EFFECT OF AROMA OIL
MASSAGE AND HERBAL COMPRESSION WITH
ANALGESIC DRUG ON LOW BACK PAIN AND ELECTROMYOGRAM OF
MUSCLE TENSION IN PERSONS WITH LOW BACK PAIN
Chakrit Sattayarom 5437876 RACN/M
M.N.S. (Community Health Nursing Practitioner)
Thesis Advisory Committee: Ladawan Ounprasertpong Nichrojana, D.N.S.,
Noppawan Piaseu, Ph.D. (NURSING)
Extended Summary
1. Background and Significance of the Problem
Low back pain is pathology of the muscles or spine which are the parts of the body
supporting weight with more movement than other parts. Consequently, these parts are prone
to injury (Van Tulder, Malmivaara, Esmail, & Koes, 2008). Although emergency treatment
is not required to treat the symptoms and low back pain is not life threatening, improperly
managed or unmanaged pain can leave persons with low back pain at risk for unrelenting
pain or relapse at a rate as high as 70-80% (Chas, 2012; Turk & Okifuji, 2010). Low back
pain can be encountered in people of all occupations and is caused by improper positioning
that puts pressure on the lower back to result in muscle stiffness and low back pain (Surakiat
Achananupab, 2010) in which 10-20% of people with acute back pain have chronic
symptoms because the symptoms are not treated until completely cured (Verbunt et al., 2003;
Maher, 2004) . According to a survey on Thai medical services during 2007-2011, the
symptoms causing patients to seek services were back, waist and hip pain ( Institute of Thai
Traditional Medicine, 2011). And according to a report in 2009, 16,789,872 people reported
illnesses involving the musculoskeletal system and connective tissues at a rate of 67.15%
( Bureau of Policy and Strategy, Ministry of Public Health, 2010) . In addition, data on the
frequency of musculoskeletal disorders in patients seeking hospital treatment from October of
2006 to September of 2007 by Associated Medical Sciences, Khon Kaen University, 688 new
patients were reported; 60% of these patients were females and the majority was 25-50 years
old. The three most common sites for symptoms were the lower back, neck and upper back
(32.8%, 29.1% and 25.7%, respectively (Wanida Donpanha, 2009).
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The most common cause of low back pain is improper posture (Lewis & Colier,
2003) while 70-80% of the cause of low back pain are unidentified (Patpong
Worapongpichet, 2006 ; Ponchai Dechanuwong, 2007). Apart from the aforementioned, still
other back pain comes from injuries to the muscles or tendons in the back, or even agerelated degeneration that increases with age because certain areas are bent and curved
combined with excessive weight and movement. These people might be found to experience
back pain that may increase if other risk factors are present, namely, heavy workload on the
back muscles and tendons, improper body posture, smoking, obesity and stress (Amnuay
Unnanan, 2004). Although low back pain is not fatal, it has tremendous impact on a patient’s
lifestyle causing physical, mental and economic problems (Sak Bawon, 2005).
The impacts of low back pain hold affect patients, families, society and the nation
with further impact on work-related duties and economic extravagance resulting from
medical treatment and income lost due to the necessity to take days off work ( Waddell,
2008). One sixth of people with low back pain require bedrest with limited activity causing
even more pain and suffering at least once in their lives (Wattana Chalaidecha, 2006). The
aforementioned physical discomfort and limited activity prevent low back pain patients from
returning to regular daily routines due to impaired ability to perform the activities and greater
time requirements in completing routine activities than in the past. Consequently, mental
impacts cause low back pain patients to be irritable as they are required to depend on other
people. As a result, the patients have reduced self-worth which further affects work-related
duties and economic extravagance spent in medical treatment costs with loss of income
caused by time taken off work ( Waddell, 2008) . Furthermore, low back pain increases the
burdens of family members who need to take the patients for treatment ( Kesorn Siangprao,
2009). Overseas studies have been conducted on expenses related to low back pain requiring
hospital treatment, including time off work for recovery. According to the findings, large
amounts of both time and money are lost. In 1998, the USA reported that the cost for treating
patients with low back pain as high as 1,668 million dollars (Ceran & Ozcan, 2006).
