Dastjerdi MN, Darooneh T, Masiri M, Moatar F, Esmaeili S, Ozgoli G. Investigating the effects of Melissa officinalis on after-pains: A randomized single-blind clinical trial. J Caring Sci. September 2019;8(3):129-138. doi: 10.15171/jcs.2019.019.

Uterine contractions following childbirth have been reported to cause pain in more than 82% of women. Oxytocin is a hormone excreted during and after labor that increases contractions and stimulates milk excretion. Postpartum pain caused by uterine contractions may reduce the mother's success in breastfeeding, negatively affect the bond between mother and newborn, and lead to a diminished quality of life for the mother. Remedies include encouraging frequent urination and application of cold or hot packs on the abdomen. Analgesics are commonly used to alleviate postpartum pain; however, they may lead to unwanted side effects. Traditional medicine supports the use of basil (Ocimum basilicum, Lamiaceae) oil, chamomile (Matricaria chamomile, Asteraceae), common sage (Salvia officinalis, Lamiaceae) oil, lily (Lilium spp., Liliacea), and cumin (Cuminum cyminum, Apiaceae) to alleviate pain (plant parts not indicated). Lemon balm (Melissa officinalis, Lamiacea) leaves have been used for its sedative, anti-spasm, and antimicrobic properties. Traditional medicine shows that lemon balm has been used for asthma, pain, stomach health, and as a treatment for Alzheimer's disease. Results from animal studies have supported sedative, analgesic, and antidepressant and anti-anxiety properties of lemon balm. This randomized, single-blind controlled trial was conducted to determine the effects of lemon balm on postpartum uterine pain.

Women (n=173) were recruited from Asgariyeh hospital in Isfahan City, Iran that had normal vaginal delivery during 2016. Additional inclusion criteria consisted of giving birth to a healthy singleton baby, capable of breastfeeding, and moderate to severe postpartum pain. Women were excluded who had forceps delivery or vacuum extraction, epidural or spinal anesthesia, history of herbal medicine use, severe complications after delivery, diagnosis of chronic disease(s), or taking other herbal or pharmaceutical drugs to alleviate pain.

Several women were excluded for not meeting inclusion criteria (n=37) or declining to participate (n=10). The remaining 126 participants were randomly assigned to the lemon balm (n=63) or placebo (n=63) groups. During follow-up, eight participants in the lemon balm group declined to participate (n=4), used other herbal medicines (n=2), or reported stomachache (n=2). In the placebo group, eight participants discontinued due to headaches (n=2), stomachache (n=3), and use of other herbal medicines (n=3). The final analysis included 55 participants.

Both groups received either one lemon balm or mefenamic acid capsule after childbirth and again every six hours for the first 24 hours. The lemon balm capsules were prepared by sequential drying, grinding, and extraction of the leaves in a 1:8 ratio of water to alcohol for 72 hours. The alcohol was removed by rotary-evaporation, and the resulting liquid dried. The dried hydroalcoholic extract was placed into capsules to contained 395 mg of pure lemon balm extract. The placebo group received capsules containing 250 mg of mefenamic acid (manufactured by Alhavi Pharmaceuticals; Iran). Demographic and childbirth data were collected from the participants before the start of the study.

The primary outcome of the study was postpartum pain intensity. The Numerical Rating Scale was used in which 1 represented no pain, 1 to 3 mild pain, 4 to 6 moderate pain, and 7 to 10 severe pain. Postpartum pain intensity was measured before the first dose and at one, two, and three hours for the first six hours, and before and after the second, third, and fourth doses during the initial 24 hours. After-pain intensity was measured one hour after administration of doses two, three, and four.

No significant differences were observed in demographic or obstetric variables and postpartum pain severity before the intervention. Age and body mass index (BMI) were similar between the two groups. Postpartum pain intensity between the two groups was not significant during the first and second hours following the first dose. The lemon balm group reported significantly lower after-birth pain intensity scores the third hour from the first dose (P<0.05), and after the second, third, and fourth doses (P<0.001 each).

The authors stress this study was designed to measure uterine cramps and pain. Pain from episiotomy stitches was not considered. Limitations of the study may include the small size, lack of phytochemical analysis on the lemon balm extract, dosing, and labeling method of the intervention and placebo. The placebo was placed in an envelope labeled with an "a" and the intervention in an envelope labeled "b". Participants may have preferred the "a" labeling. The authors conclude lemon balm may help alleviate postpartum pain. The authors recommend future studies evaluate the effects of lemon balm on pain relief following cesarean section and curettage.

The authors declare no conflict of interest.