Gnatta, Kurebayashi, Turrin & Da silva, 2016; Donovan, 2018). Some of the most 
commonly used purposes of aromatherapy massage was, to relive muscular and joint related pain 
or/and for physical and/or mental stress (Yvette, 2017; Yellow Page, 2018). Therefore, combining 
essential oil with massage provides a high level of therapy and psychological relaxation not to 
mention relief from chronic persistent pain (Yvette, 2017; Yellow Page, 2018; Mevei New York, 
2017). There are too many similar researches regarding the extraordinary effect as well as benefits 
of aromatherapy using lavender oil and other essential oils to relive different types of chronic pain 
for various age groups.  
For instance, in a research done by Nasiria, Mahmodi & Nobakhtc (2016) assessing the effect of 
aromatherapy massage with lavender essential oil on pain for patients with knee osteoarthritis, 
lavender oil was used for the aromatherapy group. On the other hand, almond oil was applied for 
the placebo group while no intervention was done for the control group. Participants pain level was 

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evaluated using visual analogue scale at baseline, immediately after intervention, 1 and 4 weeks 
after the intervention respectively. The obtained result showed that pain severity has significantly 
declined in the aromatherapy group compared with the other two groups. In another similar study 
by Sritoomma, Moyle, Cooke & o’Dwyer (2014) that compared the effect of aromatic massage 
versus Thai massage on chronic lower back pain in older adults, with each massage sessions lasting 
for 30 minutes twice a week for 5 weeks. VAS was used to measure short term (6 weeks) and long 
term (15 weeks) pain level after the intervention. The study’s outcome showed that the participants 
who received aromatic massage had significantly reduced pain level with a better result.  
In a research that aimed to assess the efficacy of aromatherapy in relieving pain in community 
dwelling Chinese elder people; in the intervention group participants received 20 minutes tailor-
made massage with a combination of lavender, sweet marjoram and eucalyptus oil twice a week for 
4 weeks. Post Intervention visual analogue scale (VAS) of subjects in the experimental group 
exhibited reduced pain level though the differences were not statistically significant (Paul, Suen & 
Ho, 2017). In another study that evaluated the effect of aromatherapy on joint pain and depression 
among elderly women, to whom aromatherapy massage was given between 15-20 minutes per day 
for 10 consecutive days. Universal pain assessment scale was used to evaluate pre-post pain 
intensity, the result reviled statistically significant decreased mean score of pain level (Vanaja, 
2015) 
On a research conducted in Turkey that assessed the effects of aromatherapy massage on pain, 
functional state, and quality of life in an elderly individuals with knee osteoarthritis by Pehlivan & 
Karadakovan (2019), senior participants were divided into three groups. The aromatherapy group 
received massage with a combination of 3 essential oils (black seed oil, ginger, and rosemary) and 
placebo group received massage with only sunflower oil. Participants in both groups received a 
total of six massage sessions twice a week for 3 weeks whereas no implementation was done for the 
control group. Data were collected in week 0, 4, and 8 and visual analogue scale (VAS) was used to 
determine the level of pain as an inclusion criteria and Pain and Functional Score (WOMAC) was 
used to evaluate pain progress after intervention. The result showed that the aromatherapy group 
pain scores were lower than the placebo and control groups in week 4 and these differences were 
statistically significant. The findings in week 8 showed that aromatherapy massage has more 
favourable and longer sustained effects than just a massage without aromatherapy. 