According to workmen’s compensation fund statistics in 2003, the pain of 4,977 low back
pain patients was caused by lifting, moving heavy objects and using incorrect postures. This
number increased to 7,486 patients in 2004 for a rate of 50.41 percent, which is correlated
with the increasing expenses incurred in treating low back pain from 12,158,972 baht
23,389,065 baht ( Janya Jitrapinet, 2005) . The aforementioned impacts compel patients to
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search for guidelines to treat their symptoms to help them return to their regular daily
lifestyles and work (Anderson et al., 2003).
Current low back pain treatment is composed of pharmacological and nonpharmacological treatments (Surasak Nilkanuwong, 2005). Pharmacological treatment may
result in complications such as gastrointestinal bleeding, inflammation of the liver, renal
impairment and potentially life-threatening allergies to medication ( Surakiat Achanuphap,
2010; McPhee, Tiemey & Papadakis, 2007) .
Non-pharmacological treatments include
offering advice on weight loss, correct posture and movement, physical therapy and
alternative medicine. In particular, aroma oil massage and herbal compression with the use
of analgesic drugs have been used to enhance treatment effectiveness for low back pain
because no singular medical science in the work is capable to treat or cure every ailment.
Every medical science has its weaknesses and gaps to make it incomplete ( Ladawan
Ounprasertpong Nichroj, 2012). According to the reports on studies conducted by the World
Health Organization (WHO) (2006) and and Gaston – Johansson ( 2005 ) , analgesic drugs
were found to be considered a significant contributor to pain relief with effectiveness at a rate
of 70 – 90 percent. Another 10-30 percent, however, report analgesic drugs as being unable
to relieve pain. Consequently, other medical treatments and fields apart from pharmacology
must be considered in order to help manage pain more completely with the promotion of
holistic healthcare referred to as integrated healthcare ( Ladawan Ounprasertpong Nichroj,
2 0 1 2 ) . The abovementioned concurs with the policy of the Ministry of Public Health in
promoting the arrangement of Thai medical services in medical facilities in order to ensure
that service recipients have access to Thai medical treatment and alternative medicine within
the national health guarantee system which has been accredited for meeting standards and
quality with greater convenience ( Bureau of Health Administration, Department of Health
Service Support, Ministry of Public Health, 2009) .
The Bor Suphan Health Promoting
Hospital is a primary public health unit providing Thai medical services since the 2009 fiscal
year. And the service recipients encountered in the group with musculoskeletal conditions
are on the rise. The same is true with the situation of persons with low back pain in the
province of Suphanburi. The out-patient data of the Suphanburi Public Health Office in 2010
– 2012 discovered patients with musculoskeletal and connective tissue disorders at 148,131,
196,358 and 219,221 people (Suphanburi Public Health Office, 2012) while the out-patient
data from Bor Suphan Health Promoting Hospital discovered patients with pathologies of the
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musculoskeletal system and connective tissues in 2010 – 2012 to have increased dramatically
from 6,934 to 7,125 and 8,013 cases. The aforementioned data is from patients with low
back pain at 2, 082, 2314 and 2, 678 cases, respectively ( Bor Suphan Health Promoting
Hospital, 2012). At the same time, the use of non-steroidal analgesic drugs in patients with
low back pain is being recognized is on the rise. In 2010-2012, the percentage of patients in
this category increased from 29.9 percent to 34.1 percent and 36.7 percent, respectively (Bor
Suphan Health Promoting Hospital, 2012).
According to the background and significance of the problem as stated above and
previous literature reviews, insufficient data has been discovered in the form of evidencebased practice to prove the effects of aroma oil massage and herbal compression with
analgesic drugs on low back pain with electromyograms of muscle tension. The role of
professional nurses is to study and train in order to obtain practical skills to prepare nursing
personnel at the graduate level with ability to integrate alternative medicine and healthcare to
properly treat illnesses and symptoms. Thus, the researcher is interested in conducting
additional study to improve and develop a study that is scientific evidence associated with the
effects of aroma oil massage and herbal compression in response to the policy of the Ministry
of Public Health in promoting the application of indigenous Thai wisdom and alternative
medicine in self-care.
