BioMed Research International 7 Left shoulder Right shoulder L:25%→22.7% 1上34.1%→20.5% C:31.5%→31.6% C:21.1%→28.9% Left elbow Back 上13.6%→6.8% 1:38.6%→34.1% Right elbow C:5.3%→10.5% C:57.9%→34.2% 上13.6%→6.8% C:5.3%→10.5% Right hip 1:18.2%→6.8% C:13.2%→7.9% Right knee Left knee Left hip 159.1%→52.3% L59.1%→47.7% 上11.4%→4.5% C:65.8%+57.9% C13.2%→5.3% C:65.2%→63.2% Right ankle Left ankle 1:9.1%→6.8% 上6.8%→6.8% C:7.9%→5.3% C:10.5%→7.9% I:Intervention group C:Control group Multiple answers can be chosen FIGURE 2:Location of pain in intervention and control groups. assessment when comparing the intervention and control the use of PET [31,32].The reduction in pain scores in groups (P 0.05).Significant differences were noted in the present study was minimal.Pain scores ranging from the depression,anxiety,and stress scores in the intervention four to five were found in both groups,indicating mild to group when comparing the baseline and postintervention moderate pain.The pain in older persons originated in the assessment results (P<0.05)(see Table 6). musculoskeletal system,while in laboratory-based studies the pain was induced by thermodes,hot water,or cold water. 4.Discussion The nature of the pain was different.In the laboratory- based studies,the essential oils were inhaled rather than The present study shows that the aromatherapy programme topically applied to pain sites as in the community-based was effective in reducing the pain,depression,anxiety,and studies [34,35].The method of administering the essential stress levels of older persons in the intervention group. oils and the duration of the aromatherapy were factors Under the total pain concept,a person not only suffers from affecting the impact of the aromatherapy programme in pain physical pain but also from psychological distress [9].The fact management that pain can induce psychological distress in older persons Lavender and bergamot essential oils are antidepressants is consistent with the total pain concept.As illustrated and relaxants [25,40].Essential oils can be absorbed by by Saunders [9],psychological distress can be related to inhalation into the olfactory pathway and from there to progressive pain.Although in the present study a decrease the brain [41].The scores on depression,anxiety,and stress in pain scores was noted in both groups,psychological decreased in the intervention group after the aromatherapy distress increased to a greater degree in the control group programme,but there was increased psychological distress than in the intervention group.This can be related to the in the control group.The results were consistent with those effect of the aromatherapy programme,which provided the of previous studies,namely,that aromatherapy was able to intervention group with adequate information on pain and relieve negative emotional symptoms [25,40,42]. pain management.Older persons in the control group did not Pleasant odours can induce a positive mood in a person receive this information and were still uncertain as to their 25].Essential oils administered in the centre-based sessions pain and pain management,resulting in an increased level and aromatic spray used in the self-administered home-based of psychological distress.The findings were consistent with sessions exposed the older persons to pleasant aromas.Their those of previous studies,namely,that the inadequate pain mood was lifted after inhaling the essential oils and aromatic management of older persons results in decreased enjoyment spray,resulting in decreased depression,anxiety,and stress of life,and pain management programmes can decrease pain- scores. related distress [4,8. Aromatherapy has been used to treat diseases for decades Laboratory-based studies have proven that the inhalation in western countries [24].Using aromatherapy as a method of odours or essential oils is effective at reducing pain under of managing pain was a new concept to the older ChineseBioMed Research International 7 I: 34.1% → 20.5% C: 21.1% → 28.9% Right shoulder I: 13.6% → 6.8% C: 5.3% → 10.5% Right elbow I: 59.1% → 52.3% C: 65.8% → 57.9% Right knee I: 9.1% → 6.8% C: 7.9% → 5.3% Right ankle I: 25% → 22.7% C: 31.5% → 31.6% Left shoulder I: 13.6% → 6.8% C: 5.3% → 10.5% Left elbow I: 18.2% → 6.8% C: 13.2% → 7.9% Right hip I: 11.4% → 4.5% C: 13.2% → 5.3% Left hip I: 38.6% → 34.1% C: 57.9% → 34.2% Back I: 59.1% → 47.7% C: 65.2% → 63.2% Left knee I: 6.8% → 6.8% C: 10.5% → 7.9% Left ankle I: Intervention group C: Control group Multiple answers can be chosen Figure 2: Location of pain in intervention and control groups. assessment when comparing the intervention and control groups (𝑃 < 0.05). Significant differences were noted in the depression, anxiety, and stress scores in the intervention group when comparing the baseline and postintervention assessment results (𝑃 < 0.05) (see Table 6). 4. Discussion The present study shows that the aromatherapy programme was effective in reducing the pain, depression, anxiety, and stress levels of older persons in the intervention group. Under the total pain concept, a person not only suffers from physical pain but also from psychological distress [9].The fact that pain can induce psychological distress in older persons is consistent with the total pain concept. As illustrated by Saunders [9], psychological distress can be related to progressive pain. Although in the present study a decrease in pain scores was noted in both groups, psychological distress increased to a greater degree in the control group than in the intervention group. This can be related to the effect of the aromatherapy programme, which provided the intervention group with adequate information on pain and pain management. Older persons in the control group did not receive this information and were still uncertain as to their pain and pain management, resulting in an increased level of psychological distress. The findings were consistent with those of previous studies, namely, that the inadequate pain management of older persons results in decreased enjoyment of life, and pain management programmes can decrease pain￾related distress [4, 8]. Laboratory-based studies have proven that the inhalation of odours or essential oils is effective at reducing pain under the use of PET [31, 32]. The reduction in pain scores in the present study was minimal. Pain scores ranging from four to five were found in both groups, indicating mild to moderate pain. The pain in older persons originated in the musculoskeletal system, while in laboratory-based studies the pain was induced by thermodes, hot water, or cold water. The nature of the pain was different. In the laboratory￾based studies, the essential oils were inhaled rather than topically applied to pain sites as in the community-based studies [34, 35]. The method of administering the essential oils and the duration of the aromatherapy were factors affecting the impact of the aromatherapy programme in pain management. Lavender and bergamot essential oils are antidepressants and relaxants [25, 40]. Essential oils can be absorbed by inhalation into the olfactory pathway and from there to the brain [41]. The scores on depression, anxiety, and stress decreased in the intervention group after the aromatherapy programme, but there was increased psychological distress in the control group. The results were consistent with those of previous studies, namely, that aromatherapy was able to relieve negative emotional symptoms [25, 40, 42]. Pleasant odours can induce a positive mood in a person [25]. Essential oils administered in the centre-based sessions and aromatic spray used in the self-administered home-based sessions exposed the older persons to pleasant aromas. Their mood was lifted after inhaling the essential oils and aromatic spray, resulting in decreased depression, anxiety, and stress scores. Aromatherapy has been used to treat diseases for decades in western countries [24]. Using aromatherapy as a method of managing pain was a new concept to the older Chinese