834 R.Perry et al.Phytomedicine 19(2012)825-835 been identified.However,our systematic and detailed search strat- Appendix A(Continued egy should have assisted in identifying all trials and in reducing bias. Publication bias is a problem in all medical research (Easterbrook Searches et al.1991)and is particularly problematic in alternative medicine 40 lofinda.ti,ab. (Ernst 2007b:Ernst and Pittler 1997).Collectively these limitations 41 ostoghodous.ti,ab. render our systematic review less than conclusive as one might postokhodous.ti.ab have hoped. Silexan.ti,ab. 44 spigandos.ti.ab Conclusions 45 exp Lavandula/ 46 1 or 2 or3 or 4or 5 or 6or 7or8 or9 or 10or 11 or 12 or 13 or 14or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 Only few RCTs of lavender,for anxiety/stress are available using or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 diverse administration methods (ie.oral,olfactory and as a mas- or 40 or 41 or 42 or 43 or 44 or 45 sage oil).The evidence for oral lavender is promising but,until Adaptation reaction.ti,ab. Adjustment disorders.ti,ab. independent replications emerge with long-term follow-up data 48 Adiustment reaction tLab. remains inconclusive.The use of more widely used forms of laven- 50 Agoraphobis.ti.ab. der administration(aromatherapy,inhalation,massage etc.)is not 51 Angst.ti,ab. currently supported by good evidence of efficacy.Future trials, 52 Anguish.ti.ab. 53 Antianxiety.ti.ab well-reported and adopting stringent methodology (e.g,adhering 54 anti-anxierv.tab to PRISMA guidelines).in combination with in vitro pharmaco- 55 Anxiets.ti.ab. logical research,would help to elucidate the therapeutic value of 56 Anxiolytics.ti,ab lavender as an anxiolytic. 57 Anxouss tiab. 58 Combat Disorders.ti,ab 59 Distress.tab. Conflict of interest 60 NeurosS.ti,ab. Neurotic.ti,ab. None 62 Obsessive-Compulsive Disorders.ti,ab. 63 Panic attack$.ti,ab. 64 Panic Disorders.ti.ab. Funding 65 PhobiaS.ti.ab. 66 Phobic DisorderS.ti.ab. None. 67 Stress.ti,ab. Worry.ti.ab. 69 exp adjustment disorders/or exp anxiety disorders/or exp neurotic Appendix A.Medline-lavender for stress disorders/ 70 exp Anxiety/ Searches 71 exp Stress.Psychological/ 72 exp Anti-Anxiety Agents/ Al birri.ti,ab. 73 47 or 48 or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 2 alhucema tiab or 60 or 61 or 62 or 63 or 64 or 65 or 66 or 67 or 68 or 69 or 70 or 71 3 arva neh.ti,ab. 0r72 4 espic.ti,ab. 74 46 and 73 5 fi rigla.ti,ab 6 firigla.tiab. 7 frigous.ti.ab hzama.ti.ab. khazama.ti,ab References 10 khirii.ti,ab. Anon,2011.Shirodhara Massage.http://www.mindbodysoul.tv/health/shirodhara- Kkhouzamaa tlab khouzami.ti.ab. massage.html (accessed 25.05.11) Boutron,I..Moher,D.,Tugwell,P..Giraudeau,B..Poiraudeau,S.,Nizard,R..Ravaud,P. 13 khuzama tiab 14 2005.A checklist to evaluate a report of a nonpharmacological trial (CLEAR NPT) Kleiner Speik.ti,ab. was developed using consensus.Journal ofClinical Epidemiology 58,1233-1240 L$x intermedia.ti,ab Braden,R.Reichow,S.,Halm,MA.,2009.The use of the essential oil lavandin 6 L$angustifoliaS.ti,ab. to reduce preoperative anxiety in surgical patients.Journal of Perianesthesia 17 L$dentata.ti.ab Nursing24(6).348-355. 