2. Conceptual Framework
The present study investigated the effects of aroma oil massage and herbal
compression with analgesic drugs on low back pain and electromyogram muscle tension in
persons with low back pain by employing the Gate Control Theory as the conceptual
framework for the study because low back pain tends to occur as a result of work or carrying
excessively heavy loads (McPhee, Tiemey & Papadakis, 2007) until the person suffers which
is an experience occurring according to the individual perceptions of each person. Aroma oil
massage in kaffir fragranced mixed with lavender us used to apply Swedish massage
composed of stroking/effleurage, superficial stroking, deep stroking, compression movement,
kneading/petrissage, picking up and rolling) ( Ladawan Ounprasertpong Nichroj, 2012) .
Massage raises the temperature of the skin in the area massaged which causes the blood
vessels to dilate as hard, constricted muscles relax and the circulation of blood and lymphatic
fluid is increased in the areas massaged with aroma oil massage and herbal compression.
Hence, the tissues receive increased nutrients and oxygen from the increased metabolic rate
5
inside the cells as waste inside the muscles is reduced. Moreover, aroma massage with herbal
compression stimulates the beta and alpha nerves to send stronger and faster
neurotransmissions. Thus, the neurotransmissions of pain sent by the beta nerves result in
increased secretions from the brain to the SG cells to reduce the neurotransmission to the
cells as the pain control gate closes. The results are decreased perceptions associated with
pain, low back pain and electromyogram muscle tension ( Thai Association for the Study of
Pain, 2009; Melzack & Wall, 1965).
After aroma massage, herbal compression is applied. The main components of the
herbal compresses are Thai plai oil, which has analgesic effects; turmeric, which has antiinflammatory effects and acts as a natural steroid and wax leaved climber helps relax
hardened tendons. In addition, camphor is used to help relieve pain and acts as a local
anesthetic. Heat and the properties of the aforementioned herbs is deeply absorbed by the
skin (1-2 centimeters) into the tissues in the at the compression site with sodium as the
conductor of the heat from the compress. Hence, the skin in the compression area rises in
temperature to 40-45 degrees Celsius ( Ladawan Ounprasertpong Nichroj, 2 0 1 2 ) , thereby
causing the muscles, tendons and connective tissues to relax. The blood vessels dilate more,
which sends nutrients to the aching muscles, tendons and connective tissues as inflammatory
substances such as prostaglandins and bradykinin, etc. are drained. Once these substances are
reduced, the tissues will receive more oxygen ( Sasikarn Nimmanarach, Wongchan
Petchapisetchian and Chachai Preechawai, 2009) and low back pain lessens. Furthermore,
herbal compresses contain the aromatic fragrances of Thai plai oil, kaffir peel, turmeric,
camphor and lavender oil mixed with the aroma oils used in massage which pass through the
nasal tissues to relax persons suffering from low back pain to a high degree, thereby affecting
the limbic system in the brain and causing secretions with morphine-like effects from the
center of the brain such as endorphins, encephalin, etc., to result in both physical and mental
relaxation (Ladawan Ounprasertpong Nichroj, 2012).
In addition, diclofenac sodium has the effect of inhibiting the production of the
enzyme, cyclooxygenase that is used in the chemical transformation of arachidonic acid into
the substrate in the production of prostaglandins, a substance causing pain and inflammation
leading to low back pain. Furthermore, receipt of tolperisone hydrochloride has the effect of
reducing the attachment of acetylcholine to the receptor cells of the striated muscles, thereby
leading to sodium-potassium exchanges as the sodium-potassium voltage gate process
6
decreases ( Pawitra Phulbudt, 2 0 0 9 ; Pongsathorn Meesawasdesom, 2 0 0 9 ) . Hence, the
constriction of the muscles at the depolarization stage, which is the phase where the muscles
become tense, lessens.
At the same time, the effects of the medication cause the
repolarization stage, or the resting phase of muscle constriction, cause the muscles to relax
longer.
Thus, muscle tension is relieved ( Pawitra Phulbudt, 2 0 0 9 ; Pongsathorn
Meesawasdesom, 2 0 0 9 ) . The conceptual framework of the study can be summarized as
follows:
Diagram 1 - Conceptual Framework of the Study
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3. General Research Objective
To study the effects of aroma oil massage and herbal compression with analgesic
drugs on low back pain and electromyogram of muscle tension in persons with low back pain.
4. Specific Research Objectives
4.1 To compare low back pain and electromyogram of muscle tension in persons
with low back pain before and after receiving aroma oil massage and herbal compression
with analgesic drugs.
