The Effect Frankincense Ointment on Pain Intensity and Episiotomy Wound Healing in Primiparous Women

Document Type : Original Article

Authors

1 M.Sc. student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Instructor, Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Professor, Department of Pharmacognozy, School of Pharmacology, Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 M.Sc. in Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

5 Social Determinants of Health Research Center, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.

Abstract

Introduction: Episiotomy is one of the common surgeries in midwifery that despite its small size may cause complications such as inflammation, infection or pain like any other wound. Frankincense due to anti-inflammatory effects is used in many cases, including pain relief and wound healing. This study was performed with aim to evaluate the effect of Frankincense ointment on pain intensity and episiotomy wound healing in primiparous women.
Methods: This experimental and three-blinded-study was performed on 95 primiparous women with vaginal delivery and mid lateral episiotomy in Mahdieh hospital of Tehran in 2017-2018. The subjects were divided into two groups of Frankincense ointment (intervention group) and placebo (control group). Demographic and obstetric questionnaire, health status forms, pain scale (VAS), perineal evaluation Index (REEDA) and drug complications questionnaire were used to evaluate the subjects. The ointments were used every 12 hours and for 10 days from the first day after delivery. Evaluation of pain intensity, perineal repair and drug complications were performed on days 1,5, and 10 after delivery. Data were analyzed using SPSS software (version 21) and Mann-Whitney, Chi-square and Fischer tests. P<0.05 was considered statistically significant.
Results:  On the first day after birth, no significant differences were observed between two groups in terms of mean score of REEDA (P=0.752) and pain intensity (P=0.50). The mean score of REEDA in the intervention group on fifth and tenth days were 2± 1.62 and 0.95 ± 0.99, respectively, and in the control group were 4.04 ± 2.38 and 2.52 ± 2.05, respectively; these differences were significant (P=0.026, P<0.001). The mean of pain intensity on the fifth and tenth days in the intervention group were 2 ± 1.23 and 0.95 ± 0.50, respectively, and in the control group were 3.16± 1.57 and 1.97 ± 1.17, respectively. In both groups these differences were statistically significant (P=0.030, P<0.001).
Conclusion: Frankincense ointment with anti-inflammatory properties is effective in the episiotomy wound healing and pain reduction.

