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).

2The 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 age-

related 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

3search 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 non-

pharmacological 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,

2012). 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

4musculoskeletal 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 evidence-

based 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

5inside 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 anti-

inflammatory 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, 2012), 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

6decreases (Pawitra Phulbudt, 2009; Pongsathorn Meesawasdesom, 2009). 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, 2009; Pongsathorn

Meesawasdesom, 2009). The conceptual framework of the study can be summarized as

follows:

Diagram 1 - Conceptual Framework of the Study

73. 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:

87.2.1 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

9fail 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

10The 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

11compresses; 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

1210.1.1 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

13samples 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

14the 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 agriculture-

related 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=.444, p = .801,

2=1.418, p = .4921, respectively).

15Concerning 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.

Level of Pain Severity

Control Group

(n= 30)

Experimental

Group

(n=30)

Entire Sample

Group (n=60)

Amoun

t%

Amou

nt%

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

Post-Test Level of Low Back Pain Severity

Mild Pain 1240.0

030

100.0

0

42 70.00

16

Moderate Pain 1550.0

0

15 25.00

Extreme Pain 310.0

0

3 5.00

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 t-test.

Variable

Control Group (n=30) Experimental Group

(n=30) t p

Min Max Mean S.D. Min Max Mean S.D.

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

Muscle Tension Reflex Reaction

Pre-Test 7.8

9

21.36 11.98 3.50 7.31 21.19 11.92 3.53 .071 .944

Post-Test 6.8

9

22.02 11.65 3.42 3.38 9.10 5.13 1.49 9.543 <.001

Pre- and Post-Test Differences in Muscle Tension Reflex Reaction

1.0

0

0.66 0.33 0.08 3.93 12.09 6.79 2.79 11.76 <.001

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.

17Table 3 - Comparison of the pre-and post-test mean low back pain and electromyogram of

muscle tension scores by using paired t-test.

Variable MeanS.D

.

Mean

difference

S.D. Mean

differencet p

Low Back Pain

Pre-Test 6.50 .63 4.03 .12 25.98

1

<.001

Post-Test 2.47 .51

Muscle Tension Reflex Reaction

Pre-Test 11.92 3.53 6.79 2.04 13.34

7

<.001

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

18traditional 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.

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.