4.2 To compare low back pain and electromyogram of muscle tension in persons
with low back pain between subjects receiving aroma oil massage and herbal compression
with analgesic drugs and subjects receiving analgesic drugs only.
5. Research Hypotheses
5.1 The low back pain and electromyogram of muscle tension in the subjects with low
back pain receiving aroma oil massage and herbal compression with analgesic drugs will be
relieved more effectively than the pain of the subjects receiving analgesic drugs only.
5.2 After receiving aroma oil massage and herbal compression with analgesic drugs,
the low back pain and electromyogram of muscle tension in persons with low back pain will
be less than the pain before receiving aroma oil massage and herbal compression with
analgesic drugs.
6. Methodology
This research is randomized control clinical trial (pretest and posttest designs with a
comparison group) (Burns & Grove, 2009) conducted to study the effects of aroma oil
massage and herbal compression with analgesic drugs on low back pain and electromyogram
of muscle tension in persons with low back pain.
7. Population and Sample Group
7.1 The target population used in conducting the present study comprised persons
with symptoms of low back pain diagnosed with low back pain by a physician.
7.2 The sample group used in the present study comprised 60 persons with
symptoms of low back pain diagnosed with low back pain by a physician and who received
services at Bor Suphan Health Promoting Hospital, Songphinong, Suphanburi, between 1-31
July 2013. The participants possessed characteristics meeting the following criteria:
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7.2.1 Inclusion Criteria
7.2.1.1 Physician’s diagnosis with low back pain.
7.2.1.2 A pain score of six points or more as evaluated on a numerical
pain scale.
7.2.1.3 Males or females aged 25-55 years old.
7.2.1.4 Body mass index not exceeding 25 kg/m2.
7.2.1.5 Administration of diclofenac sodium 25 mg. and tolperisone
HCl 50 mg at a dosage of one tablet three times a day to relieve low back pain.
7.2.1.6 Ability to listen, read, speak and understand the Thai language.
7.2.1.7 Willingness to participate in the research during the designated
time schedule with signed consent.
7.2.2 Exclusion Criteria
7.2.2.1 A history of allergies to herbs, sesame oil, or kaffir or
lavender aroma oils.
7.2.2.2 Abnormalities associated with sensory perception in the low
back area and restrictions concerning herbal compression, for example, communicable skin
diseases such as chicken pox, herpes zoster (shingles), leprosy, etc., with open sores in the
low back and nearby areas.
7.2.2.3 Plans to undergo surgery for herniated or prolapsed spinal
discs.
7.2.2.4 Receipt of low back pain treatment by injection and/or topical
medication no more than seven days before the experiment.
7.2.2.5 Receipt of treatment from any other institution or service unit
by using alternative medicine services with effects on low back pain no more than seven days
before participating in the research.
7.2.2.6 Restrictions concerning massage and herbal compression:
1) High fever of 38.5 degrees Celsius or more.
2) Pregnancy.
3) Heart disease or epilepsy.
In addition, if any of the subjects participating in the study were found
to be unable to endure heat, to exhibit allergic reactions to the herbs, to have undergone
massage and herbal compression from another institution during the course of the study or
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fail to fully participate in the research according to the designated schedule, consideration
must be given to terminating criteria.
7.2.3 Sample Size Determination
In the present study, the sample group size was determined by using Cohen’s power
analysis table (Cohen, 1988) as cited in the literature review by Tipparat Udomsuk in which
power = .80; significance = .0, one –tailed; and substituted made in Glass’s formula (Glass,
1979).
The effect Size (ES) was calculated at 1.92 with one way. When compared to the
table designating the sample size by using t-test, a sample group size of twenty subjects was
obtained. In order to ensure the research had a sample group size sufficiently large in line
with preliminary agreement of parametric statistics and to compensate for sample attrition,
two sample groups with thirty subjects each were set for a total of sixty people.
7.2.4
Random Sampling - In the present study, the researcher selected
people with low back pain according to the qualities set by the inclusion criteria and
randomly assigned the subjects to experimental or control groups by using a simple random
sampling method by drawing lots with “E” for the experimental group and “C” for the control
group. Next, the researcher employed systematic random sampling for the selection from
patients with low back pain seeking services each day until thirty subjects were recruited for
each group. The participants were unaware of the group assignments.