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In another research that investigated the effect of black cumin oil on pain for osteoarthritis geriatric 
individuals, in which participants in the experimental group were instructed to rub the oil on their 
knees 3 times a week for 1 month. Meanwhile, patients in the control group carried out their usual 
hospital routine. The VAS result showed that patients in the experimental group had significantly 
decreased pain level after the intervention (Tuna, Babadağ, Özkaraman & Alparslan, 2018).   
Typically, risen body temperature is expected after application of body massage. Moreover, the 
different types of aromatherapeutic oils used during massage are known to have numerous positive 
effects on the body (Yi, 2001; Kavitha, 2013; Eguchi et all., 2016). Some of the literatures have 
similar results like in our study in which increased body temperature was observed after 
intervention whereas in other studies no change was recorded. On a research carried out by Cinar, 
Eşer and Khorshid (2009) that assessed the effect of back massage on vital sign and anxiety level of 
elderly individuals living in nursing home, arranged the participants in a single experimental group 
in which they received 10 minutes of back massage with baby oil for 3 days. Vital signs were 
recorded right before intervention and immediately after back massage, 15 and 30 minutes 
afterwards. The obtained results showed significantly decreased vital signs except for body 
temperature. In another research that studied the effect of kyongrak massage in elderlies with 
chronic pain, increment of body temperature was seen while systolic blood pressure decreased 
significantly after the elderly participants received Kyongrak massage on their neck, spinal cord, 
upper and lower extremities as well as back for 25 minutes daily for a duration of 5 days (Yi, 2001). 
In a study by Kim et al. (2016) that assessed the effects of hand massage with nail art on 
depression, self-esteem and vital signs of elderly women living in a nursing home, participants 
received hand massage with nail art for 10 minutes in which data were collected before, shortly 
after the hand massage with nail art and one week later. After comparing the pre-post test results 
following the intervention, statistically significant risen body temperature and decreased diastolic 
blood pressure were observed while systolic blood pressure and pulse rate had no significant 
difference as to pre-intervention values. 
In a research carried out to evaluate the effect of hand and foot surface stroke massage on anxiety 
and vital signs in patients with acute coronary syndrome, participants in the intervention group 
received massage using almond oil for total of 20 minutes while participants in the control group 
have not had any type of intervention. Vital signs were recorded 30 minutes before intervention, 

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immediately after, 60 minutes and 90 minutes after the massage, statistically significant results 
were obtained after massage intervention regarding blood pressure, heart rate and respiratory rate 
(Alimohammada, Ghasemi, Shahriar, Morteza & Arsalan, 2018). Similar result was obtained in our 
research, as in the aromatherapy and placebo groups, pulse rate was statistically significant and 
decreased heart rate mean value was obtained in both the groups after massage intervention. 
When it comes to the respiratory rate value of participants in our study groups, unlike some 
literatures none of the three groups’ results were statistically significant nor there was significant 
difference when comparing pre-study values This result, is believed to be due to the short time 
interval between massage and post massage data collection as well as the short massage session can 
be mentioned.  
A crossover randomized controlled trial research was carried out to assess the effect of aroma foot 
massage on blood pressure and anxiety in Japanese community-dwelling elderly individuals. After 
randomly dividing participants into 2 intervention groups based on age (<50years old; >50years 
old) as well as systolic blood pressure values (<130mmHg; >130 mmHg), participants were 
instructed to massage their feet for 45 minutes 3 times per week for 4 weeks using mixture of 
several essential oils (lavender, chamomile, sandalwood, ylang-ylang and marjoram were blended 
with jojoba oil). Data were collected at the base line, 4-week and 8-week follow up, the obtained 
results showed that aromatic foot massage has significantly decreased the mean systolic and 
diastolic blood pressure (Eguchi et al., 2016). The reason for the different results from our study is 
thought to be because participants applied the massage themselves that allowed them to avoid the 
stress of white coat syndrome which is known to be a source for increased blood pressure (Holland, 
2017). Moreover, the fact that half of the participants were under the age of 50 and also received 
massage 30 minutes longer than our study might be other crucial factors. 
 
In another similar study that assessed the effectiveness of foot massage up on the level of blood 
pressure among elderly patients with hypertension by Kavitha (2013), participants were divided 
into intervention and control groups in which blood pressure was measured before and after 
massage. The obtained result showed decreased systolic and diastolic blood pressures values post 
intervention. In this study, participants received 20 minutes of massage for two consecutive days, 

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whereas in our research massage was applied only once for 15 minutes this could be the main 
reason for the inconsistent outcome.  
A research that compared the effects of two Swedish massage techniques on the vital signs and 
anxiety of healthy women in which first group of participants received massage on their back, neck, 
and chest while the second group got leg, arm, and face massage that lasted for three times per 
week for total of 14 weeks period. The result showed decrease systolic blood pressure, pulse rate, 
and respiratory rate (Motlagh, Jouzi & Soleymani, 2016). Regularly applied massage is known to 
increase relaxation therefore it has positive effect on the vital sign (Olney, 2005), but in our 
research massage session was only done once for 15 minutes, we believe that this might be the main 
factor for the incompatible results. 
 