Keywords


  1. Dutta DC. Text book of obstetrics: including perinatology and contraception. New Delhi: New Central Book Agency; 2004.
  2. Robinson JN, Lockwood CJ, Barss VA. Approach to episiotomy. UpTo-Date. Waltham, MA: UpToDate; 2016.
  3. Räisänen S, Vehviläinen-Julkunen K, Heinonen S. Need for and consequences of episiotomy in vaginal birth: a critical approach. J Midwifery 2010; 26(3):348-56.
  4. Masomi Z, Keramat A, Haji-aghaii R. Systematic review on the effects of medicinal plants in pain after cesarean incision and cutting of the perineum. J Med Plants 2011; 10(40):1-16.
  5. Kajoye Shirazie C, Davaty A, Zayere F. Episiotomy rates and its complication. J Ghom Univ Med Sci 2009; 3(2):1-4.
  6. Dahlen H, Homer C. Perineal trauma and postpartum perineal morbidity in Asian and non‐Asian primiparous women giving birth in Australia. J Obstet Gynecol Neonatal Nurs 2008; 37(4):455-63.
  7. Shojae KK, Dawati A, Zayeri F. Frequency and side effect of episiotomy in primiparous women: a three-month longitudinal survey. J Qom Univ Med Sci 2009; 3(2):47-50. (Persian).
  8. Khani S, Zare K, Ramezannezhad S. The frequency of episiotomy and its related factors. Iran J Nurs 2012; 24(74):45-52. (Persian).
  9. Avijgan M. Aloe Veragel as an effective and cheap option for treatment in chronic bed sores. J Guilan Univ Med Sci 2004; 13(50):45-51. (Persian).
  10. Eghdampour F, Jahdie F, Kheyrkhah M, Taghizadeh M, Naghizadeh S, Haghani H. The effect of aloe vera ointmentin wound healing of episiotomy among primiparous women. Iran J Obstet Gynecol Infertil 2013; 15(35):25-31. (Persian).
  11. Sehhati Shaffaie F, Rashidi Fakari F, Javadzadeh Y, Ghojazadeh M. Effect of the phenytoin cream on episiotomy healing in primipara women. J Shahid Sadoughi Univ Med Sci 2012; 20(2):152-8. (Persian).
  12. Santos Jde O, de Oliveira SM, da Silva FM, Nobre MR, Osava RH, Riesco ML. Low‐level laser therapy for pain relief after episiotomy: a double‐blind randomised clinical trial. J Clin Nurs 2012; 21(23-24):3513-22.
  13. Abdool Z, Thakar R, Sultan AH. Postpartum female sexual function. Eur J Obstet Gynecol Reprod Biol 2009; 145(2):133-7.
  14. Declercq E, Cunningham DK, Johnson C, Sakala C. Mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth 2008; 35(1):16-24.
  15. Karaçam Z, Ekmen H, Çalişır H, Şeker S. Prevalence of episiotomy in primiparas, related conditions, and effects of episiotomy on suture materials used, perineal pain, wound healing 3 weeks postpartum, in Turkey: a prospective follow-up study. Iran J Nurs Midwifery Res 2013; 18(3):237.
  16. Golezar S. Ananas comosus effect on perineal pain and wound healing after episiotomy: a randomized double-blind placebo-controlled clinical trial. Iran Red Crescent Med J 2016; 18(3):e21019.
  17. Shahrahmani H, Kariman N, Jannesari S, Ghalandari S, Asadi N. A systematic review on the type of treatment methods toreduce pain and improve wound healing in Iran. Iran J Obstet Gynecol Infertil 2016; 19(9):17-31. (Persian).
  18. Ghalandari S, Kariman N, Sheikhan Z, Mojab F, Mirzaei M, Shahrahmani H. Effect of hydroalcoholic extract of capsella bursapastoris on early postpartum hemorrhage: a clinical trial study. J Altern Complement Med 2017; 23(10):794-9.
  19. Navi Nezhad M, Abedian Z, Asili J, Esmaeili H, Vatanchi A. Effect of alpha ointment (fundermol) on episiotomy wound healing in primiparous women. Iran J Obstet Gynecol Infertil 2017; 20(4):58-65.
  20. Kulkarni RR, Patki PS, Jog VP, Gandage SG, Patwardhan B. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol 1991; 33(1-2):91-5.
  21. Wahab SM, Aboutabl EA, El-Zalabani SM, Fouad HA, De Pooter HL, El-Fallaha B. The essential oil of olibanum. Planta Med 1987; 53(4):382-4.
  22. Assimopoulou AN, Zlatanos SN, Papageorgiou VP. Antioxidant activity of natural resins and bioactive triterpenes in oil substrates. Food Chem 2005; 92(4):721-7.