8. Research Site
The site used for data collection in the present study was the Out Patient and
Traditional Thai Medicine Departments at the Bor Suphan Health Promoting Hospital,
Songphinong, Suphanburi providing examination and treatment services for disease and
accidents/emergencies from Monday thru Friday, 8:30 am to 8:30 pm and on Saturdays and
holidays from 8:30 am to 4:30 pm. A doctor is regularly on duty on official work days
during office hours. There are approximately 100-150 service recipients per day with a daily
mean of 10-15 patients receiving traditional Thai medicine services.
9. Research Instrumentation and Instrument Quality
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The instrumentation employed in the present study was divided into two parts,
namely, 1) instruments used in data collection and 2) instruments used in testing. The
instruments are described as follows:
9.1 Data Collection Instruments
9.1.1 Demographic Data Questionnaires composed of data on gender, age,
religion, marital status, educational attainment, occupation, family income, duration of low
back pain, cause of low back pain, medication side-effects, low back pain management
method and history of chronic disease. The questionnaires contain questions concerning low
back pain.
Content validity was examined by a panel of three experts, namely, a
musculoskeletal physician specialist, university professors with expertise in pain and the
musculoskeletal system.
Following the examination of the experts, the instrument was
revised and improved in concurrence with the recommendations of the aforementioned before
using the instrument to collect data.
9.1.2 Low Back Pain Assessment Questionnaire – A numeric pain intensity
scale with scores ranging from 0-10 points was used (McCaffery & Pasero, 1999) in which
the left-hand side meant “no pain” and the right-hand side meant “most pain”. The subjects
with low back pain were instructed to mark the spot indicating their pain intensity on the
aforementioned scale. The interpretation criteria for pain intensity was as follows: 0 points
indicated no pain; 1-3 points indicated mild pain; 4 – 6 points indicated moderate pain; 7 – 9
points indicated intense pain; and 10 points indicated unendurable pain.
9.1.3 Diclofenac Sodium 25 mg. and Tolperisone HCl 50 mg Record Form
and the electromyogram muscle tension record form created by the researcher.
Content validity was examined by Assistant Professor, Dr. Ladawan Ounprasertpong
Nichroj. Once the instrument had been revised and improved as recommended, data
was collected on electromyogram muscle tension.
9.2 Testing Instruments
9.2.1 The aroma oil massage instruments comprised the following equipment:
1) aroma massage oil mixed by the researcher with the eight drops each of kaffir and lavender
scents with 30 milliliters of sesame oil as the carrier; 2) a watch to time the massages; 3) a
large cloth covering for the subjects.
9.2.2 The herbal compression instruments comprised the following equipment:
1) two dry herbal compresses; 2) a towel to cover the compresses; 3) a tray for placing the
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compresses; 4) an electrical steam pot; 5) a watch to time the steaming of the herbal
compresses.
9.2.3 Dry herbal compresses made by Assistant Professor, Dr. Ladawan
Ounprasertpong Nichroj which had been certified for meeting Thai Community Product
Standards, No. TCPS.176/2546. The compresses contained 100 grams composed of 31.25
grams of Thai plai oil, 6.68 grams of turmeric, 9.37 grams of kaffir peel; 4.68 grams of wax
leaved climbers ½ teaspoon of camphor, ½ teaspoon of salt and other ingredients.
9.2.4 An aroma oil massage and herbal compression handbook developed by
the researcher which was modified from video on a complete version of aromatic oil massage
and aromatherapy and symptom relief by Assistant Professor, Dr. Ladawan Ounprasertpong
Nichroj ( 2009).
The instrument was validated by Assistant Professor, Dr.
Ladawan
Ounprasertpong Nichroj and university nursing instructors who had experience in research
involving aromatic oil massage.
The researcher revised and improved the instrument
according to the recommendations of the aforementioned before conducting the research.
9.2.5 The researcher and Two Sets of Research Assistants –The first set of
research assistants were professional nurses who had been nurses for three years and received
explanations and instructions on the guidelines and procedures for data collection. The
aforementioned performed the tasks of collecting the sample group’s demographic data and
assessment of low back pain and electromyogram of muscle tension. The second set of
research assistants were traditional Thai medicine staff who had received skills training in
aroma oil massage and herbal compression from the researcher performed the aromatic oil
massage and herbal compression on the subjects. Each research assistant massaged no more
than five people per day for thirty minutes per person with 15-minute breaks between
massages.