18 Is latifolia tiab Bradley.B.F..Brown,S.L.Chu,S..Lea.R.W..2009.Effects of orally administered Ls multinda ti ab lavender essential oil on responses to anxiety-provoking film clips.Human Psy- 20 L$officinalis.ti,ab. chopharmacology 24(4).319-330. L$spica Loisel.ti,ab. Brum.LF,Elisabetsky.E.Souza,D..2001.Effects of linalool on((3)H)MK801 and 22 L$stoechas.ti.ab. f(3)H,muscimol binding in mouse cortical membranes.Phytotherapy Research L$vera DC.ti.ab. 54D-4D5 24 L$vulgaris LamS.ti.ab. Buckle.J..1993.Aromatherapy:does it matter which lavender essential oil is used Nursing Times 89.32-35. 25 Lasea.ti.ab. 2 Cavanagh,H.M.,Wilkinson.J.M..2002.Biological activities of lavender essential oil. Lavanda tiab. Phytotherapy Research 16(4).301-308. 27 lavande.ti,ab. Corner.J,Cawl ey.N..Hildebrand,S.,1995.An evaluation of the use of massage 8 Lavandin.ti,ab and essential oils in the wellbeing of cancer patients.International Journal of 29 lavandino tiab Palliative Nursing 1.67-73. 0 lavando.ti.ab Coulson,LH..Khan,A.S.1999.Facial pillo titis due to lavender oil allergy. 31 Lavandula.ti,ab. Consult Dermatitis 41,111. 32 Lavandulae.ti,ab. Dunn,C.Sleep.J.Collett.D..1995.Sensing an improvement a an experimental study 3 lavanulae tLab. to evaluate the use of aromatherapy,massage and periods of rest in an intensive 34 lavenda.ti,ab. care unit lournal of Advanced Nursing 21.34-40. 5 Lavendelti.ab Easterbrook,P.I.,Berlin,J.A.,Gopalan.R.Matthews,D.R,1991.Publication bias in 6 Lavender.ti,ab. clinical research.Lancet 337,867-872. 37 Lavenol.ti,ab. Ernst.E.2002.Herbal medicinal products during pregnancy:are they safe?BJOG: 38 lawanda.ti.ab. An International Journal of Obstetric and Gynaecology 109.227-235. 39 Lofi nda.ti,ab. Ernst,E..2007.'First,do no harm'with complementary and alternative medicine Trends in Pharmacological Sciences 28(2).48-50.834 R. Perry et al. / Phytomedicine 19 (2012) 825–835 been identified. However, our systematic and detailed search strat￾egy shouldhave assistedinidentifying alltrials andinreducing bias. Publication bias is a problem in all medical research (Easterbrook et al. 1991) and is particularly problematic in alternative medicine (Ernst 2007b; Ernst and Pittler 1997). Collectively these limitations render our systematic review less than conclusive as one might have hoped. Conclusions Only few RCTs of lavender, for anxiety/stress are available using diverse administration methods (i.e. oral, olfactory and as a mas￾sage oil). The evidence for oral lavender is promising but, until independent replications emerge with long-term follow-up data, remains inconclusive. The use of more widely used forms of laven￾der administration (aromatherapy, inhalation, massage etc.) is not currently supported by good evidence of efficacy. Future trials, well-reported and adopting stringent methodology (e.g., adhering to PRISMA guidelines), in combination with in vitro pharmaco￾logical research, would help to elucidate the therapeutic value of lavender as an anxiolytic. Conflict of interest None. Funding None. Appendix A. Medline – lavender for stress Searches 1 Al birri.ti,ab. 2 alhucema.ti,ab. 3 arva neh.ti,ab. 4 espic.ti,ab. 5 fi rigla.ti,ab. 6 firigla.ti,ab. 7 frigous.ti,ab. 8 hzama.ti,ab. 9 khazama.ti,ab. 10 khirii.ti,ab. 11 khouzamaa.ti,ab. 12 khouzami.ti,ab. 13 khuzama.ti,ab. 14 Kleiner Speik.ti,ab. 15 L$ x intermedia.ti,ab. 16 L$ angustifolia$.ti,ab. 17 L$ dentata.ti,ab. 18 L$ latifolia.ti,ab. 19 L$ multifida.ti,ab. 20 L$ officinalis.ti,ab. 21 L$ spica Loisel.ti,ab. 22 L$ stoechas.ti,ab. 23 L$ vera DC.ti,ab. 24 L$ vulgaris Lam$.ti,ab. 25 