Aromatherapy and Acupuncture and Acupressure, Oh My!

A traditional PONV prevention protocol isn’t the only way to keep patients comfortable.

It’s not unusual for a resident at Raya’s Paradise, a senior care community in Los Angeles, to suffer from postoperative nausea and vomiting (PONV) in recovery from surgery, but Moti Gamburd, CEO of the facility, believes he has the answers to help.

“We’ve worked with numerous providers who combine traditional medication with alternative methods such as aromatherapy and acupressure to manage symptoms like nausea,” he says. “We’ve also used calming music, soft lighting and deep-breathing prompts to ease nausea after hospital stays. These tools give patients more control and comfort, especially when medications make them drowsy or groggy. People tend to respond better when they feel like the care plan includes their preferences, not just prescriptions. It builds trust and helps recovery feel smoother.”

This seems to follow a new set of thinking in PONV prevention, with more healthcare providers turning to innovative approaches beyond traditional methods to complement efforts to keep patients PONV-free. Increasing evidence suggests that alternative, holistic and non-pharmacological therapies such as aromatherapy, acupuncture and acupressure can play a valuable role in preventing PONV.

Alternatives emerge

Elissa B. Gartenberg, DO, a family physician and medical acupuncturist with Modern Family Medicine in Scottsdale, Ariz., frequently treats patients recovering from surgical procedures including those suffering with PONV. “While antiemetics such as ondansetron are standard, I have found that combining them with holistic interventions rooted in physiology often leads to faster and more complete relief,” she says.

By incorporating these complementary techniques into perioperative care, facilities aim to enhance patient comfort, reduce medication-related side effects and improve overall recovery experiences.

Traditional methods for preventing and treating PONV primarily involve the use of antiemetic medications such as serotonin (5-HT3) antagonists like ondansetron, dopamine antagonists such as metoclopramide and antihistamines like promethazine. Combining these agents, known as multimodal prophylaxis, can enhance efficacy and reduce PONV incidence. For some, however, these traditional methods are not the best ones. Prabhjot Kaur Chohan, ND, MD, CCRA, a member of the American Association of Naturopathic Physicians, a national professional association representing licensed naturopathic doctors, naturopathic medicine students and other healthcare professionals allied with the naturopathic profession, notes that PONV can be highly distressing for patients, often causing dehydration, imbalance of electrolytes, wound rupture and prolonged hospital stays.

“While there are multiple options available for PONV in conventional medicine, alternative medicine also has approaches that can be used alone or in conjunction with traditional medicine,” she says. “An advantage of these approaches over traditional medicine is that they are safer, can be used for a longer duration and have additional benefits.”

The challenge for advocates of alternative PONV prevention methods such as Dr. Chohan is to get mainstream providers on board with using these treatments. Many still have not embraced the concept of holistic medicines and therapies.

“The first step is education, because opening up the conversation to holistic treatments is the start of making it more acceptable in modern medicine,” says Jamie Bacharach, Dipl.Ac, a licensed medical acupuncturist and Chinese medicine practitioner based in Jerusalem, Israel. “It’s crucial that medical staff inform patients of this alternative treatment and allow the patient to make their own decision. Surgical settings are increasingly using integrative teams, which aid in bridging the gap between conventional and alternative care.”

Aromatherapy advantages

One of the most popular holistic solutions is aromatherapy, which recent research has revealed is used almost twice as much as it was just a decade ago in surgical settings.

Advocates of aromatherapy say essential oils offer numerous potential benefits for reducing PONV. For instance, they stimulate the limbic system, often referred to as “the seat of emotions in the brain,” through the olfactory senses.

“Additionally, essential oils are absorbed through the skin and help regulate cellular and organ functions, including decreasing postoperative nausea,” says Dr. Chohan. “Research has shown that ginger essential oil significantly reduces PONV. Similarly, peppermint, ginger essence oil or a combination has been found to reduce the need for antiemetics. This aligns with the common use of ginger, which is consumed orally to alleviate nausea and vomiting.”

Other essential oils studied for PONV prevention include lavender, tea tree and ylang ylang oil.

A study published this year by Japanese researchers in the journal Complementary Therapies in Medicine utilized a cohort of 182 patients to demonstrate that aromatherapy with peppermint, ginger and lavender notably enhanced patient satisfaction and reduced the severity of postoperative nausea following surgery under general anesthesia. It concluded that incorporating aromatherapy into a multimodal antiemetic approach could be advantageous in managing postoperative nausea.