9.2.6 Electromyography Biofeedback Model ProComp Infiniti for measuring
electromyogram of Quadratus lumborum muscle tension. The machine was inspected by a
specialist from an agency selling the machine to ensure accuracy and reliability before use.
10. Data Collection
The researcher collected the data for the present study by designating the following
procedures and guidelines:
10.1 Pre-Study Preparations
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10.1.1 The researcher submitted a letter of introduction to request for data to
the director of Somdejprasangkharach XVII Hospital, Songphinong Public Health Office, and
the director of the Bor Suphan Health Promoting Hospital, Songphinong, Suphanburi, to
request cooperation in preparing the sample group records and data for the research.
10.1.2 The researcher attended instruction and skill training in traditional Thai
medicine and alternative medicine as follows:
1) Instruction in aromatic oil massage and herbal compression with additional
skills training in aromatic oil massage for 14 service recipients, spending two hours for each
person for a total of 60 hours.
2) An instructional course on the subject of alternative medicine and nursing
supplementary therapy with topics involving herbal compression, herbal compression skills,
neck and shoulder massage and healthcare, usage, checking and setting of the EMG
biofeedback machine.
10.1.3 Two Sets of Research Assistants – The first set of research assistants
were professional nurses who had received explanations on the guidelines and procedures for
data collection, the methods for interviewing on the sample group’s demographic data, pain
assessment and recording, electromyogram of muscle tension assessment and recording and
training in the use of the EMG biofeedback machine in order to ensure that the research
assistants achieved skill and expertise in data collection.
The second set of research assistants comprised traditionsl Thai medical staff who had
passed a skill training course in aroma oil massage and herbal compression; the assistants
were also given the aforementioned handbook to take home for study and review.
10.1.4 Research Site – The researcher submitted letters requesting permission
to collect data to the Songphinong Public Health Office and the director of the Bor Suphan
Health Promoting Hospital. The site was set up separately from the general service area.
Next, the researcher explained the research guidelines to the traditional Thai medicine staff.
10.2 Data Collection Preparations
10.2.1 The researcher introduced himself, explained the research objectives,
data collection procedures and research schedule. The researcher assured the subjects that all
data would be kept confidential and presented only from an aggregate perspective. The
researcher then requested cooperation in research participation.
The recruits who were
willing to participate in the study were instructed to sign informed consent forms. Next, the
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samples were selected from people with lower back pain using the inclusion criteria. Simple
random sampling was performed daily to assign the sample group to either the control or
experimental group by means of drawing lots.
The tickets were labeled “E” for the
experimental group and “C” for the control group. Next, systematic random sampling was
performed on all people with low back pain seeking treatment each day until thirty subjects
had been obtained for each group. The researcher then referred the sample group to the
Traditional Thai Medicine Department at the site prepared in advance for conducting the
study.
10.3 Data Collection
10.3.1 Pretest data collection was conducted before assigning the participants
to the control and experimental groups.
Next, the researcher and research assistants
conducted interviews on demographic data and assessed low back pain and electromyogram
muscle tension in the control and experimental groups.
10.3.2 The researcher commenced the experiment by testing for allergic
reactions by using pre-mixed aromatic oil to rub the inner side of the arm on an area the size
of a five-baht coin and waiting for five minutes. If a red rash occurred, the massage would
not be performed due to the allergic reaction to the aromatic oil (Surapoaj Wongyai, 2011),
and the experiment would be terminated. If there were no signs of an allergic reaction,
aromatic oil massage and herbal compression would be performed by traditional Thai
medicine staff according to the procedures and schedule. The subjects were also given one
tablet of 25-mg diclofenac sodium and one tablet of 50-mg tolperisone HCl three times a day
for three days.
During the aromatic oil massage and herbal compression, the research
assistants were asked to remain calm and concentrate on the massage to ensure the sample
group was able to rest and obtain optimal benefits. The control group received one tablet of
25-mg diclofenac sodium and one tablet of 50-mg Tolperisone HCl three times a day for
three days and the medication adherence was recorded. All of the subjects were instructed to
not receive treatment or therapy for low back pain elsewhere or by other methods.