  23. Rijkers T, Ogbazghi W, Wessel M, Bongers F. The effect of tapping for frankincense on sexual reproduction in Boswellia papyrifera. J Appl Ecol 2006; 43(6):1188-95.
  24. Goyal S, Sharma P, Ramchandani U, Shrivastava SK, Dubey PK. Novel anti-inflammatory topical herbal gels containing withania somnifera and boswellia serrata. Int J Pharm Biol Arch 2011; 2(4):1087-94.
  25. Kasali AA, Adio AM, Kundaya OE, Oyedeji AO, Eshilokun AO, Adefenwa M. Antimicrobial activity of the essential oil of Boswellia serrata Roxb. J Essent Oil Bearing Plants 2002; 5(3):173-5.
  26. Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial. Phytomedicine 2003; 10(1):3-7.
  27. Safayhi H, Mack T, Sabieraj J, Anazodo MI, Subramanian LR, Ammon HP. Boswellic acids: novel, specific, nonredox inhibitors of 5-lipoxygenase. J Pharmacol Exp Ther 1992; 261(3):1143-6.
  28. Calzavara‐Pinton P, Zane C, Facchinetti E, Capezzera R, Pedretti A. Topical Boswellic acids for treatment of photoaged skin. Dermatol Ther 2010; 23(Suppl 1):S28-32.
  29. Ansari R, Arami R, Sahinfard N, Namjou A, Shirzad H, Rahimi M, et al. Effect of Teucrium polium and Boswellia serrata extracts on cotaneus burn wound healing in Balb/C mice. J Shahrekord Univ Med Sci 2011; 12(4):49-53.
  30. Razavi SZ, Karimi M, Kamalinejad M. The efficacy of topical oliban oil (Boswellia Carterii B.) in relieving the symptoms of knee osteoarthritis. Phys Med Rehabilit Electrod 2018; 1(1):7-13.
  31. Pore Y. Effectiveness of moist heat and dry heat application on healing of episiotomy wound. Asian J Multidiscipl Stud 2014; 2:7.
  32.  Sabzaligol M, Safari N, Baghcjeghi N, Latifi M, Koohestani HR. The effect of Aloevera gel on erneal ain and amp; wound healing after episiotomy. Comlement Med J 2014; 4(2):766-75.
  33.  Ashmen KJ, Swanik CB, Lephart SM. Strength and flexibility characteristics of athletes with chronic low-back pain. J Sport Rehabil 1996; 5(4):275-86.
  34. Azhari S, Ahmadi S, Rakhshandeh H, Jafarzadeh H, Mazlom SR. Evaluation of the effect of oral saffron capsules on pain intensity during the active phase of labor. Iran J Obstet Gynecol Infertil 2014; 17(115):1-10. (Persian).
  35. Kariman N. Assessing comparison the effect of cooling gel pads and topical olive oil on the intensity of episiotomy pain in primiparous women. Complement Med J Facul Nurs Midwifery 2015; 4(4):977-86. (Persian).
  36. Menke NB, Ward KR, Witten TM, Bonchev DG, Diegelmann RF. Impaired wound healing. Clin Dermatol 2007; 25(1):19-25.
  37. Pazandeh F, Savadzadeh S, Mojab F, Alavi Majd H. Effects of chamomile essence on episiotomy healing in primiparous women. J Ardabil Univ Med Sci 2008; 8(4):364-70. (Persian).
  38. Qurishi Y, Hamid A, Zargar MA, Singh SK, Saxena AK. Potential role of natural molecules in health and disease: importance of boswellic acid. J Med Plant Res 2010; 4(25):2778-86.
  39. Eyre H, Hills M, Watkins SD. Compositions containing boswellia extracts. Quest Int Boswellia Palent 2003; 21(2):US09913952.
  40. Calzavara‐Pinton P, Zane C, Facchinetti E, Capezzera R, Pedretti A. Topical Boswellic acids for treatment of photoaged skin. Dermatol Ther 2010; 23:S28-32.
  41. Ammon HP. Boswellic acids in chronic inflammatory diseases. Plant Med 2006; 72(12):1100-16.
  42. Nusier MK, Bataineh HN, Bataineh ZM, Daradka HM. Effect of frankincense (Boswellia thurifera) on reproductive system in adult male rat. J Health Sci 2007; 53(4):365-70.
  43. Ammon HP. Boswellic acids and their role in chronic inflammatory diseases. Cham: Anti-inflammatory Nutraceuticals and Chronic DiseasesSpringer; 2016. P. 291-327.
  44. Jamalan MM, Amin M, Safdari MK, Aghel N. Evaluation of antibacterial activity and MIC detection of oleogum resins of Boswellia carteri against infections agents of mouth and gastrointestinal tract. Quart J Expe Animal Biol 2015; 3(4):17-23.