 
5.1. Limitations 
The results are restricted by the study period and number of patients, the fact that a single 
researcher conducted the study in only algology unit can also be seen as a limitation. Moreover, 
male patients who visited the medical unit where the research too place, were very limited in 
number.   
 
 
 6. Conclusion 
The low cost, non-invasive and easily applicable aromatherapy massage should be popularized to 
manage pain intensity level and pulse rate in elderly individuals with chronic non-malignant pain.  
 
Similar studies based on complementary alternative therapies should be repeated with different 
sample groups by extending the frequency and duration of aromatherapy massage. Furthermore, 
health care providers need to apply and integrate aromatherapy into their policies as part of routine 
health service. 
 
7. Relevance to Clinical Practice 
Elderly people not only experience and suffer from non-malignant chronic pain at some point in 
their lives but might also get unwanted outcomes from pharmacological treatments, thus application 

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of aromatherapy massage can be considered a solution with nurses who are fully aware of this 
holistic modality. Health care facilities like nursing homes, intensive care units and palliative care 
centres can integrate aromatherapy massage as part of their daily treatment routine to relive chronic 
pain.  
 
8. Conflict of interest  
We declare that authors have no conflict of interests. 
 
9. Founding - No founding  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Yvette 
Brazier. 
(2107). 
Aromatherapy: 
what 
you 
need 
to 
know. 
Medical 
today.  
https://www.medicalnewstoday.com/articles/10884 
 
 
 
What does this paper contribute to the wider global clinical community? 
• This study explores chronic pain, the benefites and effects of aromatherapy massage for the 
eldelry community. 
• Popularizing non-invasive, cheap and easily applicable aromatherapy massage to manage 
pain intensity for the senior population in health care facilities like nursing homes, intensive 
care units and palliative care centres should be considered to be included in the policy of 
health care provideres.   
 
 
 

20 
 
 
TABLE 1. Homogeneity Test of Baseline for Participants (n=66) 
 
Features 
Aromathera
py Group 
n=22 
Placebo 
Group 
 n=22   
Control 
Group  
n=22    
TOTAL 
 
n=66 
 
P 
 
 
 
 
X ± SD 
X ± SD 
X ± SD 
X ± SD 
 Age 
73.14±5.540 
74.05 ±6.275 
74.05 ±7.108 
73.74 ±6.257 
0.911 
Chronic pain 
duration 
 81.41 ± 9.327 63.36 ±7.495 
87.82±13.22  
 
0.832 
 
n (%) 
n (%) 
n (%) 
n (%) 
 
Age Group 
65-74 old 
75-84 old 
≥ 85 old 
 
11(50) 
11(50) 
- 
 
11(50) 
10(45.5) 
1(4.5) 
 
13(59.1) 
7(31.8) 
2(9.1) 
 
35(53.0) 
28(42.4) 
       3(4.5) 
 
 
0.911 
Gender 
Female 
Male 
 
12(54.5) 
10(45.5) 
 
11(50) 
11(50) 
 
10(45.5) 
12(54.5) 
 
33(50) 
33(50) 
 
0.836 
Marital status  
Married 
Single 
widow 
Divorced 
 
12(54.5) 
- 
7(31.8) 
3(13.6) 
 
17(77.3) 
1(4.5) 
4(18.2) 
- 
 
14(63.6) 
1(4.5) 
7(31.8) 
- 
 
43(65.2) 
2(3.0) 
18(27.3) 
3(4.5) 
 
 
0.161 
Educational 
status  
Illtreat 
Primary-middle 
Highschool 
University 
 
 
1(4.5) 
17(77.3) 
1(4.5) 
3(13.6) 
 
 
1(4.5) 
14(63.6) 
3(13.6) 
4(18.2) 
 
 
4(18.2) 
14(63.6) 
2(9.1) 
2(9.1) 
 
 
6(9.1) 
45(68.2) 
6(9.1) 
9(13.6) 
 
 
 
0.278 
Social security  
Yes 
No 
 
20(90.9) 
2(9.1) 
 
21(95) 
1(4.5) 
 
21(95) 
1(4.5) 
 
62(93.9) 
4(6.1) 
 
 
0.769 
Profession 
Office worker 
Labourer  
Farmer  
Retired  
Self-employed 
Housewife 
Other 
 
1(4.5) 
3(13.6) 
- 
8(36.4) 
3(13.6) 
6(27.3) 
1(4.5) 
 