10.3.3 Post-Test Data Collection, - After three days of experimentation, the
researcher and research assistants conducted interviews on demographic data and assessed
lower pain and electromyogram of muscle tension in the control and experimental groups.
10.3.4 At the end of the experiment, the control group received aroma oil
massage and herbal compression for thirty minutes per person and all of the subjects received
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the instructional handbook for people with low back pain which had been modified by the
researcher from Thipsuda Lappakdee (2008). Each of the subjects was also given an herbal
compression ball to practice healthcare independently.
11. Data Analysis
11.1 The researcher used descriptive statistics to analyze demographic data such as
gender, age, religion, marital status, educational attainment, occupation, family income, pain
duration, causes, side effects, pain management methods history of chronic illness. These
data were analyzed by frequency distribution and calculated for percentage, mean, standard
deviation, maximum and minimum values.
11.2 Paired t-test was used to compare the differences in the mean pre- and post-test
low back pain and electromyogram of muscle tension scores for the experimental group
before and after aroma oil massage and herbal compression with analgesic drugs.
Independent t-test was used to compare the differences in the mean low back pain and
electromyogram of muscle tension post-test scores between the experimental group receiving
aroma oil massage and herbal compression with analgesic drugs and the control group
receiving analgesic drugs only.
12. Findings
The present study comprised random sampling research aimed at exploring the effects
of aroma oil massage and herbal compression with analgesic drugs on low back pain and
electromyogram of muscle tension in persons with low back pain. The sample group was
composed of 60 subjects. Thirty of the subjects were assigned to the control group and the
other thirty subjects were assigned to the experimental group; 53.33% of the subjects were
males and 46.67% were females; 46.67% were 36-46 years of age with a mean age of 40.70
years. A hundred percent of the subjects were Buddhists; 68.33% were married and living
with spouses; 50.00% were primary and secondary school graduates; 40.00% had agriculturerelated occupations and 56.67% had mean family incomes between 5,000-10,000 baht/month.
When demographic data on gender, age, religion, marital status, educational, occupation and
average family income were tested for similarities among the variables by using chi-square
statistics, no differences with statistical significance were encountered at p>.05 (2= .268, p
= .605, 2= 2.819, p = .244,
2= .077, p =.781, 2= -, p = 1.000,
2=1.418, p = .4921, respectively).
2=.444, p = .801,
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Concerning history of lower back pain, 56.67% of the sample group reported having
had lower back pain for 1-2 years. With regard to the causes of lower back pain, 95.00% was
due to the fact that the body was required to carry excessively heavy loads; 88.33% of the
sample group had no medication-related side effects; 96.67% of the sample group managed
low back pain by administering the drug themselves. In terms of chronic disease, 78.33% of
the sample group had no chronic diseases; 55.00% of the sample group had normal BMI.
When data on history of lower back pain, namely, duration of the condition, causes, side
effects, previous pain management methods, chronic disease and body mass index, were
tested on for similarity among the variables by using chi-square statistics, no differences
with statistical significance were encountered at p >.05 ( 2= .601, p = .438; 2= 2.654, p
=.845; 2= .875, p = .350; 2= 1.975, p =.975; 2= .098, p =.754; 2= 1.647, p =.619,
respectively).
The findings on the sample group’s level of low back pain revealed the subjects’
lower back pain to be moderate and severe in intensity (56.67% and 43.33%, respectively)
before the aroma oil massage and herbal compression with analgesic drugs. After the aroma
oil massage and herbal compression with analgesic drugs, the control group’s lower back
pain remained moderate (50%), but the experimental group’s lower back pain was mild
(100%) as shown in Table 1.
Table 1 - Number and percentage of sample group classified by pre- and post-test low back
pain intensity.
Control Group
(n= 30)
Level of Pain Severity
Amoun
Group
(n=30)
%
t
Experimental
Amou
nt
%
Entire Sample
Group (n=60)
Amou
nt
%
Pre-Test Level of Low Back Pain Severity
Moderate Pain
18
60.00
17
56.67
35
58.33
Extreme Pain
12
40.00
13
43.33
25
41.67
30
100.0
42
70.00
Post-Test Level of Low Back Pain Severity
Mild Pain
12
40.0
16
0
Moderate Pain
15
Extreme Pain
3
0
50.0
15
25.00
3
5.00
0
10.0
0
The comparison of the pre- and post-test mean low back pain and electromyogram of
muscle tension scores revealed the low back pain and electromyogram of muscle tension of
the experimental group receiving aroma oil massage and herbal compression with analgesic
drugs to be lower than the control group receiving analgesic drugs only with statistical
significance (p<.001) as shown in Table 2.