Lasea.ti,ab. 26 Lavanda.ti,ab. 27 lavande.ti,ab. 28 Lavandin.ti,ab. 29 lavandino.ti,ab. 30 lavando.ti,ab. 31 Lavandula.ti,ab. 32 Lavandulae.ti,ab. 33 lavanulae.ti,ab. 34 lavenda.ti,ab. 35 Lavendel.ti,ab. 36 Lavender.ti,ab. 37 Lavenol.ti,ab. 38 lawanda.ti,ab. 39 Lofi nda.ti,ab. Appendix A (Continued ) Searches 40 lofinda.ti,ab. 41 ostoghodous.ti,ab. 42 postokhodous.ti,ab. 43 Silexan.ti,ab. 44 spigandos.ti,ab. 45 exp Lavandula/ 46 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 47 Adaptation reaction.ti,ab. 48 Adjustment disorder$.ti,ab. 49 Adjustment reaction.ti,ab. 50 Agoraphobi$.ti,ab. 51 Angst.ti,ab. 52 Anguish.ti,ab. 53 Antianxiety.ti,ab. 54 anti-anxiety.ti,ab. 55 Anxiet$.ti,ab. 56 Anxiolytic$.ti,ab. 57 Anxious$.ti,ab. 58 Combat Disorder$.ti,ab. 59 Distress.ti,ab. 60 Neuros$.ti,ab. 61 Neurotic.ti,ab. 62 Obsessive-Compulsive Disorder$.ti,ab. 63 Panic attack$.ti,ab. 64 Panic Disorder$.ti,ab. 65 Phobia$.ti,ab. 66 Phobic Disorder$.ti,ab. 67 Stress.ti,ab. 68 Worry.ti,ab. 69 exp adjustment disorders/or exp anxiety disorders/or exp neurotic disorders/ 70 exp Anxiety/ 71 exp Stress, Psychological/ 72 exp Anti-Anxiety Agents/ 73 47 or 48 or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or 60 or 61 or 62 or 63 or 64 or 65 or 66 or 67 or 68 or 69 or 70 or 71 or 72 74 46 and 73 References Anon, 2011. Shirodhara Massage. http://www.mindbodysoul.tv/health/shirodhara￾massage.html (accessed 25.05.11). Boutron, I., Moher, D., Tugwell, P., Giraudeau, B., Poiraudeau, S., Nizard, R., Ravaud, P., 2005. A checklist to evaluate a report of a nonpharmacological trial (CLEAR NPT) wasdevelopedusing consensus.Journal ofClinical Epidemiology58,1233–1240. Braden, R., Reichow, S., Halm, M.A., 2009. The use of the essential oil lavandin to reduce preoperative anxiety in surgical patients. Journal of Perianesthesia Nursing 24 (6), 348–355. Bradley, B.F., Brown, S.L., Chu, S., Lea, R.W., 2009. Effects of orally administered lavender essential oil on responses to anxiety-provoking film clips. Human Psy￾chopharmacology 24 (4), 319–330. Brum, L.F., Elisabetsky, E., Souza, D., 2001. Effects of linalool on ((3)H) MK801 and {(3)H} muscimol binding in mouse cortical membranes. Phytotherapy Research 15, 422–425. Buckle, J., 1993. Aromatherapy: does it matter which lavender essential oil is used. Nursing Times 89, 32–35. Cavanagh, H.M., Wilkinson, J.M., 2002. Biological activities of lavender essential oil. Phytotherapy Research 16 (4), 301–308. Corner, J., Cawley, N., Hildebrand, S., 1995. An evaluation of the use of massage and essential oils in the wellbeing of cancer patients. International Journal of Palliative Nursing 1, 67–73. Coulson, I.H., Khan, A.S., 1999. Facial pillow dermatitis due to lavender oil allergy. Consult Dermatitis 41, 111. Dunn, C., Sleep, J., Collett, D., 1995. Sensing an improvement an experimental study to evaluate the use of aromatherapy, massage and periods of rest in an intensive care unit. Journal of Advanced Nursing 21, 34–40. Easterbrook, P.J., Berlin, J.A., Gopalan, R., Matthews, D.R., 1991. Publication bias in clinical research. Lancet 337, 867–872. Ernst, E., 2002. Herbal medicinal products during pregnancy: are they safe? BJOG: An International Journal of Obstetric and Gynaecology 109, 227–235. Ernst, E., 2007. ‘First, do no harm’ with complementary and alternative medicine. Trends in Pharmacological Sciences 28 (2), 48–50