- 
- 
1(4.5) 
11(50.0) 
1(4.5) 
7(31.8) 
2(9.1) 
 
- 
1(4.5) 
2(9.1) 
8(36.4) 
3(13.6) 
7(31.8) 
1(4.5) 
 
1(1.5) 
4(6.1) 
3(4.5) 
27(40.9) 
7(10.6) 
20(30.3) 
4(6.1) 
 
 
 
 
0.706 
Children  
Yes 
No  
 
22(100) 
- 
 
19(86.4) 
3(13.6) 
 
22(100) 
- 
 
63(95.5) 
3(4.5) 
 
0.098 
Smoking 
Yes  
No 
Quitted 
 
3(13.6) 
16(72.7 
3(13.6) 
 
- 
19(86.4) 
3(13.6) 
 
2(9.1) 
16(72.7) 
4(18.2) 
 
5(7.6) 
51(77.3) 
10(15.2) 
 
 
 
 
0.652 

21 
 
 
TABLE 2. Pain severity VAS Medians Measurement in Aromatherapy, Placebo and Control                 
                Groups  
Pain Level (VAS) 
Aromatherapy Group  
(n=22) 
Placebo Group   
(n=22) 
Control Group 
(n=22) 
 
(SD) 
' 
(Min±Max) 
 
(SD) 
X ' 
(Min±Max) 
 
(SD) 
X ' 
(Min±Max) 
Pre-massage   
4.64 
 (3.32) 
4.5 
(0-10) 
5.68 
 (3.09) 
5.0 
(1-10) 
5.36 
(3.29) 
5.5 
(0-10) 
Post-massage  
2.68 
 (2.63) 
2.0 
(0-9) 
4.31    
(3.41) 
4.0 
(0-10) 
5.27 
(3.18) 
5.5 
(0-10) 
 
Statistical Test, p  
   
  Z=-3.658     p=0.000 
 
            CP*=-42.24% 
 
Z= -2.534   p=0.011 
                    
          CP*=-23.94% 
 
Z= -1.000      p=0.317 
            
           CP*=-1.68% 
Z: Wilcoxon Statistics Test; p<0.05 significance level; CP*: change in percentage; VAS: visual analogue scale 
 
 
 
 
 
 
 
 
 
 
 
 
 
X

22 
 
TABLE 3. Comparison of vital Sign in Aromatherapy, Placebo and Control  
                              Groups 
Vital Signs  
Aromatherapy 
Group(n=22) 
Placebo 
Group (n=22) 
Control 
Group (n=22) 
Body Temperature 
Preprocedural 
Postprocedural 
 
36.82±0.22 
36.91±0.23 
 Z=-2.980    p= 0.003 
 
36.88±0.17 
36.88±0.22 
Z=0.000      p= 1.000 
   
36.87±0.26 
36.89±0.27 
Z=0.835   P= 0.404 
Pulse Rate 
Preprocedural 
Postprocedural 
 
81.27±11.69 
79.14±10.70 
Z= -2.182     P=0.029 
 
75.45±12.55 
72.23 ±12.79 
Z= -2.639     P=0.008 
 
72.14± 10.77 
71.64 ±11.16 
Z= -0.956         P= 0.339 
Respiratory Rate 
Preprocedural 
Postprocedural 
 
17.64±3.19 
17.50±3.17 
  Z= -2.75    P= 0.783 
 
16.1± 3.47 
16.27±2.91 
  Z= -2.75     P= 0.783 
 
18.0±3.12 
18.0±3.36 
Z= -0.9122      P= 0.903 
Systolic 
Blood 
Pressure  
Preprocedural 
Postprocedural 
 
 
135.73±19.65 
129.545±12.80 
Z=-1.526     P=0.127 
 
 
140.91±22, 26 
135.05±22.09 
Z=-2.113      P=0.035 
 
 
136.14±23.61 
131.23±22.20 
Z=1.919       P=0.055 
Diastolic 
Blood 
Pressure 
Preprocedural 
Postprocedural 
 
 
76.36 ±10.84 
75.00 ±9.16 
Z= -0.54     P= 0.589 
 
 
79.09±10.92 
77.68±11.90 
Z= -1.210     P= 0.226 
 
 
75.05 ±11.12 
73.64±11.06 
Z= -1.322     P= 0.186 
Z: Wilcoxon test; P<0.05 significance level