Table 2 - Comparison of the mean pre- and post-test low back pain and electromyogram of
muscle tension scores between the control and experimental groups using paired ttest.
Variable
Control Group (n=30)
Min Max
Experimental Group (n=30)
Mean S.D. Min
Max
Mean
S.D.
t
p
Low Back Pain
Pre-Test
6
8
6.47
.629 6
8
6.50
.630
-.205
.838
Post-Test 3
7
5.17
.874 2
3
2.47
.507
14.630
<.001
21.19
11.92
3.53
.071
.944
9.10
5.13
1.49
9.543
<.001
11.76
<.001
Muscle Tension Reflex Reaction
Pre-Test
7.89 21.36 11.98 3.50 7.31
Post-Test 6.89 22.02 11.65 3.42 3.38
Pre- and Post-Test Differences in Muscle Tension Reflex Reaction
1.00 0.66
0.33
0.08 3.93
12.09
6.79
2.79
The comparison of the pre-and post-test mean low back pain and electromyogram of
muscle tension scores revealed the low back pain and electromyogram of muscle tension of
the experimental group receiving aroma oil massage and herbal compression with analgesic
drugs to be lower than before the experiment with statistical significance (p<.001) as shown
in Table 3.
Table 3 - Comparison of the pre-and post-test mean low back pain and electromyogram of
muscle tension scores by using paired t-test.
17
Variable
Mean S.D.
Mean
S.D. Mean
difference
difference
4.03
.12
25.981 <.001
6.79
2.04
13.347 <.001
t
p
Low Back Pain
Pre-Test
6.50
.63
Post-Test
2.47
.51
Muscle Tension Reflex Reaction
Pre-Test
11.92
3.53
Post-Test
5.13
1.49
13. Research Limitations
13.1 This study included four research assistants with three years of experience in
traditional Thai medicine. This could affect the massaging postures because Thai massage
generally requires more pressing force than the Swedish massage used in this study.
13.2 The research participants had agricultural occupations and had to work daily.
Despite the researcher’s request for cooperation in avoiding work or lifting heavy loads, some
of the participants still needed to perform the aforementioned tasks, which might have
resulted in an external variable. Furthermore, the researcher was unable to control and
maintain the stability of the factors associated with the participants’ occupations.
14. Recommendations
14.1 Nursing Practice – According to the findings, the effects of aroma oil massage
and herbal compression with analgesic drugs on low back pain and electromyogram of
muscle tension can relieve low back pain and muscle tension with relaxation and comfort.
Thus, aroma oil massage and herbal compression should be promoted and combined with
modern medicine to ensure that service recipients receive holistic care.
14.2 Nursing Administration - Aroma oil massage and herbal compression relieve low
back pain and muscle tension when administered with the right model.
Thus, nursing
administrators should promote capacity development to ensure that nursing staff and the
healthcare teams gain knowledge and skills for the implementation of the knowledge in
traditional Thai medicine clinic effectively and safely in compliance with policy for
promoting traditional Thai medicine and alternative medicine set forth by the Ministry of
Public Health.
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14.3 Nursing Education – The effects of aroma oil massage and herbal compression
indicate the aforementioned as alternative traditional Thai medicine offering effective and
safe integration with modern medicine as a complementary solution.
In addition, the
aforementioned are within the scope of professional nursing tasks. Thus, traditional Thai
medicine and alternative medicine should be taught at university and post-graduate levels.
Furthermore, training and special courses should be offered to improve nursing roles and
capacity in order to produce graduates with knowledge and ability in multiple fields of
science who can go out and serve society to support healthcare in ASEAN.
14.4 Nursing Research - Because aroma oil massage and herbal compression can
relieve low back pain and muscle tension, offering relaxation and comfort within thirty
minutes following the massage and herbal compression, studies should be conducted to study
the effectiveness of aroma oil massage and herbal compression to determine the duration of
the aforementioned effects.