Additionally, a randomized controlled trial published in the Journal of PeriAnesthesia Nursing showed that peppermint oil significantly reduced postoperative nausea within minutes of inhalation, while a 2020 meta-analysis in Complementary Therapies in Clinical Practice confirmed the efficacy of both peppermint and ginger essential oils in reducing nausea across various surgical populations.

Acupressure benefits

Acupressure is a non-invasive therapeutic method that applies physical pressure to specific acupuncture points using the finger, elbow, hand or various devices such as a wristband.

“PC6 is a very common acupressure point used in clinical practice,” says Dr. Chohan. “The PC6 acupoint lies between the two main wrist tendons, namely the palmaris longus and flexor carpi radialis muscles, 4 cm away from the wrist crease. Evidence has shown that stimulating the PC6 point influences various systems in the body. It stimulates the body’s endocrine system, regulates the level of beta-endorphins or ‘happy chemicals’ in cerebrospinal fluid and facilitates the transmission of endogenous opioids or pain-reducing substances.”

The point of acupuncture

The two most commonly researched and used acupuncture points are PC6 and ST36. Dr. Chohan says PC6 can alleviate the severity of nausea due to the modulation of the relationship between the cerebellum and the insula of the cerebral cortex, while ST36 is a remarkable point for managing gut conditions, including nausea and vomiting.

“Its action is associated with the regulation of gastrointestinal motility through vasovagal and sympathetic reflexes,” she says. “Therapies such as acupoint injection and capsicum have also been shown to be effective in reducing postoperative nausea.”

Dr. Gartenberg is also a big believer in the P6 acupuncture point, also known as Neiguan.

“This point is located on the inner forearm, three finger widths below the wrist crease, between the palmaris longus and flexor carpi radialis tendons,” she says. “Stimulation of this point modulates vagal activity, reduces gastric dysrhythmia and interrupts the nausea reflex.”

Common concerns about using acupuncture are related to pain and the invasiveness of the procedure, which is why it’s used less frequently than other holistic methods.

Dr. Bacharach notes that when acupuncture is used to target P6, it can be an effective treatment for PONV.

NEEDLE AND THE HEALING DONE Jamie Bacharach uses acupuncture to help reduce the number of medications used to treat nausea. | Jamie Bacharach

“This is a great alternative for people who are sensitive to certain medications, or who are seeking an alternative to pharmacological treatments,” she says. “As of late, more and more anesthesiologists and surgical teams are also seeming to embrace this technique when requested by patients.”

Dr. Bacharach believes acupuncture usually works best for PONV prevention when it’s incorporated into a larger treatment regimen. The idea, which she says has been demonstrated by numerous clinical studies and meta-analyses, is that you can reduce the number of medications used to treat PONV by supplementing them with acupuncture.

“Some patients may feel unsure about it, while others fervently believe in it,” she says. “However, many people think it’s worth trying because the danger is minimal and, when done properly, seldom results in harm or causes negative side effects.”

Bobby Koser, DC, founder of Tampa-based HealthSpine Chiropractic, notes auricular acupuncture, which targets specific points on the outer ear, has also shown promising results.

“In traditional Chinese medicine, the ear maps to internal organs via cranial and vagus nerve pathways,” he says. “Points like Shen Men, Stomach and Point Zero in the ear are commonly used to reduce nausea, calm the nervous system and support recovery. For ongoing benefit, ear seeds or press pellets can be applied and left in place for gentle stimulation.”

Accessibility to acupuncture remains the major drawback at the moment. Many medical teams don’t have access to qualified acupuncture practitioners.

“It can also be an issue for people who are afraid of needles and might actually make them feel more nauseous due to the anxiety that being pricked by needles may cause for them,” adds Dr. Bacharach. “People who suffer from bleeding conditions should also stay clear of this practice, which is best implemented in addition to established procedures rather than in substitute of them.”

Effective complement

By integrating these evidence-informed strategies for holistic solutions, advocates believe healthcare professionals can improve PONV prevention.

“In my experience, patients often welcome these natural options, especially when they want to minimize medication use or feel more empowered during recovery,” says Dr. Koser. “These methods rarely replace antiemetic drugs entirely, but they effectively complement pharmacological strategies, often reducing the dosage or frequency needed, and they come with little to no side effects.” OSM